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Fertility testing explained
When you started trying to get pregnant, you probably didn’t think you’d ever have a problem. After all, most people can get pregnant really easily, right? Not always. When months and then years go by, and you haven’t had any success, it’s time to undertake some fertility testing. There are two main types of fertility tests – blood tests and imaging tests. Blood tests measure male and female hormones and overall health, while imaging looks at the physical structures of your body, like the uterus and testes.

When should you get a fertility test?

If you or your partner are younger than 35 and haven’t conceived naturally after more than one year, it’s time to speak to your doctor about fertility testing. However, if you or your partner are older than 35, you should undergo testing after only six months.

Some people choose to undergo fertility tests even sooner. If you have a family history of certain inherited conditions, it’s smart to look into your reproductive health as soon as you start trying (or even before).

You might also seek out these tests if you have any medical conditions that are known to affect fertility.

Some of these conditions include endometriosis, fibroids, thyroid disorders, and polycystic ovary syndrome (PCOS).

Are fertility tests accurate?

Fertility tests are accurate, but you need to remember that a single test can rarely give you the answers you seek. Instead, your doctor needs to look at wide array of different factors to diagnose your problem, if there is one. Just remember – sometimes, even with all of the available tests, the doctors and specialists cannot pinpoint the problem.

Questions your doctor will ask during fertility testing

Fertility testing can be a long and complicated process. Your doctor will have many questions for you, so it’s smart to think about them in advance. That way, you can arrive with all of the important information.

Tell your doctor the following facts:

  • Your medical history, including mental health
  • Your family medical history, including anyone who has had cancers and surgeries
  • All medications you take
  • Any drinking you do, and if you smoke or take drugs
  • Your physical activity levels
  • What supplements you take and your nutrition levels

Fertility testing for women

Here are some of the important fertility tests for help diagnose any possible issues preventing a pregnancy

There are two main types of fertility testing for women – hormonal and structural. They need to be considered in relation to one another, and in the context of your overall health.

Let’s first talk about hormonal testing. Having too little or too much of any female hormone can negatively impact fertility. Here are some of the fertility hormones that will be assessed with blood tests.

