If they’re struggling to conceive, couples might need fertility tests from an OB-GYN or reproductive endocrinologist. Here’s what to expect for male fertility tests and female fertility tests.

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Couple at Fertility Doctor
Credit: Photographee.eu/Shutterstock

For some couples, getting pregnant proves elusive. In fact, one in eight couples suffer from infertility, or the inability to conceive after a year of having regular, unprotected sex (or six months for women over 35), according to Amy Schutt, M.D., a reproductive endocrinologist at the Family Fertility Center at Texas Children’s Pavilion for Women. 

Female infertility has a wide range of causes, including advanced maternal age, fallopian tube blockage, endometriosis, ovulation disorders like polycystic ovary syndrome (PCOS), and more. Male infertility, on the other hand, usually stems from an issue with sperm production or motility.

Couples struggling to conceive should visit an OB-GYN or reproductive endocrinologist (fertility specialist) for an evaluation. Fertility tests for men and women may be used to determine your level of fertility and to detect potential problems.

Here’s what you need to know about common fertility tests. Remember, however, that your doctor will schedule fertility tests based on your own situation and medical history; therefore, you may not require all of these tests, and they may be done in a different order. 

Medical History Evaluation

Both male fertility tests and female fertility tests often begin with an interview. While talking about your medical history, your doctor will ask about conditions that have a bearing on fertility, such as a hormonal imbalance, diabetes, sexually transmitted diseases, and thyroid disease. He/she will need full transparency about any medication that you've taken or are currently taking. Other questions may concern your sex life, such as timing and frequency of intercourse, and the reproductive histories of your parents and siblings.

Physical Exam 

Both partners will be asked to undergo a general physical exam, including a gynecological check-up for the woman.

Semen Analysis and Culture

This step only comes up in a fertility test for men. Low sperm count or poor sperm quality is the culprit in roughly 30 to 40 percent of infertility cases, so doctors usually recommend an analysis of the man's semen. To do the fertility test, a man collects his ejaculate in a sterile container. The sample is then analyzed to determine whether an adequate number of sperm is present, and whether the shape, appearance, and motility (activity level) of the sperm are normal. The seminal fluid will also be cultured to check for infection.

Hormone Screening

In this fertility test for women, her blood and/or urine will be tested to check the levels of various hormones necessary for ovulation and implantation. Blood and urine may need to be sampled several times throughout the menstrual cycle to check that each hormone is present at an adequate level at the proper point in time.

Intrauterine Ultrasound Exam

This painless female fertility test uses sound waves to examine the body's interior. During the exam, a wand-shaped transducer is inserted into the vaginal opening. The sound waves sent out and collected by the transducer are then converted into images that appear on a nearby monitor. Ultrasound gives the practitioner information about the ovaries, uterus, and the follicles that hold eggs prior to ovulation. Fibroid tumors and ovarian cysts can often be detected with ultrasound.

Cervical Mucus Test

The most common cervical mucus test is the post-coital test, in which a bit of the woman's cervical mucus is sampled and examined several hours after the couple has intercourse. This test reveals whether the sperm can survive in the woman's body and move freely toward the egg. Cervical mucus exams should be conducted just prior to ovulation, the point in the woman's cycle when the mucus is most receptive to her partner's sperm. To time ovulation, most doctors will ask the patient to use an ovulation prediction kit, such as Clearblue Fertility Monitor Test Sticks.

Evaluation of Reproductive Organs

The doctor may need to perform one or more of the following procedures to evaluate the woman's uterus, fallopian tubes, or ovaries:

  • Hysterosalpingogram (HSG):  An X-ray procedure in which a special dye is injected through the cervix into the fallopian tubes to reveal: 1) whether the passages are open or blocked, and 2) whether structural abnormalities exist. Most women report cramping and some discomfort during this procedure; ask your doctor about taking pain relief medication, such as ibuprofen, beforehand.
  • Endometrial Biopsy: This fertility test sees if the woman has a hormonal imbalance that prevents her from sustaining a pregnancy. It involves inserting a catheter through the cervix into the uterus, then collecting a bit of tissue from the uterine lining (this may cause mild pain or cramping, similar to menstrual cramps). Doctors then analyze tissue in a lab.
  • Laparoscopy: In this surgical procedure, a narrow fiber optic telescope is inserted through a tiny incision in the woman's abdomen. The telescope allows the doctor to examine the uterus, fallopian tubes, and ovaries and to look for evidence of endometriosis or pelvic adhesions—two conditions that can impair fertility. The test is done under local, regional, or general anesthesia, and it can require up to several days postoperative rest and recovery.

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