Infertility Tests

Overview

What are infertility tests?

Infertility tests are done to help find out why a woman cannot become pregnant. The tests help find whether the problem is with the man, the woman, or both. Tests usually include a physical examination, semen analysis, blood tests, and special procedures.

See illustrations of the male reproductive system and the female reproductive system .

Should I be tested?

Before you have infertility tests, try fertility awareness methods to find the best time to become pregnant. A woman is most fertile during ovulation and 1 to 2 days before ovulation. Some couples find that they have been missing the most fertile days when trying to become pregnant. A woman should keep a record of her menstrual cycle and when she ovulates. This record will help your doctor if you decide to have infertility tests. For more information, see the topic Fertility Awareness.

Consider infertility tests for you or your partner if:

• There is a physical problem, such as not being able to release sperm (ejaculate) or not ovulating or irregular menstrual cycles.
• You are in your mid-30s or older, have not used birth control for 6 months, and have not been able to become pregnant.
• You are in your 20s or early 30s, have not used birth control for a year or more, and have not been able to become pregnant.

How do infertility tests feel?

Some tests, such as a semen analysis, physical examination, and blood tests, do not cause pain. However, some procedures, such as an endometrial biopsy, a laparoscopy, or a hysterosalpingogram, may cause some pain.

Do the tests cost a lot?

Infertility tests can cost a lot and cause stress. You need to regularly record your sex life and talk to your doctor about it. In some cases, you must do this soon after having sex. This can be embarrassing.

Before you have infertility tests, talk with your partner about how much testing you want to do. Sometimes you may not find out what causes infertility even after many tests, so it is important to know how many tests you want to try. For more information, see:

Should I have infertility tests?

What are the risks of infertility tests?

Simple tests, such as semen analysis, blood tests, or an ultrasound, do not usually cause any problems. Other tests which are medical procedures, such as hysteroscopy or laparoscopy, have a higher chance of problems after the test.

Where are infertility tests done?

Many infertility tests, including the physical examination, medical history, and blood tests, can be done in your doctor's office or clinic by a gynecologist, an obstetrician, or a reproductive endocrinologist. Your family doctor or general practitioner may do some of the first tests. Tests on a man may be done by a urologist. Some medical procedures are done in an operating room.

What are the benefits of infertility tests?

Infertility tests may find what is causing the problem and you can sometimes be treated during the tests. For example, a blocked fallopian tube may be opened during a hysterosalpingogram.

Sometimes tests cannot find the cause of infertility and not all infertility problems can be treated. Infertility in men is often less successfully treated than infertility in women. However, you may still be able to become pregnant using assisted reproductive technology, which can treat male or female problems.

What tests are done first?

Tests to find the cause of infertility

Who	Test name	Description
Both partners	Medical history	Your doctor will ask questions about your sex life, your birth control methods, any sexually transmitted disease (STDs), medicine use, and the use of caffeine, tobacco, alcohol, or illegal drugs. Your menstrual cycle and exercise patterns will be checked. If STDs are suspected, more tests may be done.
	Physical examination	A complete physical examination of both you and your partner is done to check your health. A woman's physical examination usually includes a pelvic examination and Pap test. For more information, see the medical tests Pelvic Examination and Pap Test. A man's physical examination usually includes a testicular examination. For more information, see the medical test Testicular Examination.
	Blood or urine tests	Luteinizing hormone (LH) and progesterone tests may be done during a woman's menstrual cycle to help see whether she is ovulating. LH may be checked in a man to see whether he has a pituitary gland problem. For more information, see the medical tests Luteinizing Hormone (LH) and Progesterone. Thyroid function tests may be done to check for thyroid hormone problems that may be preventing ovulation. For more information, see the medical tests Thyroid Hormone Tests and Thyroid-Stimulating Hormone (TSH). Prolactin is a hormone made by the pituitary gland. It may be checked if a woman has menstrual cycle or ovulation problems. For more information, see the medical test Prolactin. In some cases, follicle-stimulating hormone (FSH) may be used to check a woman's egg supply (ovarian reserve). Experts question the value of the FSH testing for infertility. For more information, see the medical test Follicle-Stimulating Hormone. A testosterone test may be used to see whether a problem with the testicles or pituitary gland is preventing a man from being able to father a child. A low amount of testosterone can lead to low sperm counts. For more information, see the medical test Testosterone. Tests for sexually transmitted diseases (STDs) may be done. These may include urine samples or samples from the cervix or urethra.
Man	Semen analysis	A semen analysis checks the number of sperm (sperm count), the number of sperm that look normal, the number of sperm that can move normally, the number of white blood cells in the semen, and how much semen is made. For more information, see the medical test Semen Analysis.
Woman	Post-coital test	The post-coital test checks a woman's cervical mucus after sex to see whether sperm are alive and able to move normally through the mucus. This test must be done the day before or the day of ovulation. Many doctors question the value of the post-coital test to check for infertility. It is not done very often. For more information, see the medical test Post-coital Test.
	Home test	Home LH urine test kits can be used to see when ovulation occurs. Sometimes a woman's basal body temperature (BBT) is also checked at the same time. For more information, see the medical test Fertility Awareness.