  • Oestradiol – This is a type of oestrogen that helps control female reproductive organs, which includes the health of the fallopian tubes and the thickness of the vaginal and uterine lining. Your ovarian follicles produce oestradiol, which creates cervical mucus. This is very important for fertilisation. Women’s normal oestradiol levels tend to be between 30 to 400 pg/ml.
  • Anti-Müllerian Hormone (AMH) – Anti-Müllerian hormone, produced by your ovaries, helps doctors understand how many eggs you have left. While most women have an AMH level above 1 ng/ml, a higher level is not necessarily better, as it can be a sign of PCOS. Remember – your AMH level can give you an idea of how many eggs you have, but it does not tell you anything about your egg quality or viability.
  • Saline Sonogram – Saline sonograms are also called sonohysterograms. They are similar to a hysterosalpingogram, but they utilise ultrasound technology instead of X-ray technology.
  • Follicle Stimulating Hormone (FSH) – At different stages throughout your menstrual cycle, your pituitary gland produces follicle-stimulating hormone. This helps stimulate follicle growth and triggers ovulation. Your doctor will assess your baseline FSH level, which should be less than 10 mIU/ml. However, this information needs to be considered in the context of your overall health and other tests results.
  • Luteinising Hormone (LH) – During the first half of your cycle, your FSH stimulates follicles. Your pituitary glands then produce LH to trigger the release of an egg. This surge of LH hormone tends to raise your bodily temperature, which can then be tracked to determine when you are most fertile.
  • Progesterone – Progesterone is one of the most important female reproductive hormones. It helps to thicken your uterine lining, getting it ready for implantation. If you do become pregnant, your progesterone levels increase throughout the pregnancy. If you do not become pregnant, your progesterone levels fall. On average, a healthy progesterone level is between 8-10 ng/ml.
  • Androgens – Androgens are predominantly a male sex hormone, but women do produce small levels of testosterone and DHEA-S. A doctor might want to measure your androgen levels to look for polycystic ovary syndrome (PCOS), which can be determined by high testosterone levels. For reference, normal female testosterone levels are between 15 and 70 ng/dL.
  • Prolactin – Your body produces prolactin when you breastfeed, because this hormone encourages milk production. Your doctor might test your prolactin levels, because if they are elevated even when you are not nursing, this can indicate a growth on the pituitary gland, which can impact fertility. Typical prolactin levels for non-breastfeeding women should be lower than 25 ng/ml.
  • Thyroid Hormones – Most fertility investigations will include thyroid tests because they can help identify a wide array of fertility problems. Most thyroid tests measure the thyroid-stimulating hormone (TSH) your pituitary gland produces, which should be between 0.4 to 4.0 mIU/L.
  • Transvaginal ultrasound – You might hear this one called an internal scan, because the ultrasound wand is inserted vaginally. With a transvaginal ultrasound, the device uses high-frequency sound waves and gives the doctor a clear picture of your ovaries and uterus. They can use this scan to look for masses, fibroids, polyps, and other abnormalities. They can also check the thickness of your uterine lining and ovarian follicle count.
  • Hysterosalpingogram (HSG) – During an HSG test, a doctor will pass a thin catheter through your cervix and then pump your uterus and fallopian tubes full of coloured water. They will then view it on an X-ray to get a real-time view of your reproductive system’s functions. An HSG can cause pain and severe cramps, so speak with your doctor about pain management.
  • Saline Sonogram – Saline sonograms are also called sonohysterograms. They are similar to a hysterosalpingogram, but they utilise ultrasound technology instead of X-ray technology.
  • Hysteroscopy – A hysteroscopy is an intensive and invasive procedure. During a hysteroscopy, a doctor passes a thin camera and water wand through your cervix for a clear picture of your uterus. It can also remove fibroids and polyps. Some doctors prefer to do this procedure under general anaesthetic, because approximately 25% of women describe the pain as unbearable. Speak to your doctor about pain management, especially if you have never had a vaginal delivery.

Fertility testing for men

There can be issues preventing a pregnancy from a man's side too. Here are some tests to check .

Do you still hear people saying that infertility is a ladies’ issue? This isn’t true – nearly half of all infertility cases are caused by the guy’s side of things. So, male factor infertility is actually very common. The most common cause of male infertility is damaged sperm.

Fertility testing for men assesses sperm health, looks for abnormalities, and looks at sperm delivery to make sure everything is normal. It also measures male hormone levels.

Here are some of the most common male fertility tests:

  • Semen analysis – This is the most common male infertility test. Semen analysis looks at your sperm to check for abnormalities and measures motility (movement), morphology (shape), and overall sperm count.
  • Hormone blood tests – Male fertility blood tests measure follicle-stimulating hormone (FSH) and testosterone to make sure you have enough of these hormones.
  • Ejaculation analysis – Your doctor will examine your penis to check for the functional delivery of sperm. They’ll look for blockages that could be stopping your sperm from leaving your penis in a normal fashion.
  • Post-ejaculation urinalysis – In some cases, men have sperm in their urine. That means that they are experiencing retrograde ejaculation. When this occurs, sperm doesn’t travel out of the urethra; it instead travels backwards into the bladder.
  • Psychological assessment – If you’re having problems sustaining an erection or having intercourse to orgasm, you might be experiencing some emotional issues. Your doctor will want to hear more about your state of mind.
  • Scrotal ultrasound – A scrotal ultrasound can look for structural abnormalities in your testicles and scrotum. Some of these abnormalities include duct blockages, varicoceles (enlarged testicular veins), and epididymal abnormalities.

Fertility testing can seem time-consuming and sometimes costly, however, if months or even years pass without success, taking a fertility test becomes a priority. Testing will hopefully give you some clues about what’s happening with your fertility and your next steps. It’s so important to understand if there are any issues preventing a pregnancy and diagnosis is key. 

Good luck with your journey!

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