What common fertility tests check first?

What do common fertility tests try to find?

Common fertility tests look for the most likely reasons a pregnancy has not happened yet. They usually start with the least invasive tests that can detect common causes, and they should include both partners when possible ASRM. ACOG describes infertility evaluation as exams and tests used to find the reason pregnancy has not occurred, and notes that treatment may be possible even when no cause is found ACOG.

Key takeaways

• Fertility testing often begins with semen analysis, bloodwork, and imaging.
• Semen analysis checks sperm number, movement, and shape.
• Hormone tests can help show whether ovulation is happening and whether thyroid or prolactin problems may be involved.
• Imaging tests look at the uterus, ovaries, and fallopian tubes.
• Not everyone needs every test; the workup is usually tailored to symptoms and earlier results.

What does semen analysis check?

Semen analysis is a basic and essential part of fertility evaluation. It measures how many sperm are present, how well they move, and what shape they have ASRM. ACOG also notes that testing for men often includes semen analysis, which assesses sperm count, shape, and movement ACOG.

That matters because sperm-related problems are one of the most common causes of male infertility. In ACOG’s description, the most common male factor involves sperm cells and how they function ACOG. Even if a man has fathered children before, semen analysis is still considered necessary in the infertility evaluation ASRM.

What hormone tests are used in fertility evaluation?

Hormone tests help check whether the body is ovulating normally and whether hormone-related conditions could be affecting fertility. Blood tests can measure progesterone, thyroid function, prolactin, and ovarian reserve markers, while urine testing can help identify ovulation timing ACOG.

Progesterone is commonly checked in the second half of the menstrual cycle. A higher level suggests ovulation has occurred, while a urine test for luteinizing hormone, or LH, can show when ovulation is likely to happen soon ASRM. ACOG similarly notes that a urine test can detect the LH rise that suggests ovulation will occur in the next 24 to 48 hours ACOG.

Why are thyroid and prolactin tests part of the workup?

Thyroid-stimulating hormone, or TSH, and prolactin are commonly checked because both thyroid disorders and high prolactin can interfere with fertility and menstrual regularity. ASRM says these blood tests are useful for identifying thyroid problems and hyperprolactinemia, which may cause fertility problems, irregular periods, and repeated miscarriages ASRM.

ACOG also notes that thyroid disease can affect fertility and that blood levels tied to the thyroid can be measured when a thyroid problem is suspected ACOG. In women, ACOG lists thyroid and pituitary gland problems among the health conditions that may affect fertility ACOG.

What is ovarian reserve testing?

Ovarian reserve testing estimates how the ovaries are likely to respond to fertility treatment and gives a sense of egg supply. Common tests include anti-Müllerian hormone, or AMH, antral follicle count by ultrasound, and follicle-stimulating hormone, or FSH, drawn early in the menstrual cycle ASRM. ASRM notes that ovarian reserve testing becomes more important in people over 35 and in several situations such as prior ovarian surgery, chemotherapy, pelvic radiation, endometriosis, unexplained infertility, or a poor response to ovarian stimulation ASRM.

It is useful to think of this testing as a measure of quantity and expected response, not a direct guarantee of pregnancy. ASRM describes the age of the ovaries as the best indicator of egg quality, with older age associated with a higher chance of chromosome problems in eggs ASRM.

What imaging tests look at the uterus and tubes?

Imaging studies help check whether the uterus, ovaries, and fallopian tubes look normal and whether the tubes are open. ACOG says these tests and procedures may include ultrasound, sonohysterography, hysterosalpingography, hysteroscopy, and laparoscopy ACOG. ASRM also recommends hysterosalpingogram, or HSG, or saline infusion sonogram to see whether the fallopian tubes are open and whether the uterine cavity has a normal shape ASRM.

A transvaginal ultrasound lets a clinician look for abnormalities such as fibroids and ovarian cysts ASRM. ACOG adds that ultrasound can also be used to see follicle changes and help predict ovulation ACOG.

What is an HSG or saline infusion sonogram?

An HSG is an X-ray procedure, and a saline infusion sonogram uses ultrasound, but both are aimed at showing the inside shape of the uterus and whether the fallopian tubes are open ASRM. During these tests, liquid is placed through a catheter into the uterus so the cavity and tubes can be outlined ASRM.

ACOG describes hysterosalpingography as an X-ray procedure that shows the inside of the uterus and whether the fallopian tubes are blocked ACOG. These tests are especially useful when doctors are checking for scarring, blockage, or a uterine cavity shape issue that could affect pregnancy ASRM.

When are hysteroscopy and laparoscopy used?

Hysteroscopy and laparoscopy are more direct procedures that use a camera. Hysteroscopy places a thin lighted camera through the cervix into the uterus, which can show problems inside the uterus and may help guide minor surgery ACOG. Laparoscopy places a lighted camera through the abdomen to view the fallopian tubes, ovaries, and the outside of the uterus ACOG.

These procedures are usually not the first step for everyone. ACOG says the exact tests depend on symptoms and prior results, and some are done only after earlier testing points to a reason to look more closely ACOG.

How are fertility tests usually chosen?

Testing is usually individualized rather than done all at once. ASRM says the evaluation should be focused and cost-effective, should include both partners, and should use the least invasive methods first ASRM. ACOG likewise says you may not have all possible tests, because later tests depend on symptoms, history, and earlier results ACOG.

That approach is practical because infertility can involve more than one factor. ACOG notes that common causes include ovulation problems in women and sperm problems in men, while ASRM adds that the evaluation should account for age, how long conception has been attempted, and the medical history of both partners ACOG ASRM.

How long does fertility testing usually take?

In many cases, an infertility evaluation can be completed within a few menstrual cycles ACOG. The pace depends on which tests are needed, since some results lead naturally to the next step and not everyone needs every imaging study or blood test ACOG.

For many people, the most useful way to think about fertility testing is as a stepwise process: start with sperm testing, hormone testing, and ultrasound or X-ray imaging, then move to more specific procedures only if the earlier results suggest a reason ASRM.