Fertility Testing for Men and Women

Difficulty getting pregnant can be caused by female factors (such as ovulation problems), male factors (such as not enough sperm) or both. In about 10-15 percent of cases, the cause is never determined—but that doesn’t mean you can’t be successfully treated. To map out the best treatment plan, it’s important to evaluate both you and your partner.

Your doctor will begin by reviewing your medical, sexual and pregnancy history. At your first consultation, be sure to bring records of any medical treatment or conditions. Here is an overview of some of the tests your doctor may suggest.

For Men

Men’s fertility can be affected by lifestyle factors like smoking, drinking, using drugs and being exposed to environmental toxins like pesticides and certain heavy metals. It also can be affected by prescription medications, excessive heat to the groin area and past medical problems like mumps, hernia, urinary tract infections, prostatitis, athletic injuries and sexually transmitted diseases.

Many of these factors decrease the number or quality of sperm. Other factors—like impotence, vasectomy and structural problems—prevent sperm from fertilizing an egg. Your doctor will thoroughly evaluate all possible causes, using methods such as these:

Physical examination—Your doctor will examine the groin and genital areas to look for lumps or abnormalities such as an undescended testicle or prostate problems. A physical exam also may reveal a vericocele, a bundle of varicose veins around the testicle that can interfere with sperm production.

Semen analysis—This is the most important test of male fertility. You’ll be asked for a sperm sample in a private room in the doctor’s office. Specialists will then evaluate the sample for:

• Total volume, a measure of how much semen is present in one ejaculation. Normal volume is 2-5 milliliters. Low volume may indi- cate a problem with the prostate gland or the seminal vesicles (struc- tures that produce semen, located just above the prostate gland).
• Sperm count per milliliter. Normal range is 20-300 million.
• Sperm shape (“morphology”). At least 14 percent should be normal shape.
• Sperm movement (“velocity”) and motility; at least half should be active and show forward movement.
• Liquefaction, or going from a gel consistency to a liquid in about 20 minutes. An abnormally long liquefaction time may indicate an infection or problem with the seminal vesicles.
• Fructose level. Fructose provides energy for sperm, and if none is present it could indicate a problem with the seminal vesicles.
• Semen pH, or acidity. An abnormally high or low pH can kill sperm or impede their movement. Normal pH is 7.1-8.0.
• White blood cell count. The presence of a large number of white blood cells (or bacteria) could indicate an infection or sexually transmitted disease.
• Additional tests of the sperm can evaluate antisperm antibodies and the sperms’ ability to get through the cervix and mucous and penetrate the egg.

Blood tests—These can measure the amount of reproductive hormones your body is producing. Tests measure the amounts of various hormones that point to problems of the thyroid or pituitary gland, or other endocrine disorders. Occasionally, your doctor may do a blood test called a karyotope to determine whether a chromosome defect could be preventing pregnancy or causing miscarriages.

Ultrasound—This test uses sound waves to produce a picture of the testicles, prostate and seminal vesicles. It can detect blockages, lumps, inflammation and other factors that could contribute to infertility.

Testicular biopsy—Occasionally, a small tissue sample may be taken to evaluate sperm production. It is generally not used to test for cancer.

For Women

Infertility testing is complex for women because there are so many possible causes. You should be aware that age is one of the biggest issues in female fertility. You’re one-third less likely to conceive in your late 30s than in your early 20s. By age 40, your chance of becoming pregnant declines to 30 percent and by age 45, to 5 percent.

Problems with egg production—which can be age-related or not—account for about 20 percent of female-related infertility. Often, the cause is a hormone or thyroid disorder such as polycystic ovarian syndrome. This common hormonal disorder is a leading cause of infertility; symptoms include irregular or absent menstrual periods, excess facial hair, acne and weight gain.

Female factor infertility also can be caused by endometriosis, problems with the uterus, or “premature ovarian failure” (menstrual periods stop before age 40). A condition called luteal phase defect, in which the uterine lining won’t accept a fertilized egg, can cause infertility and early miscarriage.

Many of these factors are affected by smoking, drinking, prescription and nonprescription drugs, too much exercise, poor nutrition, being overweight or underweight, and exposure to hazardous chemicals. Your doctor will talk with you about how to maximize your chances of becoming pregnant, as well as possible causes of infertility.

Physical examination—This will include a pelvic exam, breast exam and thyroid exam. Your doctor may evaluate your cervical mucous and do a Pap test for cervical cancer. You’ll also be examined for any unusual or excessive hair patterns on your face and body, which could indicate a hormonal imbalance affecting fertility.

Home testing—You may be asked to measure and record your basal body temperature (your temperature when you first wake up) to track ovulation. Ovulation predictor kits also can help track ovulation by measuring a hormone in your urine.

Blood tests—Measuring the level of various hormones in your blood at different times in your cycle can determine whether and when you’re ovulating and how well your ovaries are functioning. For example, levels of follicle stimulating hormone (FSH) and estrogen may indicate problems with egg quality or production; and levels of prolactin, testosterone and thyroid stimulating hormone (TSH) help indicate a hormonal disorder affecting ovulation. Blood tests (along with vaginal secretions) also can detect antisperm antibodies—a condition that triggers your immune system to attack sperm. Finally, a karyotype blood test can examine your chromosomes for defects that prevent pregnancy or cause miscarriages.

Postcoital test—This test analyzes cervical mucous after intercourse to determine whether sperm are alive and able to move normally. A day or two before you ovulate, your doctor will have you come to the office within a few hours of intercourse so a mucous sample can be taken and analyzed.

Ultrasound—This test uses sound waves to monitor the size and structure of the uterus and ovaries, through either the vagina or the abdomen. Ultrasound also can track growth of follicles (the sacs in the ovaries where eggs develop) or detect ovarian cysts or fibroids.

Hysterosalpingogram—This X-ray test examines the inside of the uterus and fallopian tubes using water or dye. It may reveal internal problems that could prevent a fertilized egg from implanting, or a blockage in the tubes that could stop an egg or sperm. Sometimes the blockage can be opened during the procedure. Possible causes of blocked tubes include pelvic inflammatory disease and endometriosis.

Sonohysterogram—This ultrasound test uses saline injected into the uterus to evaluate uterine fibroids or polyps.

Laparoscopy—This is a surgical procedure performed under general anesthesia. Using a thin, lighted scope inserted through a small incision in your abdomen, the doctor examines the uterus, fallopian tubes and ovaries. Laparoscopy can detect cysts, fibroids, scar tissue and infections that can affect fertility. It also can be used to remove growths or adhesions caused by endometriosis and other conditions.

Endometrial biopsy—A small piece of tissue from the uterine lining (endometrium) is examined under a microscope to determine whether it can support a fertilized embryo.

Hysteroscopy—A tiny telescope with a fiber optic light is inserted into the uterus to examine the uterus and lining. It also can be used to obtain a small tissue sample for biopsy and to remove growths, small fibroids, polyps or tissue that may be blocking conception, or to open blocked fallopian tubes.

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