Fertility Tests for Women & Men: How They Work & What to Expect

If you’re trying to become pregnant without success, you’re not alone. An estimated 11% of women and 9% of men in the United States have had issues with infertility, according to the National Institute of Child Health and Human Development.

One option is to consider fertility testing, which is available for both women and men. This overview will discuss your testing choices, how they work and what you can expect.

Fertility tests for women

Ovulation tests

Ovulation occurs as part of the monthly menstrual cycle when an ovary releases an egg into the fallopian tube for fertilization. The Women & Infants Fertility Center says that ovulation fertility tests check for ovulation issues like blocked fallopian tubes or an abnormally shaped uterus. These tests include blood (hormone) tests and ultrasound or other imaging.

“Generally, the important things to confirm is that a woman is ovulating and [if there is] any anatomical abnormality with either her uterus or fallopian tubes,” explained Dr. Bryan Hecht, division director of reproductive endocrinology at MetroHealth Medical Center in Cleveland.

“So, typically an ultrasound of the pelvis supplemented by a test of her fallopian tube patency [condition], traditionally an X-ray called a hysterosalpingogram or sometimes testing with ultrasound and saline as an alternative to a conventional X-ray test of the fallopian tubes [is done],” he said.

It’s common, Hecht said, to test blood progesterone levels about a week before menstruation begins. Progesterone hormone levels normally rise after ovulation, according to Medline Plus, which causes the uterine lining to thicken so the fertilized egg can attach to it. Low progesterone levels after ovulation could mean the egg can’t attach and grow into a baby.

Treatment options for ovulation issues include in vitro fertilization and surgery, Hecht said. The National Infertility Association notes that low progesterone treatment options include different forms of progesterone supplementation.

Ovarian tests

Ovarian reserve testing is the main type of ovarian fertility test.

“Ovarian reserve testing is looking for a potential decline in egg quality or egg quantity, often due to a woman's advancing age, but sometimes due to other factors,” Hecht said.

It includes the following blood hormone tests:

• AMH (anti-Müllerian)
• FSH (follicle-stimulating hormone)
• Estrogen

If these tests determine that you have diminished ovarian reserve (DOR), treatment options include fertility preservation; ovarian superovulation, in which hormones are injected to stimulate release of multiple eggs, which are then collected; and donor eggs combined with in vitro fertilization, according to the Women & Infant’s Fertility Center.

Male fertility tests

For men, fertility tests focus on sperm evaluation and reproductive tract functioning, said Dr. Rebecca Flyckt, medical director of University Hospitals Fertility Center in Beachwood, Ohio.

“Men can undergo semen analysis, physical evaluation of the male reproductive tract and other more specialized testing to understand the quality and function of the sperm,” she said.

Semen analysis

“A semen analysis can tell us about the number, movement and physical attributes of the sperm as well as other factors like inflammation and/or infection that can impair sperm quality or function,” Flyckt said.

The sample is typically collected at a doctor’s office and sent to a lab for analysis, according to University Hospitals. You will ejaculate into a sterile container, and the results will include sperm count, volume, size, shape, motility (travel ability) and pH (acidity) level.

Assay test

A semen sample may also be used to check how well your sperm can fertilize an egg. The most accurate way to do this is by using a sperm penetration assay test, according to University of Utah Health. Results of less than 50% penetration could indicate issues with your sperm’s size, shape, motility or other attributes.

Vasography and ultrasound imaging

Imaging tests are used to find physical blockages that may be stopping sperm from traveling along the male reproductive channels. The University of California, San Francisco, says these tests can include:

• Vasography, an X-ray of the vas deferens
• Ultrasound, which can take pictures along the reproductive tract to check for varicose veins and obstructions

At-home fertility tests

The Women & Infants Fertility Center notes there are three common at-home tests:

• Ovulation predictor kits to test the fertile window
• Semen analysis tests to measure sperm count
• FSH fertile tests to measure ovarian reserve

“Although this would not be my first choice, at-home fertility tests may be helpful in identifying certain issues that could cause fertility issues, for example, low egg reserve or low sperm counts,” Flyckt advised.

When to see your doctor about fertility testing

“The guideline is if you're [a female] under 35, a year of unprotected sex; if you're over 35, after six months; and if you're over 40, immediately,” Hecht advised.

Some couples should be seen even sooner, Flyckt noted. “This includes couples where there is a known gynecologic condition (like endometriosis or fibroids) or irregular cycles, as well as known or suspected sperm issues,” she said.

SOURCES: Bryan Hecht, MD, division director of reproductive endocrinology, MetroHealth Medical Center, Cleveland; Rebecca Flyckt, MD, division chief, reproductive endocrinology and infertility, University Hospitals Fertility Center, Beachwood, Ohio

Resources

National Institute of Child Health and Human Development: How common is infertility?

Women & Infants Fertility Center: Fertility Testing & Diagnosis for Women

Women & Infants Fertility Center: Diminished Ovarian Reserve

Women & Infants Fertility Center: Tips on Getting the Most from At-home Fertility Tests

Medline Plus: Progesterone Test

National Infertility Association: Progesterone and Pregnancy: A Vital Connection

University Hospitals: Semen Analysis

University of Utah Health: Male Fertility Tests & Procedures

University of California, San Francisco: Infertility in Men Diagnosis