Fertility issues are a very common problem, affecting around 1 in 7 couples who are trying to have a baby (1). If you are struggling with your fertility, it may be a good idea to ask your doctor for some tests to try and find out why you’ve been unable to conceive. Read on to find out some on the most common fertility tests you may be referred for.
When Should You Have a Fertility Test?
Guidelines recommend that women under the age of 36 should have initial fertility tests done after one year of trying, whilst those aged 36 and older should get a check-up after 6 months (2). However, there’s nothing to say you can’t have some fertility tests earlier if you don’t want to wait that long. There aren’t currently any guidelines that take male age into consideration.
Semen Analysis
Many people incorrectly view infertility as an issue that only impacts women, however, it affects men and women equally (3). A semen analysis is a straightforward way to get an idea of a man’s reproductive potential and is often one of the first tests recommended during fertility investigations. A semen analysis looks at key aspects of a semen sample, including (2):
· Volume
· pH
· Sperm count (concentration)
· The number of swimming sperm (motility)
· The number of normally shaped sperm (morphology)
Many labs will determine whether a semen sample is normal based on values provided by the World Health Organization (WHO), which you can see in the table below (4). If your partner’s results fall below the lower threshold, your doctor may ask that he repeat the analysis to confirm the diagnosis. If the result is confirmed, your doctor will recommend suitable next steps such as further testing (e.g., hormone profiling), lifestyle changes (e.g., diet improvements), referral to a male fertility expert (a urologist), or fertility treatment.
Parameter | Lower Normal Reference value (5th Centile) |
Semen Volume (ml) | 1.4 |
Semen pH | 7.2 |
Total Sperm Number (10^6 per ejaculate) | 39 |
Sperm Concentration (10^6 per ml) | 16 |
Total Motility (%) | 42 |
Progressive Motility (%) | 30 |
Normal Forms (%) | 4 |
Source: World Health Organization (2021)
Ovarian Reserve Tests
The term ‘ovarian reserve’ refers to the number of eggs a woman has in her ovaries. Ovarian reserve assessments are often one of the first fertility tests performed, as a low number of eggs can make conceiving more challenging. There are many tests that can check a woman’s ovarian reserve, with some of the most common shown in the table below (2). Your doctor may recommend one or a combination of these tests.
Ovarian Reserve Test | What is it? | When is it measured? | How is it tested? | What result suggests a low ovarian reserve? | What result suggests a normal ovarian reserve? |
Antral Follicle Count (AFC) | A physical count of the number of follicles in the ovaries. | Day 2-5 of the menstrual cycle. | Internal ultrasound scan | ≤ 4 | > 16 |
Anti-Müllerian Hormone (AMH) | A hormone released by the follicles in the ovaries. | Any day of the menstrual cycle. | Blood test. | ≤5.4 pmol/l | ≥ 25.0 pmol/l |
Follicle Stimulating Hormone (FSH) | A hormone that encourages the eggs to develop. | Day 3 of the menstrual cycle. | Blood test. | > 8.9 IU/l | < 4.0 IU/I |
Please note: the lab values are indicative and could differ depending on the lab
Ovarian reserve decreases with age as women do not create any new eggs after birth. This means that typically, older women have lower ovarian reserves than younger women. However, this is not always the case. Some young women have a low or ‘diminished’ ovarian reserve, and around 1% of women under the age of 40 have primary ovarian insufficiency (POI) (5). POI is sometimes referred to as early menopause as it is often associated with absent periods. Unlike the menopause, some women with POI can get pregnant using their own eggs (6). If you are diagnosed with a low ovarian reserve or POI, you may be recommended fertility treatment to help you conceive.
A high ovarian reserve may be completely normal or could indicate a woman has polycystic ovary syndrome (PCOS). This is a hormonal condition that can make conception more difficult by disrupting ovulation and causing an imbalance of fertility hormones. If you are diagnosed with PCOS, your doctor may recommend lifestyle or medical interventions to help you become pregnant, with referral for fertility treatment if these techniques aren’t successful.
It's important to note that ovarian reserve tests can’t tell you anything about the genetic health of your eggs, which is essential for creating a healthy pregnancy. Unfortunately, there are currently no tests available that can check your egg’s genetic health, though we do know that this will decrease with age. This is good news if you are a younger woman with a low ovarian reserve, as research suggests you may still be able to produce genetically healthy eggs and embryos (7).
Ovulation Testing
Your doctor will likely want to check that you are ovulating each month as this is essential for creating a pregnancy (2). This is tested by monitoring the amount of the hormone progesterone in your body towards the end of your menstrual cycle. A high progesterone level will suggest that you have ovulated, whilst a low level suggests you have not. If it is found that you are not ovulating, your doctor may recommend additional tests to try and find a cause and might prescribe medications to help you ovulate.
