The Complete Fertility Workup

Have you ever wondered how a Fertility Specialist actually tests your fertility? Read about the different tests and information your doctor gathers to assess your fertility potential.

Infertility Struggles are Not Uncommon

“Why am I not getting pregnant?” If you have asked yourself this question, don’t worry, you’re not alone. One in 7 couples struggle to conceive and there are several different causes of infertility.

A Reproductive Endocrinology and Infertility specialist is an expert in all things fertility and she can help you figure out your fertility status and identify barriers that are preventing you from getting pregnant. They may perform an infertility workup to determine possible causes that are preventing a successful conception.

When assessing fertility, it’s really important to do a really thorough and comprehensive fertility evaluation to figure out all the potential risk factors, both big and small, affecting your fertility. This information is used to create a personalized treatment plan to optimize your chances of getting pregnant.

During a fertility or infertility workup, your specialist will typically cover the following items:

1. Review Your Medical History

A good fertility evaluation always starts with a thorough review of your medical history. Your specialist will take a look at the big picture and see if there are any notable indicators in your life that might be contributing to infertility. These might include:

• Past or current medical conditions
• Past surgeries, distant and recent
• Previous testing and treatments
• Use of medication or supplements
• Allergies or toxic exposures
• Lifestyle factors
• Family medical history

In many cases, a patient’s medical history will reveal important clues about why someone is struggling to conceive. From there, your fertility specialist can arrange for the appropriate diagnostic testing.

2. Test Your Ovarian Reserve

Ovarian reserve is a measure of your reproductive potential, how many eggs you have left, and helps determine your prognosis for success with fertility treatment.

There are several ways to evaluate one’s ovarian reserve. These tests together provide a holistic assessment, can be used to predict response to fertility treatment, and can be helpful in determining the best treatment method to achieve success.

These tests can include:

Follicle-Stimulating Hormone (FSH)

Follicle-stimulating hormone (FSH) is a hormone that promotes egg development. A simple blood test to check your FSH level on cycle day 2 or 3 can help predict how you will respond to fertility medications.

Anti Mullerian Hormone (AMH)

Another blood test that gives valuable information about the ovarian reserve is the anti-mullerian hormone (AMH), which is a hormone made by the ovaries. AMH levels also correlate with response to fertility treatment.

Ultrasound

During an infertility workup, a fertility specialist can assess ovarian reserve by doing an ultrasound. Here, they will examine the ovaries and count the number of small resting follicles or antral follicles.

Antral Follicle Count (AFC)

Lastly, the antral follicle count (AFC) can also be used to predict response to ovarian stimulation.

3. Check Key Hormones

There are several other key hormones involved in reproduction that are important to check. If there are issues with any of the hormones identified during the workup, this can help your fertility specialist determine a more effective treatment plan.

Thyroid-stimulating hormone (TSH) and thyroxine (free T4) are used to screen for thyroid problems, which have been associated with poor pregnancy outcomes and miscarriage. Prolactin is another important hormone that can affect your ability to ovulate.

Luteinizing hormone (LH) can be useful when evaluating patients for polycystic ovary syndrome (PCOS) or other hormone imbalances. Insulin resistance or diabetes can significantly impact fertility as well so it’s important to test for this and identify patients that may be at risk.

4. Figure Out if You are Ovulating

Ovulation is the release of a mature egg from the ovary. Ovulatory problems are common and account for about 40% of female infertility.

During a fertility workup, a fertility specialist can determine if you are ovulating using a few different strategies, such as:

Menstrual Cycle Analysis

One simple way is to analyze your menstrual cycle. If you are having regular monthly periods, there’s a good chance that you are ovulating. A doctor may also ask about the frequency at which you experience your periods to determine if there are any irregularities that require further evaluation.

Other Ovulation Signs and Symptoms

Your doctor may also ask you about certain symptoms that may be signs of ovulation like cramping, breast tenderness, and bloating. A fertility specialist can also test for ovulation by checking a mid-luteal progesterone level or by doing ultrasounds to track follicular development.

5. Test the Sperm

Healthy sperm is an important part of the equation and male factor infertility is a contributor in 30-40% of couples struggling to conceive. In addition to a thorough male history, semen analysis is the primary test used to assess the health and quality of the sperm.

