How Does A Doctor Test For Infertility In Women?

fertility testing
How Is Female Fertility Tested?

Fertility testing in women is more complicated than in men because hormone levels can fluctuate during the menstrual cycle making a diagnosis more difficult. There are 3 possible levels of tests to determine the causes of infertility. Some women may only need to undergo testing at the first level, whereas others may need to undergo all 3 before a doctor can reach a conclusion.

Level 1 Tests: Doctor Tests
Your doctor will start with some simple blood tests (known as baseline blood tests). These tests are used to measure hormone levels and can be carried out in your doctor’s office and sent to a lab for testing. The first test is taken on days 1-3 of your menstrual cycle. It gives an idea of the quality of your eggs as well as how many you have. A woman is born with all the eggs she will ever have. As she ages the amount of eggs she has slowly declines (referred to as her ovarian reserve). This is why pregnancy after 35 is more difficult. By the time a woman reaches menopause she has long run out of fertilizable eggs in her ovaries. Technicians will be checking the blood for FSH levels (follicle stimulating hormones): women approaching perimenopause have higher levels (which is why FSH levels are also checked in menopause testing). They will also check LH levels (luteinizing hormones) because high levels indicates polycystic ovary syndrome (PCOS). Another blood test will be performed on days 21-28 of your cycle to check levels of progesterone. This will indicate if you are ovulating or not. You may also undergo a cervical mucus test and an ultrasound scan to check the size and shape of your ovaries and womb. These are explained in more detail in our article on fertility tests.

Level 2 Tests: Clinic Tests
If all your hormones appear normal in the first level of tests, it indicates you are fertile but something else is stopping you from conceiving. The next step will be to check for blockages in the fallopian tube that could prevent the egg reaching the sperm. You will be referred to a specialist clinic by your doctor for these tests. A HSG (hysterosalpingogram) will be performed, where a small tube is inserted into the cervix and a dye squirted through it. An X-ray will be used to follow the progress of the dye. If it stops in any of your tubes this indicates a blockage. If blockages are found, minor surgery can be performed to correct it. If doctors discover uterine fibroids, a fibroids treatment plan will be recommended. Or, if the issue is endometriosis, a plan for endometriosis treatment will be discussed. Other possible diagnostic procedures you may be offered include a sonohysterogram, laparoscopy or hysteroscopy.

Level 3 Tests
After undergoing all these tests, 20 percent of couples will still be told that they have 'unexplained infertility problems'. For these couples, if invasive tests and surgery have failed, the next stage is level 3 testing. This stage may also be recommended if you have a history of miscarriage - or you have good embryos that fail to implant with IVF treatment. It involves further blood tests to screen your immune system (our natural defense system which fights disease and infections). Certain reactions by the immune system may result in the body rejecting a fertilized embryo (although this is debatable). If doctors discover the presence of certain cells in the body they try to correct the balance so that you can carry a baby to full-term. While your doctor could take your blood samples, most women choose to attend a specialist fertility clinic for the full process (testing and treatment). Immunological screening, as it is referred to, is expensive, complex and requires repeat testing even when you eventually fall pregnant.

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• Got another question? See: Womens Health Questions and Guide To Infertility

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