If you and your partner are trying to have a baby but haven't been able to, you may start to wonder if you should get fertility tests. Experts say it's time to check with a doctor if you've had regular sex without birth control for 12 months if you are under the age of 35 and for 6 months if you are over 35.
It's important for the two of you to go for testing together. When you see your doctor, they'll probably start by asking questions about your health and lifestyle. They'll want to know things about you and your partner like:
- Medical history, including any long-term conditions or surgeries
- Medicines you take
- Whether you smoke cigarettes, drink alcohol, eat or drink things with caffeine, or use illicit drugs
- If you had contact with chemicals, toxins, or radiation at home or work
They'll also want to know about your sex life, such as:
- How often you have sex
- Your history of birth control use
- If you've had sexually transmitted diseases
- Any problems having sex
- Whether either of you had sex outside the relationship
Your doctor will also have questions about things connected with your periods, such as:
- Have you been pregnant before?
- How often have you had periods over the last year?
- Have you had irregular and missed periods or had spotting between periods?
- Did you have any changes in blood flow or the appearance of large blood clots?
- What methods of birth control have you used?
- Have you ever seen a doctor for infertility, and did you get any treatment?
Infertility Tests for Women
There is no single best test for infertility. Doctors use a variety of ways to identify any problems that might help cause fertility trouble.
You may get a Pap smear, which is used to detect abnormal cells around the cervix. The test can detect cervical cancer and other problems with the cervix, or sexually transmitted diseases. Any of these can interfere with getting pregnant.
To get pregnant, you need to release an egg each month -- called "ovulation." You may need tests that check for that.
Your doctor may ask you to take a urine test at home for luteinizing hormone, or LH. This hormone shows up in high levels just before you ovulate.
Your doctor also may check levels of the hormone progesterone in your blood. Increases in progesterone show that you are ovulating.
On your own, you can check your body temperature each morning. Basal body temperature rises a bit just after ovulation. By checking it each morning, you'll learn your pattern of ovulation over several months.
Your doctor may also run tests on your thyroid, or check for other hormonal problems, to rule out conditions that might cause missed or irregular ovulation.
Tests of Reproductive Organs
Hysterosalpingogram (HSG). Also called a "tubogram," this is a series of X-rays of your fallopian tubes and uterus. The X-rays are taken after your doctor injects liquid dye through the vagina. Another method uses saline and air instead of dye and an ultrasound.
The HSG can help you learn if your fallopian tubes are blocked or if you have any defects of your uterus. The test is usually done just after your menstrual period.
Transvaginal ultrasound. A doctor places an ultrasound "wand" into the vagina and brings it close to the pelvic organs. Using sound waves, they'll be able to see images of the ovaries and uterus to check for problems there.
Hysteroscopy. Your doctor puts a thin, flexible tube -- with a camera on the end -- through the cervix and into the uterus. They can see problems there and take tissue samples if needed.
Laparoscopy. Your doctor makes small cuts in your belly and inserts tools, including a camera. This surgery can check your entire pelvis and potentially correct problems, such as endometriosis, a disease that affects your pelvic organs.
Other Infertility Tests
A doctor may order other tests to check for fertility problems.
You may get a blood test to check your levels of follicle-stimulating hormone, or FSH, which triggers your ovaries to prepare an egg for release each month. High FSH can mean lower fertility in women. The FSH blood levels get checked early in your menstrual cycle (often on day 3).
Clomiphene citrate challenge testing can be done with the FSH test. You take a pill of clomiphene citrate on the fifth through ninth days of your menstrual cycle. FSH gets checked on day 3 (before you take the medicine) and on day 10 (after). High FSH levels suggest you have lower chances of getting pregnant.
Your doctor may also suggest a blood test to check for anti-müllerian hormone (AMH). AMH levels can give an idea of how well the ovaries function. This is called their ovarian reserve. Very low levels can suggest low ovarian reserve.
Another exam is called postcoital testing. Your doctor examines your cervical mucus after you've had sex. Some studies suggest it may not be so useful.
Your doctor may also recommend an endometrial biopsy. In this procedure, they take a sample of tissue from the lining of your uterus. But evidence is mounting that endometrial biopsy is not helpful in predicting or treating infertility.
You may not need to have all these tests. Your doctor can discuss with you which ones are best in your situation. After the testing is done, about 85% of couples will have some idea about why they're having trouble getting pregnant.