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.

Introduction

“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.

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. In this Rise Fertility Blog, let’s go through the key components of a comprehensive and complete fertility workup.

1. Review Your Medical History

A good fertility evaluation always starts with a thorough review of your medical history. It’s important to discuss any medical problems or surgeries as well as review any previous testing, treatments, or medical records to see what was done in the past. We also discuss medication and supplement use, allergies, lifestyle factors, toxic exposures, and family history. In many cases, the history will reveal important clues about why someone is struggling to conceive and can prompt 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 check ovarian reserve. 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. Another blood test that gives valuable information about ovarian reserve is anti-mullerian hormone (AMH), which is a hormone made by the ovaries. AMH levels also correlate with response to fertility treatment. We can also assess ovarian reserve by doing an ultrasound to look at the ovaries and count the number of small resting follicles or antral follicles. The antral follicle count (AFC) can also be used to predict response to ovarian stimulation. These tests together give a global assessment of a woman’s ovarian reserve, they can be used to predict response to fertility treatment, and they can be helpful in determining the best treatment method to achieve success.

3. Check Key Hormones

There are several other key hormones involved in reproduction that are important to check. 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. A Fertility Specialist can figure out if you are ovulating using a few different strategies. One simple way is to analyze your menstrual cycle. If you are having regular monthly periods, there’s a good chance you’re ovulating. 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 are 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, the semen analysis is the primary test used to assess the health and quality of the sperm. 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 hormone or genetic testing, imaging, or even referral to a Urologist.

6. Make Sure the Uterus is Healthy

The uterus is the home for the pregnancy so making sure that 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.

Checking the uterus usually starts with a simple ultrasound, but more advanced testing of the uterine cavity should 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. Alternatively, a hysteroscopy can be performed, which 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. Both of these tests can often be performed right in the office.

7. Determine if the Fallopian Tubes are Open

The fallopian tubes are where the egg and sperm meet to form an embryo so making sure the tubes are open is an important step in the fertility workup. There are several causes of tubal blockage, including chlamydia or pelvic infections, ectopic pregnancy, pelvic surgery, and endometriosis. 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.

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 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 thorough evaluation will point you in the right direction and set you up for success on your fertility journey.

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