What is a Semen Analysis?

The semen analysis provides information about important semen parameters such as volume, pH, sperm concentration, motility, and morphology. The results may also prompt additional testing, such as a hormone or genetic testing, imaging, or even referral to a urologist.

If your male partner is determined to have an issue with their sperm, a doctor may develop a treatment plan for them to help increase healthy sperm production to improve the chances of conceiving.

6. Make Sure the Uterus is Healthy

The uterus is the home for the pregnancy so making sure that the home is healthy and ready for implantation is critical. There can be structural or anatomic problems like fibroids or scar tissue that can affect implantation.

There are a few ways to evaluate the health of your uterus during an infertility workup. These can include:

Ultrasound

Checking the uterus usually starts with a simple ultrasound. Here, the doctor can evaluate the structural health of the uterus and look for any visible warning signs like tumors that could be affecting conception.

Sonohysterogram and Saline Infusion Sonogram

Using ultrasound technology, more advanced testing of the uterine cavity can be done in one of two ways. A sonohysterogram (SHG) or saline infusion sonogram (SIS) is an ultrasound test in which water is infused into the uterus and an ultrasound is used to assess the inside of the cavity.

Hysteroscopy

A hysteroscopy can also be performed. This is a simple office procedure where a camera is used to actually look inside the uterine cavity. Hysteroscopy is considered the gold standard for evaluating the cavity and has the advantage of being both diagnostic and therapeutic – if a problem is found, it can usually be fixed at the same time.

7. Determine if the Fallopian Tubes are Open

The fallopian tubes are where the egg and sperm meet to form an embryo. Ensuring sure the tubes are open is an important step in the fertility workup.

To determine if your tubes are open, a hysterosalpingogram (HSG) is performed, which involves injecting dye into the uterus and using an x-ray or fluoroscopy machine to determine whether the dye flows through and spills out from one or both fallopian tubes.

If one or both tubes are blocked, your doctor may perform a further evaluation in order to diagnose the issue. There are several possible causes of tubal blockage, including:

Chlamydia

Chlamydia is a common sexually transmitted infection that can cause scarring and blockage of the fallopian tubes. If diagnosed, it can be treated with antibiotics.

Pelvic Inflammatory Disease (PID)

Another common cause of tubal blockage is pelvic inflammatory disease or PID. This is a serious infection of the reproductive organs that can be caused by sexually transmitted infections like chlamydia, as well as other bacteria. If left untreated, PID can damage the fallopian tubes, but it can be treated with antibiotics.

Ectopic Pregnancy

An ectopic pregnancy is a condition where a pregnancy implants outside of the uterus, usually in the fallopian tubes. This is a life-threatening condition and immediate medical attention is required. 

Typical symptoms of an ectopic pregnancy include pelvic pain and vaginal bleeding. Depending on the severity and how early it is caught, medications, surgery, or therapeutic procedures can be used to treat the condition.

Endometriosis

Endometriosis is the name of a condition where the tissue that normally lines the inside of the uterus grows outside of the uterus. If diagnosed, a doctor may prescribe hormone medications or recommend surgery as treatment. 

Pelvic Surgical History

If you have undergone surgical procedures in your pelvic region in the distant or recent past, there may be factors present that affect the health of the fallopian tubes. It is important to disclose any surgical procedures to your doctor to determine if any of them could be contributing to infertility.

8. Screen for Genetic Diseases

There are certain genetic diseases that you or your partner could carry and potentially pass on to your offspring. Genetic carrier screening is a simple blood test that tests you for several hundred different diseases that could be passed on. The goal of this test is to provide patients with information about their reproductive risks before they conceive and to discuss their options.

Depending on the results, a Fertility Specialist may recommend more advanced fertility treatments like in vitro fertilization (IVF) with preimplantation genetic testing in order to screen for a specific genetic disease.

Summary

A complete fertility workup consists of several important tests and key pieces of information to help you understand your fertility potential. It helps to identify risk factors or certain barriers that may need to be addressed or optimized prior to starting treatment. This information is used by Fertility Specialist to figure out the best strategy to help you get pregnant. There are several different reasons why you may be struggling to get pregnant and a thorough evaluation will point you in the right direction and set you up for success on your fertility journey.