How is Fertility Evaluation Done? A Step-by-Step Guide

Infertility affects millions of couples worldwide, and trying to get pregnant can be a rollercoaster. One month you’re hopeful, the next you’re staring at yet another negative test. If this sounds familiar, you’re not alone. Many couples and individuals experience the same frustration. That’s where fertility testing comes in. It is a roadmap offering clarity and direction to the next best steps.

Before diving into medications, procedures, or alternative treatments, the first real step is understanding what’s happening beneath the surface. Whether you're just beginning your journey or have been trying for a while, a fertility evaluation can help uncover obstacles and point you toward the best course of action. 

Knowing what to expect from a fertility evaluation can ease anxiety and prepare you for the road ahead. This guide walks you through each stage, demystifying tests and procedures so you’re equipped to make informed decisions.

So, how does it all work? Let’s take a closer look.

What is a Fertility Evaluation?

Fertility evaluation is a series of diagnostic tests and assessments used to identify why conception hasn’t occurred. It’s like detective work for your reproductive system, offering an in-depth analysis of hormone levels, organ function, and overall reproductive health.

The reason why many fertility clinics perform this evaluation because the tests provide clarity, and clarity leads to effective treatment.

Purpose of Fertility Testing

Fertility testing serves several functions:

• It identifies hormonal imbalances or any ovulatory issues
• It detects anatomical issues in the reproductive organs
• It evaluates sperm quality and quantity
• It reveals potential genetic challenges

When to Consider Getting Evaluated

There are several reasons that can push a clinic or individual to suggest fertility evaluation, some of which include:

• You’re under 35 and have been trying to conceive for over a year
• You’re over 35 and have tried for more than six months
• You have irregular menstrual cycles
• You’ve experienced multiple miscarriages

Common Tests in a Fertility Evaluation

Once you and your doctor agree to proceed with testing, a series of tests will be scheduled These aren’t one-size-fits-all, but here’s what most people can expect:

Blood Tests (FSH, LH, AMH)

Blood tests offer a snapshot of your hormonal environment. Fertility doctors look at:

• Follicle-Stimulating Hormone (FSH). Elevated levels can be a sign of diminished ovarian reserve.
• Luteinizing Hormone (LH). This hormone is key during ovulation, and imbalances may suggest conditions like PCOS.
• Anti-Mullerian Hormone (AMH). This hormone provides an estimate of the remaining egg supply.
• Estradiol and progesterone. Both assess cycle regularity and ovulation quality.

Blood tests are typically scheduled on specific cycle days to ensure accuracy.

Ultrasound and Imaging

Most people assume that an ultrasound is just for pregnancy. However, in fertility evaluations, ultrasounds and imaging give real-time images of the reproductive organs. These scans help identify physical barriers to conception.

• A transvaginal ultrasound is done to assess the uterus, ovaries, and antral follicle count (AFC).
• Hysterosalpingogram (HSG) uses contrast dye to determine if the fallopian tubes are open.
• Sonohysterogram (SHG) is a saline-based scan that checks for uterine abnormalities like fibroids or polyps.

Semen Analysis

Often overlooked, male fertility contributes to about half of all infertility cases. A semen analysis is a straightforward but revealing way to know if the male partner has some fertility challenges.

• Parameters assessed in a semen analysis include:
• Sperm count, or the total number of sperm per ejaculate
• Percentage of moving sperm (motility)
• Shape and structure of sperm (morphology)
• Volume and pH, which help you see the overall ejaculate health

Additional tests, like sperm DNA fragmentation, may be suggested if results are borderline or abnormal. A sperm DNA fragmentation test checks the integrity of sperm DNA and looks for breaks or damage in the genetic material that can be a factor in infertility and increased risk of miscarriage.

Genetic Testing

Sometimes the issue is in your DNA. A genetic test can:

• Identify inherited conditions like cystic fibrosis that affect fertility
• Determine chromosomal abnormalities
• Highlight potential risks for offspring

These are especially important for couples with a family history of genetic disorders or repeated miscarriages.

