Initial Fertility Testing

According to the Centers for Disease Control and Prevention, 11.8 percent of American women age 15 to 44 have problems getting pregnant or carrying a baby to term. The American Pregnancy Association says infertility affects 10 percent of American couples of childbearing age. (See References 1 and 2) Many of these individuals will seek fertility treatment. Although this process can be daunting, some initial fertility tests are standard.

Timing

• The most common definition of infertility is the inability to conceive after one year of trying or the inability to stay pregnant. (See References 3 and 4) Consistent with this definition, doctors recommend couples try to conceive for at least one year before starting fertility testing. Some doctors recommend that women over age 35 should seek medical attention after six months of trying to conceive because the ability to achieve a pregnancy decreases with age. (See References 3)

Fertility Factors

• Achieving and maintaining a pregnancy both depend on several factors: the production of healthy sperm by the male partner and healthy eggs by the female partner; the ability of sperm to travel unimpeded to the egg; the ability of sperm to fertilize the egg; the ability of a fertilized egg to implant in the woman's uterus; and an adequate environment for the embryo to develop. (See References 3) According to the Jones Institute for Reproductive Medicine (the location of the first baby born in the United States as a result of in vitro fertilization), an infertility evaluation will test each of these factors to isolate and identify the faulty step (or steps) in the pregnancy process. (See References 5)

Initial Exam

• Before any specific fertility testing begins, doctors recommend that both partners have a general examination to rule out physical disorders or infections as the cause of the couple's infertility. In addition, questions about the couple's sexual habits can help determine whether the couple has timed intercourse properly to achieve a pregnancy. (See References 3)

Male Tests

• A semen analysis is the first---and often only---fertility test for the male partner. During this test, sperm is collected in a specimen jar and examined under a microscope. The analysis focuses on the number, shape, quality, mobility, viability and progression of the sperm. Semen volume and extraneous semen content (such as white blood cells that indicate infection) are also considered. (See References 6 and 7)

Female Tests

• Fertility tests for the female partner are more involved. The female partner may need to track her basal body (or waking) temperature for several months to determine whether she is ovulating. Over-the-counter ovulation tests are also available for home use.

  Blood work measures hormone levels for the female partner. Follicle stimulating hormone (FSH), luteinizing hormone (LH), and progesterone, among others, are key components to achieving and maintaining a pregnancy and are analyzed at specific points in the woman's menstrual cycle. (See References 8) An initial fertility analysis may also include a pelvic ultrasound test---possibly at several different points during the female partner's cycle---to assess the condition of the uterus and ovaries. In particular, the thickness of the lining of the uterus and development of egg follicles will be monitored. (See References 8)

Additional Tests

• If initial tests fail to pinpoint the cause of a couple's infertility, additional testing may be recommended. For the male partner, additional analyses of the sperm can establish whether the sperm can penetrate an egg. A biopsy of the tubules in the testes can determine the rate at which the male partner produces sperm, and an ultrasound test can identify blockage or damage to the male reproductive tract. (See References 6) For the female partner, a hysterosalpingogram (HSG) test, which is an x-ray of the uterus and fallopian tubes, can spot a blockage. A laparoscopic examination, which is minor surgery to see inside the female partner's abdomen, can determine the presence of scar tissue, endometriosis (abnormal growth of the uterine lining), or other damage to the female reproductive tract. (See References 4 and 8)