Fertility testing can feel like an impossible maze to get through, with the complex terms and way too many acronyms. If you’ve ever found yourself Googling, “Why am I Not Getting Pregnant?” or “What does AMH mean?” even after your long doctor’s appointment, then you’re not alone. Fertility testing, at its core, is about understanding what is going on in your body, what might need a little help, and what options are available to help you conceive.
So, in this simple guide, we’ll walk you through what fertility testing in women involves, when to get tested, and what your results might mean — and yes, we’re including fertility testing in men too, because it is important to look at the full picture when you’re trying to get pregnant.
What Is Fertility Testing?
Fertility testing is a series of medical tests to help you check your ability to conceive. For women, it involves looking at different parts of the reproductive system, including the hormone levels, the health of the ovaries, egg count, whether the fallopian tubes (where the egg and the sperm meet) are open, or the overall health of the uterus.
While it might sound complicated, the goal is to provide answers regarding your reproductive health and why you and your partner might be having difficulty conceiving.
When Should You Consider Fertility Testing?
There is no perfect timeline for everyone, but the general guidelines recommend fertility testing if you fall into any of the categories:
- If you’ve been unable to conceive after a year of regular and unprotected sexual intercourse (with no birth control).
- If you’re a woman older than 35 years and have been unable to conceive after 6 months of regular and unprotected sexual intercourse (with no birth control).
- If you have irregular cycles, usually longer than 35 days.
- If you have other symptoms like very painful periods, heavy bleeding, or a history of conditions like Polycystic Ovarian Syndrome (PCOS), endometriosis, or pelvic infections.
It is important to note that fertility testing isn’t only for people actively trying to get pregnant. If you’re planning for the future or you’re just curious about your fertility status, you can also get tested.
What Are the Fertility Tests for Women?
When it comes to fertility testing for women, think of it like putting together a puzzle. Each test looks at different aspects of the reproductive system to help get a clearer picture. Some of these tests are done together and may include:
– Hormone blood tests
These tests measure the level of your hormones at specific points in your menstrual cycle. Some of the key hormones checked include:
- Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH): These 2 hormones work closely together. FSH helps your ovaries to mature the eggs, while LH helps trigger ovulation. If either is out of balance, it may signal that your ovaries are not responding as well as they should.
- Oestradiol: This is a form of oestrogen that helps grow the lining of the womb, early on in the menstrual cycle.
- Progesterone: This hormone rises after ovulation and is best measured a week (7 days) after ovulation. For example, in a regular 28-day cycle, ovulation would occur on day 14, and progesterone should be tested 7 days after, on day 21.
- Anti-Mullerian Hormone (AMH): Women are born with a fixed number of eggs, and no new eggs are made later in life. The AMH test helps estimate your ovarian reserve, that is, how many eggs you might have left, by measuring the level of AMH. This is because this hormone is released by small follicles, the tiny sacs in your ovaries where the eggs grow and mature.
- Prolactin: Prolactin helps after childbirth. If these levels are high when you’re not pregnant or breastfeeding, it can interfere with ovulation.
- Thyroid Hormones: High or low thyroid hormone levels can affect your menstrual cycle and ability to conceive.
-Pelvic Ultrasound Scan
This test helps look at the structures of the female reproductive tract. It helps identify issues like ovarian cysts, PCOS, fibroids, or other abnormalities.
Hysterosalpingogram (HSG)
This test uses a special dye and an X-ray to determine if the fallopian tubes are blocked or open.
Hysteroscopy
During this test, a small camera is inserted by your doctor through your cervix to examine the inside of your womb for issues like polyps, fibroids, or scar tissue.
Laparoscopy
This is a minor surgical procedure, where a small camera is inserted into the abdomen by the doctor to check for conditions like endometriosis or adhesions (scar tissue) that might affect fertility.
It is also important to note that the right test for you depends on several other factors, including age, health history, and sexual history.
How to Understand Your Fertility Test Results
So, you’ve done the tests and have the results, but now you’re staring at a bunch of numbers, hormone levels, and complex terms, without understanding what they mean. Here’s a general guide to help you make sense of your results:
- High levels of FSH, early in your menstrual cycle (typically between day 2 and 5), may indicate that your ovaries are working harder than normal to mature an egg, a sign of reduced ovarian reserve.
- High levels of LH, especially when significantly higher than FSH, can be a sign of PCOS.
- Low mid-luteal progesterone (7 days after ovulation was meant to occur) may indicate that ovulation didn’t occur, or the body isn’t producing enough progesterone after ovulation.
- High levels of oestradiol, early in the menstrual cycle, could mask high levels of FSH or suggest the presence of an ovarian cyst.
- Low levels of AMH suggest that the ovarian reserve is low, i.e., you have fewer eggs left. High levels can also be seen in PCOS. Note that AMH doesn’t tell us about quality, just quantity.
- Ultrasound results may also note an Antral Follicle Count (AFC), which counts the small follicles in both ovaries that could develop into mature eggs. Between 10 and 20 antral follicles in total is typically considered a good ovarian reserve, although this can vary depending on the age. The ultrasound may also take note of the thickness of the uterine lining mid-cycle, which is usually between 7-14 mm.
Are there Home Fertility Tests for Women?
Yes! Home fertility tests for women are available and can be a useful starting point. You can use ovulation test kits, which are urine tests that check the level of LH, to help you discover your fertile window, when the chances of pregnancy are higher.
However, a home fertility test, while convenient, isn’t a substitute for a specialist.
Do Men Need Fertility Tests?
Did you know that in many cases, about 40% of infertility is due to the male factor, 40% is due to the female factor, 10% is due to a combination of both, and about 10% is unexplained? This tells us that fertility is not just a woman’s issue, and testing for men is just as important when trying to conceive.
Common fertility tests for men include:
- A seminal fluid analysis to check the sperm count, motility (movement), and morphology (shape).
- Hormonal tests are used to check for testosterone and other hormones that affect sperm production.
- Testicular ultrasound, especially when something unusual is found on physical examination, like pain or swelling, or if the semen fluid analysis is abnormal.
- Post-ejaculatory urinalysis tests to see if there is sperm in the urine. This helps detect a condition known as retrograde ejaculation, when the sperm flows backwards into the bladder, instead of out through the penis.
Final Thoughts
Fertility testing is not about blame, panic, or rushing blindly into treatments. When it comes to fertility, knowledge is truly power. Knowing the right tests to take, when to take them, and what they mean can help you understand the right options to help you conceive.
If you don’t know where to start, you can schedule a session with our fertility specialist to discuss the fertility testing options and get you on the right path to making an informed decision.
