Fertility Tests for Women

If you and your partner are having trouble conceiving and are seeking help to get pregnant, you’ll need to undergo a range of fertility tests. There can be many reasons why you and your partner may be struggling to conceive. Fertility testing helps your doctor to diagnose why you are finding it difficult to get pregnant, and to develop a personalised fertility treatment plan for you.

What fertility tests will be performed initially?
If you opt to visit your family doctor at the start of your fertility journey, they may conduct some simple and less invasive fertility tests on you or your partner. These may include:

General physical examination

Weight check

Pelvic and genital examination

Breast exam

Routine cervical screening (smear) test

Blood tests

Afterwards, you and/or your partner will be referred to a fertility specialist should there be a need for further or more invasive tests.

What Do Fertility
Doctors Test For?

Your fertility doctor will check that you and/or your partner have:

The right balance of hormones to help eggs to mature

Regular ovulation

A healthy, functioning uterus and intact
fallopian tubes

A thick uterus lining that could nourish
an embryo

Who performs the fertility tests at the clinic? Your fertility team is made up of a range of doctors and fertility nurses, along with specialists such as reproductive endocrinologists and embryologists, who oversee more complex treatments such as in vitro fertilisation (IVF).

Should you have any concerns or require additional information, do not hesitate to ask your doctor or fertility team about their different roles and how they will be supporting you.

Preliminary Tests12

Personal History

You will be asked about your medical history and sex life in detail. If you feel uncomfortable discussing certain topics in front of your partner, ask to speak with your doctor in private.

Physical exam

You may have to undergo a pelvic examination to check the shape and size of your uterus. Your breasts may also be examined physically, with your weight and body mass index (BMI) measured.

Cervical screening (smear) test

You may be asked about the results from your most recent cervical screening test. If you have not gone for a cervical screening test recently, a new test may be performed. This procedure will help to rule out any infection or abnormal cells on your cervix.

Screening blood and urine tests

You will have some routine and some investigational blood and urine tests. For more information, please ask your fertility clinic about the tests that will be done.

General health tests

You may be tested for rubella (German measles), chlamydia, hepatitis B and C, and human immunodeficiency virus (HIV). Depending on your heritage, you may also be tested for diseases or disorders that are more common amongst certain ethnic groups, such as sickle cell anaemia or thalassaemia.

Fertility Tests

Hormone blood and urine tests

These tests will be taken on specific days of your menstrual cycle to measure different hormone levels3 and will help to determine if you are ovulating4,5 as well as the quality and quantity of the eggs produced (your ovarian reserve)6. Additionally, these tests will be able to help predict the ovary's response to IVF treatments. Depending on the couple, blood tests on either the female or the male may be necessary. These tests may include testing for day 3 follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), anti-mullerian hormone (AMH), prolactin, testosterone (T), and progesterone (P4)7.

Assessment of ovarian reserve

This assesses the remaining egg supply of a woman and is conducted via blood and ultrasound tests. Blood testing will show day 3 FSH, LH and estradiol hormone testing and AMH hormone levels, while the ultrasound checks for the ovarian volume and antral follicle counts.

Assessment of adequate ovulation

This assessment can be conducted in various ways. It has been discovered that about 25% of all infertility is caused by an ovulation disorder. One type of ovulation problem known as polycystic ovarian syndrome for example, can be effectively treated with medication.

Antral follicle count (AFC)

This test uses an internal ultrasound scan to show the number and size of follicles present in your ovaries8.

Anti-Mullerian Hormone (AMH)9

The anti-mullerian hormone (AMH) is a substance produced by granulosa cells in the ovarian follicles. Blood levels of this substance have been used in fertility tests to attempt to measure the size of the pool of growing ovarian follicles in women, since AMH is produced only in small ovarian follicles. AMH blood levels are thought to reflect the size of the remaining egg supply, also known as the “ovarian reserve”.

Temperature

Your temperature may also be taken throughout the menstrual cycle to identify when you are ovulating10.

