Fertility tests: what's checked and why

Fertility testing aims to identify any factors that might be preventing conception. A complete evaluation typically includes both partners.

What fertility testing can reveal:

For women:

• Whether ovulation is occurring
• Egg supply (ovarian reserve)
• Condition of fallopian tubes
• Health of the uterus
• Hormone imbalances

For men:

• Sperm count and quality
• Ability to deliver sperm
• Hormone levels if needed

When testing is recommended:

• Under 35: After 12 months of trying
• 35-39: After 6 months of trying
• 40+: Consider testing before or soon after starting
• Any age: If known risk factors exist

Who orders tests:

• GPs can arrange basic tests
• Fertility specialists do comprehensive evaluations
• Some tests may require referral

Important perspective:

Testing provides information, not always answers. About 10-30% of couples have unexplained infertility despite normal tests. Conversely, abnormal results don't mean conception is impossible - they guide treatment decisions.

Blood tests measure hormones that affect fertility:

Day 2-3 tests (early in your cycle):

FSH (Follicle Stimulating Hormone)

• Stimulates egg development
• Normal: Under 10 IU/L
• Higher levels may suggest reduced ovarian reserve
• Should be interpreted with estradiol

LH (Luteinising Hormone)

• Triggers ovulation
• Abnormal LH:FSH ratio can indicate PCOS
• Normally similar to FSH in early cycle

Estradiol (E2)

• Should be low early in cycle
• High levels may artificially suppress FSH
• Helps interpret FSH results

AMH (Anti-Müllerian Hormone)

• Measures ovarian reserve
• Can be done any day of cycle
• Lower values suggest fewer remaining eggs
• Doesn't measure egg quality

Mid-cycle or day 21 tests:

Progesterone

• Confirms ovulation occurred
• Tested 7 days before expected period
• Levels above 30 nmol/L suggest ovulation

Other hormones sometimes tested:

Thyroid function (TSH)

• Thyroid disorders affect ovulation
• Important to optimise before conception

Prolactin

• High levels can prevent ovulation
• May cause irregular periods or absent periods

Testosterone/androgens

• Elevated in PCOS
• Can affect ovulation

Imaging provides visual information about reproductive organs:

Transvaginal ultrasound

A probe inserted vaginally gives detailed images.

What it shows:

• Ovaries: size, follicle count, cysts, appearance
• Uterus: size, shape, fibroids, polyps
• Endometrial lining thickness

Antral follicle count (AFC):

• Counts small follicles visible in early cycle
• Correlates with ovarian reserve
• Normal: 6-10 per ovary

When done:

• Usually day 2-5 of cycle for baseline
• May be repeated during treatment cycles

Hysterosalpingogram (HSG)

X-ray with contrast dye to check tubes and uterus.

What it shows:

• Whether fallopian tubes are open
• Shape of uterine cavity
• Any blockages or abnormalities

The procedure:

• Done in radiology department
• Speculum inserted, dye injected
• X-rays taken as dye flows
• Some discomfort/cramping common
• Takes about 15-30 minutes

Saline sonohysterogram (SIS)

Saline injected into uterus during ultrasound.

Shows:

• Uterine cavity in detail
• Polyps, fibroids affecting cavity
• Alternative to HSG for uterine assessment

HyCoSy

Ultrasound with contrast to check tubes.

• Alternative to HSG
• No radiation
• Done in ultrasound clinic

Male partner testing is essential - male factors contribute to about 40% of fertility issues:

Semen analysis

The primary test for male fertility.

What's measured:

• Volume: Amount of ejaculate (normal: 1.5ml+)
• Count: Sperm per millilitre (normal: 15 million+)
• Total count: Total sperm (normal: 39 million+)
• Motility: Percentage swimming (normal: 40%+)
• Progressive motility: Swimming forward (normal: 32%+)
• Morphology: Normal shape (normal: 4%+)

How it's done:

• Sample collected by masturbation
• Usually in clinic; home collection sometimes possible
• 2-7 days abstinence recommended before
• Results in days to weeks

Important notes:

• One abnormal result should be repeated
• Sperm quality varies; multiple samples recommended
• Lifestyle can affect results

Additional tests if needed:

Hormone tests:

• Testosterone
• FSH, LH
• If low sperm count or symptoms of hormone issues

Sperm DNA fragmentation:

• Measures DNA damage in sperm
• May be useful in unexplained infertility
• Not routinely done

Ultrasound:

• If varicocele suspected
• If blockage suspected

Genetic testing:

• If very low sperm count
• Before certain treatments

Sometimes additional tests are needed:

Laparoscopy

Keyhole surgery to look inside the pelvis.

When used:

• Suspected endometriosis
• To check tubes directly
• Unexplained infertility
• Treat problems found

What it involves:

• General anaesthetic
• Small incisions in abdomen
• Camera inserted
• Day surgery usually
• 1-2 weeks recovery

Hysteroscopy

Camera inside the uterus.

When used:

• Suspected polyps or fibroids
• Abnormal HSG or ultrasound
• Recurrent miscarriage

What it involves:

• Often done without general anaesthetic
• Camera through cervix
• Can treat problems found
• Quick recovery

Genetic testing:

For women:

• Karyotype (chromosome analysis)
• Fragile X carrier testing
• Other carrier screening

For men:

• Karyotype
• Y chromosome microdeletion
• Cystic fibrosis testing

When considered:

• Very low sperm count
• Recurrent miscarriage
• Family history of genetic conditions
• Before IVF in some cases

Interpreting fertility test results requires context:

Key principles:

Single tests don't tell the whole story

Results should be interpreted together, not in isolation.

Normal ranges vary

Different labs may have different reference ranges.

Results can fluctuate

Hormone levels and sperm parameters vary cycle to cycle.

Abnormal doesn't mean impossible

Many people with suboptimal results conceive naturally or with treatment.

Common result scenarios:

"Your results are all normal"

• Good news, but doesn't guarantee conception
• May be unexplained infertility
• Egg quality can't be directly tested
• Consider treatment options if conception delayed

"Your ovarian reserve is low"

• Means fewer eggs remaining
• Doesn't measure egg quality
• May still conceive naturally
• Time may be more important factor
• Earlier treatment might be advisable

"Your tubes are blocked"

• Prevents natural conception
• IVF bypasses tubes completely
• Surgery may help in some cases

"Sperm count/quality is low"

• Very common finding
• Many treatments available
• Lifestyle changes may help
• IVF/ICSI can work with few sperm

Questions to ask:

• What does this specific result mean for us?
• Does this need repeating to confirm?
• What treatment options does this suggest?
• What are our chances with treatment?