What if the first tests do not find a cause?

If the first tests do not find a cause for infertility, the woman may have one or more of the following tests.

Tests for women to find the cause of infertility

Test	Description
Pelvic ultrasound	A pelvic ultrasound looks at the size and structure of the uterus and both ovaries. It can also check the condition and size of the ovaries during treatment for infertility. For more information, see the medical test Pelvic Ultrasound.
Hysterosalpingogram	A hysterosalpingogram is an X-ray test that looks at the inside of the uterus and the fallopian tubes. The pictures can show a blockage of the fallopian tubes that would prevent an egg from reaching the uterus or prevent sperm from moving into a fallopian tube to join (fertilize) an egg. This test may also see problems on the inside of the uterus that might prevent a fertilized egg from attaching (implanting) to it. For more information, see the medical test Hysterosalpingogram. A sonohysterogram is an ultrasound test that uses a special dye (contrast material) to look at the female reproductive organs.
Endometrial biopsy	An endometrial biopsy is done to take out a small piece of the uterine lining (endometrium) to see whether the lining has normal changes during the menstrual cycle. For more information, see the medical test Endometrial Biopsy.
Laparoscopy	Laparoscopy is a procedure to look at a woman's pelvic organs (uterus, fallopian tubes, and ovaries) using a thin, lighted scope that is put through a small cut (incision) in the belly. This procedure is used to find cysts, scar tissue (adhesions), fibroids, and infections that can affect fertility. Laparoscopy can also be used to treat conditions, such as endometriosis. Laparoscopy is usually done with general anesthesia. For more information, see the medical test Laparoscopy.

What other tests may be done?

If a hysterosalpingogram, laparoscopy, or endometrial biopsy does not find a reason for your infertility, or if your infertility treatment has been unsuccessful, one or more of the following tests are sometimes used.

Other tests to find the cause of infertility

Who	Test name	Description
Both	Antibody blood tests	Antibody blood tests may be done to find antisperm antibodies in blood, semen, or vaginal fluids. Doctors question the value of antibody tests for finding the cause of infertility. For more information, see the medical test Antisperm Antibody Test.
	Karyotype (chromosome analysis) or genetic test	Karyotyping is a blood test that looks for problems in the genetic material (chromosomes) in your cells. Some genetic problems make it hard to become pregnant. For more information, see the medical test Karyotype Test. Genetic tests may be done to help find the cause of infertility. For more information, see the medical test Genetic Test.
Man	Ultrasound	Ultrasound uses sound waves to make a picture of structures inside the body. It may be done to see whether a problem in the testicles is causing a problem with the sperm. For more information, see the medical test Testicular Ultrasound.
	Testicular biopsy	In rare cases, a testicular biopsy may be done to check the sperm in the man's testicles. For more information, see the medical test Testicular Biopsy.
Woman	Hysteroscopy	Hysteroscopy is a procedure that looks at the lining of the uterus using a thin, lighted scope that is put through the vagina and cervix into the uterus. Hysteroscopy is used to find problems in the uterine lining. Sometimes your doctor can use small tools during the procedure to take out growths or take samples of tissue (biopsy) or open a blocked fallopian tube. For more information, see the medical test Hysteroscopy.

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Author:	Carrie Henley Jan Nissl, RN, BS	Last Updated August 31, 2006
Medical Review:	Adam Husney, MD - Family Medicine Joy Melnikow, MD, MPH - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology Femi Olatunbosun, MB, FRCSC - Obstetrics, Gynecology and Reproductive Medicine
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