Hysterosalpingogram (HSG)

This test applies a coloured dye inside the uterus to check the shape and size of the uterus and fallopian tubes. It will also show your doctor if there are any tubal blockages or cysts11.

Laparoscopy12

This test involves insertion of a small surgical telescope into the abdomen, under general anaesthetic. This allows your doctor to check for any blockages, growths or signs of endometriosis around the uterus and fallopian tubes.

If you require more information about a specific test, please do not hesitate to consult your fertility doctor.

References:

  1. Assessment of female fertility in the general practice setting 2020 Sarah Hunt, Beverley Vollenhoven 10.31128/ajgp-01-20-5205 Australian Journal of General Practice.
  2. National Institute for Health and Care Excellence (NICE). Fertility problems: assessment and treatment: CG156. 2016. Available at: https://www.nice.org.uk/guidance/cg156. Accessed: September 2016.
  3. Broer SL, Broekmans FJ, Laven JS, Fauser BC. Anti-Müllerian hormone: ovarian reserve testing and its potential clinical implications. Hum Reprod Update. 2014 Sep-Oct;20(5):688-701. doi:
  4. 1093/humupd/dmu020. Epub 2014 May 12. PMID: 24821925. Manders M, et al. Cochrane Database Syst Rev 2015;(3):CD011345.
  5. Khalaf Y. BMJ 2003;327(7415):610–613.
  6. Khalaf Y. BMJ 2003;327(7415):610–613.
  7. National Institute for Health and Care Excellence (NICE). Fertility problems: assessment and treatment: CG156. August 2016. Available at: https://www.nice.org.uk/guidance/cg156. Accessed: September 2016.
  8. European Association of Urology (EAU). Guidelines on Male Infertility 2015. Available at: uroweb.org/wp-content/uploads/17-Male-Infertility_LR1.pdf. Accessed: September 2016.
  9. National Institute for Health and Care Excellence (NICE). Fertility problems: assessment and treatment: CG156. August 2016. Available at: https://www.nice.org.uk/guidance/cg156. Accessed: September 2016.
  10. European Association of Urology (EAU). Guidelines on Male Infertility 2015. Available at: uroweb.org/wp-content/uploads/17-Male-Infertility_LR1.pdf. Accessed: September 2016.
  11. European Association of Urology (EAU). Guidelines on Male Infertility 2015. Available at: uroweb.org/wp-content/uploads/17-Male-Infertility_LR1.pdf. Accessed: September 2016.
  12. Kliesch S. Euro Uro Suppl 2014; 13(4):73–83. 19. Kliesch S. Euro Uro Suppl 2014; 13(4):73–83.
  13. European Association of Urology (EAU). Guidelines on Male Infertility 2015. Available at: uroweb.org/wp-content/uploads/17-Male-Infertility_LR1.pdf. Accessed: September 2016.
  14. American Society for Reproductive Medicine (ASRM). Medications for inducing ovulation. A guide for patients. 2016. Available at: http://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/booklet_medications_for_inducing_ovulation.pdf. Accessed: January 2018.
  15. Fritz M and Speroff L. Chapter 31. Assisted Reproduction. In: Clinical Gynecologic Endocrinology and Infertility. 6th ed. Lippincott Williams & Wilkins, 1999.
  16. Rowell P, Braude P. BMJ 2003;327(7418):799–801.
  17. Braude P and Rowell P. BMJ 2003;327(7419):852–855. 25. Fritz M and Speroff L. Chapter
  18. Assisted Reproduction. In: Clinical Gynecologic Endocrinology and Infertility. 6th ed. Lippincott Williams & Wilkins, 1999.
  19. Braude P and Rowell P. BMJ 2003;327(7419):852–855.
  20. Rowell P and Braude P. BMJ 2003;327(7418):799–801. 28. Levran D, et al. Fertil Steril 1998;69(1):26–30. 

Disclaimer : The information provided by Merck is not a substitute for professional medical care or advice and intended for educational purposes only and should be used only as an aid in understanding the medical condition and treatment. A physician or another healthcare professional should always be consulted for any health problem or medical condition.

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