Fertility tests for women and men: what to expect and why

Not getting pregnant can be worrying, and many people are unsure what testing involves. This article explains how fertility problems are investigated in women and men, drawing on the NHS and MedlinePlus.

1. Introduction

Fertility tests look for the common reasons why a couple has not conceived. The NHS advises that both partners attend appointments, because a problem can affect either or both of them ^[1]. MedlinePlus explains that testing differs for women and men and may include blood tests, imaging and a semen test ^[2].

2. When testing starts

The NHS says to see a GP if you have not conceived after a year of regular unprotected sex, meaning sex every 2 to 3 days. Go sooner if the woman is 36 or over, has had cancer treatment, or thinks she may have had a sexually transmitted infection ^[1]. MedlinePlus and the NICHD use a shorter timeframe of 6 months for women around 35 and older ^{[2, 4]}.

3. The first visit

At the first visit a doctor usually gathers background information ^[1]. Expect questions about:

• Previous pregnancies, births and miscarriages, or children from earlier relationships
• How long you have been trying, how often you have sex and any difficulty with sex
• Medical conditions, past infections and, for women, periods and bleeding
• All medicines, including herbal remedies and supplements

The doctor will also ask about smoking, weight, alcohol, drug use and stress, and may suggest changes ^[1]. A physical examination follows. For women this includes weight and body mass index and often a pelvic examination to look for infection, lumps or tenderness. For men the doctor checks the testicles for lumps or deformities and examines the penis ^[1].

4. Tests for women

The NHS and MedlinePlus describe these tests ^{[1, 3]}:

• Blood tests for ovulation. Ovulation is the release of an egg each month. A blood test for the hormone progesterone, timed to your cycle, shows whether you are ovulating. If periods are irregular, other hormones called gonadotrophins are measured ^[1]. MedlinePlus lists further hormone tests, including those for AMH, FSH, LH, estrogen and prolactin ^[3].
• Chlamydia test. This is a swab from the cervix, or a urine test. Antibiotics are given if it is positive ^[1].
• Ultrasound scan. This checks the ovaries, womb and tubes and can show conditions such as endometriosis and fibroids or signs of a blocked tube. A transvaginal scan uses a small probe placed in the vagina ^[1].
• Checks of the fallopian tubes. In one test, fluid is passed through the cervix into the womb and followed on ultrasound. In another, called a hysterosalpingogram, dye is injected and an X-ray is taken. Both look for blockages ^[1].
• Laparoscopy. This is keyhole surgery. A small cut is made in the lower abdomen and a thin tube with a camera looks at the womb, tubes and ovaries. It is usually kept for likely problems, such as past pelvic inflammatory disease or a blockage seen on a scan ^[1].

MedlinePlus also lists a karyotype test, which is a genetic test, among the tests that may be used ^[3].

5. Tests for men

The main test is a semen analysis. The NHS says it checks the sperm count and how well the sperm move ^[1]. MedlinePlus adds a blood test for testosterone levels ^[5]. Men are also offered a urine chlamydia test, with antibiotics if it is positive ^[1].

6. Preparing for your appointments

A little preparation can make visits easier. It helps to know how regular your periods are, because the NHS says the timing of the progesterone blood test depends on this ^[1]. Bring a list of all the medicines, herbal remedies and supplements you take, and any past test results or hospital letters. Partners may find it useful to write down questions beforehand, such as how long each test takes, when results will be ready and what happens if nothing abnormal is found. Fertility problems can be stressful for relationships, and the NHS notes that stress may reduce desire for sex ^[6]. Ask your doctor about counselling or support groups, which MedlinePlus says can help ^[2].

7. After the tests

After the examination, the NHS says the GP may refer you to a specialist NHS infertility team or a fertility clinic. If a scan suggests a blocked tube, you will be referred for further checks such as laparoscopy ^[1]. Testing can also show that no cause is found, which the NHS says happens in about 1 in 4 couples ^[6]. Treatment depends on the cause and what is available locally ^[6].

8. When to see a doctor

See a doctor after a year of trying, or sooner if the woman is 36 or over ^[1]. MedlinePlus gives 6 months for women aged 35 or older ^[2]. The NHS also advises going sooner after cancer treatment or if a sexually transmitted infection is possible ^[1], and MedlinePlus lists irregular periods and a history of pelvic inflammatory disease as reasons to seek care ^[2]. The NHS says people who already know of a possible fertility problem should also go sooner ^[6].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

Fertility testing is a step-by-step process that begins with a conversation and examination and may include hormone blood tests, scans, tube checks and semen analysis. Both partners are usually checked. The results help your doctor explain the options, and the doctor decides which tests and treatments are right for you.