How Fertility Testing Works: A Guide for Women and Men

When you’re trying to get pregnant and you’re struggling, you can easily get lost in your thoughts or go down a Google rabbit hole. However, fertility testing can pull back the curtain and show you what’s going on. It’s not just about identifying problems but also giving you answers, options, and control over your reproductive health.

Fertility challenges affect both women and men, yet many people delay testing out of fear or stigma. In reality, early testing is a great way to go as it can uncover silent issues and pave the way for targeted treatments. It’s usually the first real step toward successful conception.

Fertility testing is different in men and women. This article will walk you through the different types of fertility tests, what they measure, and what to expect when you finally decide to take the leap. 

Female Fertility Testing

In most cases, the goal of female fertility is to understand if ovulation is occurring normally, if the egg supply is adequate, and whether the uterus and fallopian tubes are healthy enough to support conception. Testing typically begins with bloodwork, followed by imaging and sometimes specialized procedures.

Blood Tests for Fertility (AMH, FSH, LH, Progesterone)

In blood testing, your hormone levels help your fertility doctor to better understand your menstrual cycle. These tests are often timed with your menstrual cycle, requiring specific scheduling. Hormones checked include:

• Anti-Müllerian Hormone (AMH) is like your ovarian reserve meter. It estimates how many eggs you have left. While it doesn’t assess egg quality, it gives a general idea of the lifespan of your eggs.
• Follicle-Stimulating Hormone (FSH) is secreted by the pituitary gland. FSH prompts your ovaries to develop eggs. High levels can indicate diminished ovarian reserve.
• Luteinizing Hormone (LH) increases just before ovulation, and abnormal patterns may point to conditions like PCOS.
• Progesterone confirms if ovulation has occurred. It is tested around day 21 of a typical cycle. 

Ultrasounds & Antral Follicle Count

A transvaginal ultrasound is used in testing to view the uterus and ovaries in real-time. Ultrasounds can also detect fibroids, ovarian cysts, or structural issues that may impact implantation or ovulation. 

Additionally, the antral follicle count (AFC) test is used to count the small follicles in your ovaries. Each of these follicles has the potential to mature into an egg. The AFC test is done in the early days of your cycle, and when combined with AMH levels, it gives a better picture of egg quantity.

HSG Test for Fallopian Tube Blockages

The Hysterosalpingogram (HSG) is a radiologic procedure that checks if your fallopian tubes are blocked and whether your uterus has a normal shape. Blocked tubes can prevent egg and sperm from meeting, making conception impossible. Knowing if your tubes are blocked early can save months of fruitless trying to conceive.

During the test, a dye is injected through the cervix, and x-rays track the dye’s flow through your fallopian tubes or uterus. If the dye spills freely through both tubes, it means there are no blockages.

Male Fertility Testing

Though men contribute to a large portion of infertility in couples, it is often overlooked. Fortunately, testing is usually simple, quick, and non-invasive. At Pacific Northwest Fertility, the primary goal is to assess sperm quality and identify any underlying medical or hormonal issues.

Semen Analysis: What It Measures

This is the cornerstone of male fertility testing. The process is straightforward. All you have to do is provide a sperm sample, and this can be done in the privacy of your home or at a fertility clinic.

A semen analysis evaluates:

• Sperm count, or how many sperm are in a single ejaculation.
• Motility, or how well the sperm move to reach an egg for fertilization.
• Morphology, or the sperm’s shape and structure.
• Volume and pH, which indicate gland and ejaculation health.

Even if sperm count is normal, low motility or abnormal morphology can affect fertility. One analysis may not be completely accurate because sperm does change from day to day. This is why repeat tests are often advised.

Sperm DNA Fragmentation Testing

This test digs deeper into the genetic health of sperm. It’s not part of standard screening but is used when couples experience unexplained infertility, IVF or ICSI cycles fail repeatedly, and if miscarriages occur frequently.

DNA fragmentation looks at breaks in the sperm’s genetic material, which can impair embryo development. Lifestyle factors like smoking, obesity, and heat exposure can worsen breaks in sperm DNA.

Hormonal Testing for Men

Just like women, men rely on different hormones for reproduction. Key hormones tested include:

• Testosterone: Low levels may impair sperm production and libido.
• FSH & LH: These pituitary hormones stimulate testicular function.
• Prolactin and Estradiol: Elevated levels can interfere with fertility and point to underlying health issues.

Blood tests can reveal endocrine disorders, testicular failure, or even tumors, offering crucial insight for treatment.

What to Expect During a Fertility Evaluation

Your first fertility appointment isn’t a quick in-and-out visit. You should expect a comprehensive review of both you and your partner. The fertility specialist will look at medical history, lifestyle habits, and prior reproductive experiences. 

Typically, fertility testing starts with a detailed questionnaire covering cycle history, illnesses, surgeries, and sexual habits. Next, physical exams are done on both partners. Blood draws, semen collection, and imaging are scheduled based on cycle timing.

These appointments can bring up fear, guilt, or even shame. It helps to go in with questions, take notes, and carry support if possible.

Next Steps After Your Test Results

When the results come in, things may go one of three ways:

• You could get the all clear. This means that fertility looks good, and timing or lifestyle tweaks may be enough to promote a successful pregnancy. 
• Mild issue detected. Here, medication, supplements, or minor procedures might do the trick.
• Significant concern. In this case, options like IUI, IVF, egg/sperm donation, surrogacy, or surgery may be explored.

Either way, your provider will walk you through the best path forward. Sometimes, this might involve referrals to reproductive endocrinologists, urologists, or genetic counselors.

FAQs

How do I know if I need a fertility test?

You should consider a fertility test if you’ve been trying to conceive for 12 months (or 6 months if over age 35) without success, you have a history of irregular periods, PCOS, endometriosis, or reproductive health conditions, you’ve had multiple miscarriages, you have a history of pelvic infections, STDs, or previous reproductive surgeries or you or your partner have known fertility risk factors, such as low sperm count or prior chemotherapy.

What does an AMH test show?

An Anti-Müllerian Hormone (AMH) test measures a woman’s ovarian reserve, indicating:

• Egg quantity but not necessarily quality.
• How much time you have left before menopause.
• How you may respond to fertility treatments like IVF.
• Potential diagnoses of PCOS (high AMH levels) or diminished ovarian reserve (low AMH levels).

Is male fertility testing painful?

No. Male fertility testing is not painful. A semen analysis is non-invasive and requires providing a sperm sample. Bloodwork may come with minor discomfort from a standard blood draw. A testicular biopsy is rare and involves brief discomfort. But it’s usually performed under local anesthesia.

How long do fertility test results take?

Male fertility tests can take somewhere between 24 and 48 hours or sometimes up to 3 weeks. On the other hand, female fertility tests can take a few days to a few weeks, depending on where you are in your cycle. 

Can lifestyle changes improve fertility test results?

Yes, lifestyle changes can improve fertility test results. Your daily habits matter more than you might think.