How to Prepare for a Fertility Test

It’s important to prepare for a fertility test, and the preparation isn’t just physical; it’s emotional and mental too. This is why knowing what to expect can ease the experience.

Diet and Lifestyle Tips

Before your evaluation, your fertility doctor may recommend making some lifestyle changes. These changes include:

• Eat a balanced diet rich in antioxidants
• Reducing alcohol and caffeine intake
• Quit smoking and avoid recreational drugs
• Maintaining a healthy weight
• Managing stress through meditation or therapy

What to Expect on the Day of the Test

It’s okay to be nervous on the day of the tests. Make sure you are well-rested and mentally prepared for the tests. Some tests may require needles, and if you fear needles, you will need to talk to your doctor beforehand. 

• For blood tests, arrive fasted. This depends on the hormone being tested.
• For a semen analysis, you will be required to abstain from ejaculating for 2–5 days.
• For imaging, some tests will require a full bladder, which means you may need to have drunk water, and you will be told how much water you will need to drink. 

Always follow the clinic's instructions precisely to ensure the accuracy of results.

Understanding Your Results

Before reading your results, it’s important to understand that abnormal results don’t always mean you’re infertile. The results could just mean your path to conception may require some help.

What Abnormal Results May Indicate

Some abnormal results you may get include:

• Low AMH/High FSH, which may indicate a low ovarian reserve
• Irregular LH/FSH ratio could suggest polycystic ovary syndrome (PCOS)
• Blocked tubes on HSG may require surgical intervention or in vitro fertilization (IVF)
• Poor sperm morphology or motility might benefit from intracytoplasmic sperm injection (ICSI)

Results are always considered in context, and a single abnormal reading isn’t a diagnosis for infertility. 

Next Steps for Treatment

As expected Pacific Northwest Fertility will determine your treatment plan based on what the tests reveal. Treatment may look like: 

• Lifestyle changes and supplements like Coenzyme Q10 (CoQ10)
• Ovulation induction medications
• Intrauterine insemination (IUI)
• In-vitro fertilization (IVF)
• Surgical correction of anatomical issues
• Donor sperm or eggs
• Surrogacy

You and your doctor will create a personalized plan based on your goals and medical history.

FAQs

What is the purpose of a fertility evaluation?

A fertility evaluation helps identify potential causes of infertility in individuals or couples who are struggling to conceive. It assesses reproductive health, hormone levels, ovarian reserve, sperm quality, and overall fertility potential. The results guide doctors in recommending the most effective treatment options.

How long does a fertility test take?

The duration of a fertility test depends on the type of evaluation. Blood tests for hormone levels take a few minutes, while an ultrasound or semen analysis may take 20–30 minutes. Some tests, like an HSG (hysterosalpingogram) to check for blocked fallopian tubes, may take up to an hour. Comprehensive fertility evaluations, including multiple tests, may be completed over a few days.

What tests are included in a fertility evaluation?

For women:

• Blood tests (AMH, FSH, LH, estradiol, progesterone, prolactin, thyroid levels)
• Ultrasound (to check ovarian reserve and uterine health)
• Hysterosalpingogram (HSG) or Sonohysterogram (SHG) (to check for blocked fallopian tubes)
• Antral follicle count (AFC)

For men:

• Semen analysis (evaluates sperm count, motility, and morphology)
• Hormone testing (testosterone, FSH, LH)
• Sperm DNA fragmentation test (if needed)

Can fertility evaluations predict my chances of getting pregnant?

Fertility evaluations provide valuable insights into reproductive health, but cannot guarantee pregnancy. They only help to identify potential obstacles to conception and guide treatment. 

Does insurance cover fertility testing?

Insurance coverage for fertility testing varies by provider and policy. Some insurance plans cover diagnostic fertility tests, such as blood work and semen analysis, while others may only cover testing if certain medical conditions are suspected. It's best to check with your insurance provider or consult a financial counselor at your fertility clinic to explore coverage options.

Final Thoughts

Fertility evaluations can feel intimidating, but they are key to getting the answers you need. When you’re armed with clear results and a compassionate medical team, you're in a much better position to navigate your fertility journey with confidence and clarity.