What is infertility?
Infertility is defined as a
couple's inability to become pregnant after 1 year of sex without using birth
control. But "normal fertility" is defined as the ability to naturally conceive
within 2 years' time.
A man's fertility is not known to be
severely affected by age. A woman's fertility gradually drops from her mid-30s
into her 40s, due in great part to the natural
aging of the egg supply. For any couple, defining infertility is a personal
issue-influenced by a woman's age and how much time a couple chooses to try
conceiving without medical intervention.
What causes infertility?
In about 35% of couples,
testing reveals a male fertility problem, as with sperm production or
ejaculation. In about 50% of couples, the primary cause is a female fertility
fallopian tube function, or other pelvic problems,
endometriosis. Some couples find that both partners
have a fertility problem. In 10% of couples, no cause of infertility is
What types of infertility testing are available?
Testing for causes of infertility can range from simple, inexpensive, and
painless to complicated, expensive, and surgically invasive. If you decide to
test for a cause of infertility, your doctor will want to check both of you at
the same time. Using your
fertility awareness information, semen analysis, and
blood tests for hormone levels, your doctor can easily check for the most
common male and female infertility problems.
- Initial tests of male and female hormone and
semen analysis can signal problems with egg or sperm production. Typically, an
abnormal sperm analysis will be followed by a repeat analysis. Depending on the
problem, abnormal hormone or sperm results are followed up with further testing
or treated with medicines or hormones.
- Tests that examine the reproductive tract, such as
hysteroscopy, hysterosalpingogram, sonohysterogram, endometrial biopsy,
ultrasound, laparoscopy, and transrectal ultrasound, can identify disease or
structural problems that might be reversible.
Use the following reference as you consider whether to
proceed with various types of testing. Initial tests are listed first, followed
by other tests that may be recommended, depending on initial testing
Infertility tests: Benefits and concerns
| Which partner is tested and type of
|| Reasons to have this testing
|| Potential concerns
Female partner, at home:Basal body temperature and other
fertility awareness measures
- Not painful or
- Tunes you in to your body's cycles and fertile
- Provides valuable information for an initial fertility consult
with your doctor; can be used with home ovulation test
- Low cost, low-stress, private
- At least 2 cycles of daily
temperature charting are needed to provide useful
- Daily early morning temperature-taking may be
difficult for women with irregular work/sleep schedules.
helpful for exact timing of intercourse
Female partner, at home: Home ovulation test kit for
luteinizing hormone (LH)
- Not painful or invasive (urine
- Provides immediate confirmation that you're within 12 to 36
- Requires 2 or more days in a row of
- May need more than one kit per cycle (best used with cervical mucus monitoring or basal body
temperature chart and other fertility awareness information)
Male partner: Semen analysis
- Not painful or
- Provides necessary data for treatment planning
Hormone tests, including
luteinizing hormone (LH),
follicle-stimulating hormone (FSH),
thyroid-stimulating hormone (TSH),
- Easily provides key information about
possible causes of infertility
- Minimally invasive (require blood
Female partner: Hysterosalpingogram
- Provides clear view of
fallopian tubes and
uterus without having surgery
- The fluid
that is flushed into the uterus and tubes may clear a mild tubal blockage and
increase your chances of pregnancy.
- Invasive (small tube inserted via the
vagina), with slight risk of infection or uterine or tubal
- May cause cramping during or after the
- Uses X-ray
Hysterosonogram with transvaginal ultrasound to evaluate the uterus and fallopian tubes (also
known as sonohysterogram)
- Abdominal test is not painful or
invasive; no X-ray used.
- Provides view of follicle development, and
reproductive organs; used to guide egg retrieval
- Hysterosonogram is invasive (a thin
tube and larger ultrasound transducer inserted via the
- Compared to laparoscopy, it is not sufficient for
evaluating some conditions.
Female partner: Laparoscopy
- Allows inspection of reproductive
organs when a problem, such as
endometriosis, is suspected
- Simple tubal
repairs can be performed during same procedure if necessary.
- Invasive (surgical procedure requires
small abdominal incision) with slight risk of injury or
- Operating room-based; may require hospitalization or
missed work days
general anesthesia, which has
risks and prolongs recovery time
Male partner: Sperm antibody test
- Not painful or
- Shows whether sperm impairment is caused by
- Sometimes used after sperm
analysis reveals clumped-together sperm (agglutination) and poor sperm movement
(motility); may also be used when no other cause of infertility can be
Many doctors no longer use this test, citing questionable usefulness. Sperm problems require
in vitro fertilization with
intracytoplasmic sperm injection (ICSI) regardless of
these test results.
Female partner: Hysteroscopy
- No incision
- Provides view of uterine growths or defects that cannot
be seen during other tests, such as ultrasound
- Small uterine
growths or biopsy samples can be removed during the same procedure.
- Invasive (scope is inserted through
vagina to uterus)
- Not usually used if
hysterosalpingogram results were normal
Male partner: Testicular ultrasound
- Not painful or invasive; no X-ray
- Provides view of
varicocele if present in testes
Male partner: Testicular biopsy
- Collects sperm for evaluation or for
assisted reproductive procedures
evaluates sperm when male hormone levels are normal, yet sperm in semen are
abnormal or dead
- Invasive (requires small
- Slight risk of infection
Both partners: Karyotype, other genetic testing
- Evaluate possible genetic causes of
conception, miscarriage, or stillbirth problems
- Can identify
possible genetic problems that a couple could pass on to their child
- Slightly invasive; uses blood
- Used only in select cases, such as repeat
in vitro fertilization failures or
miscarriages, or when there are known genetic risk
Both partners:Culture of semen and cervical mucus
- Not painful or invasive (but requires
woman to have cervical mucus sample taken and man to provide semen
- Evaluates for infection as cause of infertility
How can you and your partner use the information from infertility tests?
Based on your unique test results, your doctor
can give you the best possible information about your next testing or treatment
options. At each point in the testing process, pause and assess what you have
learned and decide what you want to do next.
Here is a general
example of how a couple and their doctor might use information from infertility
If a couple's initial tests are normal, finding no reason for their difficulty conceiving
(unexplained infertility), they can:
- Continue trying to conceive naturally,
having sex just before ovulation to increase their chances of
- Continue testing for an infertility cause. Further
testing checks the fallopian tubes to be sure that eggs can enter the tubes, be
fertilized, and implant in the uterus. These tests are more invasive,
uncomfortable, and risky.
- Try treatment with
intrauterine insemination (IUI), with or without
If a sperm analysis shows a sperm problem, a woman may not need any tests. But to conceive a
pregnancy, the sperm problem may require insemination or
assisted reproductive technology (ART) treatment,
which intensively involves the female partner. ART uses medicine, tests, and
procedures to produce, collect, fertilize, and implant multiple
If a sperm analysis is normal but a woman's basal body temperature and hormone tests suggest that she isn't ovulating, she may not need further tests. She may choose to try
medicine that stimulates her ovaries to produce and release eggs.
If test results show a problem with the fallopian tubes, a couple may choose a
fallopian tube procedure or
in vitro fertilization (IVF) to conceive a pregnancy.
- When successful, a fallopian tube
procedure can enable a woman to have more than one pregnancy without ongoing
fertility treatment and repeated use of IVF.
- Tubal surgery does not
work for tubal problems that are severe.
At any point in the infertility testing and treatment
process, a couple has the freedom to stop or take a break. Many couples find
that a break in the intensity is necessary for them to maintain their physical
and mental health.
If you need more information, see the topic