Fallopian Tube Patency Tests
Blocked fallopian tubes are thought to affect around 20% of women who have never been pregnant (8). If your medical history suggests it would be beneficial, your doctor may recommend a tubal patency (openness) test to check for obstructions along your fallopian tubes. The fallopian tubes act as the site of fertilisation and early embryo development, so any blockages could stop the egg and sperm from meeting and increase the chance of an ectopic pregnancy. An ectopic pregnancy is a pregnancy where an embryo implants outside of the uterus. This type of pregnancy is sadly not viable and can become life threatening if not treated quickly. The patency of the fallopian tubes is typically assessed using one of the following two methods (9):
Hysterosalpingogram (HSG): A specialist dye is inserted into the fallopian tubes and an X-ray is used to check for any obstructions.
Hysterosalpingo-contrast-sonography (HyCoSy): A specialist dye is inserted into the fallopian tubes and an ultrasound scan is used to check for obstructions.
If a blockage is found along your fallopian tubes, you may be able to have an operation to re-open your tubes, or you might be recommended fertility treatment to help you conceive.
Uterus Health Tests
If clinically indicated, your doctor may want to take a close look at the inside of your uterus using a camera during a procedure called a hysteroscopy (2). A healthy uterus is essential for achieving a successful pregnancy, as it is the site where the embryo will implant and develop into a baby. Large growths inside the uterus, such as fibroids, can make implantation more difficult and may increase the risk of miscarriage (10). If any abnormal growths are found, your doctor may recommend having them surgically removed.
Additional Hormone and Infection Testing
Hormones that can influence fertility include thyroid-stimulating hormone (TSH) and prolactin (2). If clinically indicated, your doctor may wish to check your levels of these hormones to see if they are out of balance. If the levels are found to be abnormal, further testing may be required to determine the cause and your doctor may also prescribe you medications to return the hormones to normal concentrations.
Your doctor may also ask to perform a sexual health screening for you and your partner, as fertility issues can be caused by an underlying sexually transmitted infection (STI) like chlamydia or gonorrhoea. Often, people with these conditions will not have any symptoms so may not even know they are infected. If you test positive for an STI, it may be treatable with a course of antibiotics, though some can have long-lasting effects on fertility.
Making Sense of Your Fertility Data
Once you start having fertility tests, you can soon end up with a large collection of lab reports and doctors’ notes. It can be tricky keeping tabs on all this information and if you’re anything like us, you’ll want somewhere easy and convenient to input and track your fertility data. That’s where Rainbow Data comes in!
Our innovative technology allows you and your doctor to monitor your fertility data to see how it’s changing over time. We combine the information from your test results with your period and medication data to provide a custom algorithm that can help predict when you’re likely to be ovulating.
Rainbow Data is now available for free for iOS in the app store, so what are you waiting for? Download today to make sense of your fertility data!
References
(1) NHS (2020) ‘Infertility’. Available at: https://www.nhs.uk/conditions/infertility/
(2) NICE (2017) ‘Fertility problems: assessment and treatment’. Clinical guideline [CG156]. Available at: https://www.nice.org.uk/guidance/cg156
(3) NIH (2021) ‘How common is male infertility, and what are its causes?’ Available at: https://www.nichd.nih.gov/health/topics/menshealth/conditioninfo/infertility
(4) WHO (2021) ‘WHO laboratory manual for the examination and processing of human semen’ 6th Edition. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.
(5) Chon, S. J., Umair, Z., and Y, M-S. (2021) ‘Premature Ovarian Insufficiency: Past, Present, and Future’ Frontiers in Cell and Developmental Biology, volume 9. DOI: 10.3389/fcell.2021.672890.
(6) ACOG (2021) ‘Primary Ovarian Insufficiency in Adolescents and Young Women’ Committee Opinion. Available at: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/07/primary-ovarian-insufficiency-in-adolescents-and-young-women
(7) Fouks, Y. et al (2022) ‘A diagnosis of diminished ovarian reserve does not impact embryo aneuploidy or live birth rates compared to patients with normal ovarian reserve’ Fertility and Sterility, DOI: https://doi.org/10.1016/j.fertnstert.2022.06.008.
(8) Al Subhi, T. et al (2013) ‘Prevalence of tubal obstruction in the hysterosalpingogram of women with primary and secondary infertility’, Journal of Reproduction and Infertility, 14 (4), pp. 214-6.
(9) Grigovich, M. et al (2021) ‘Evaluating Fallopian Tube Patency: What the Radiologist Needs to Know’, RadioGraphics, 41 (6), pp. 1876-18961.
(10) NHS (2018) ‘Fibroids’. Available at: https://www.nhs.uk/conditions/fibroids/
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