What Kinds of Tests Can Diagnose Infertility?

Tests Done for Infertility

You’ve been off your birth control for a while and even though you know there’s no magic wand that can get you pregnant overnight (if only!), maybe you thought it would’ve happened by now—and you’re constantly shaking off a nagging feeling that something’s just…off. Should you trust that weird gut instinct? How long is too long to try conceiving on your own? How would you even know if you had a fertility issue in the first place? (Like what exactly is going on in there, anyway?)

It’s totally normal to have questions when you’re in the early days of your #ttc journey—that’s trying to conceive for the newbies. Lucky for you, we have answers to most of them. No, we can’t tell you what to do about that annoying voice in your head, but we can help with pretty much everything else. Here’s how to get started.

When should I call my doctor?

That depends on how old you are. According to Dr. Jane Frederick, reproductive endocrinologist at HRC Fertility, in Orange County, California, the length of time you should try conceiving on your own varies with age. Assuming you’re fairly healthy, this means:

  • If you’re under 35: try for one year before seeking treatment (yes, patience is a virtue, blah, blah, blah).
  • If you’re between the ages of 35-40: try for six months before seeing a doc.
  • If you’re over 40: you should go straight to a specialist because time isn’t exactly on your side—you can’t really afford a “wait and see” approach.

Keep in mind that if you already know you have a medical condition that could affect your pregnancy chances (like PCOS), you don’t have to stick to these guidelines–you can be proactive from the get-go. You may even want to see a specialist instead of your regular OB/GYN.

What tests are done for infertility?

Since male factor infertility happens pretty much as often as female factor (RESOLVE estimates about 30% of the time), your doctor is going to order tests that could diagnose a problem in male and female partners of a heterosexual couple. At this early stage, the testing will give your doctor a good overview of your fertility potential.

Basically, says Dr. Frederick, there are three tests right out of the gate that can screen your eggs, your ovaries, and your sperm for issues:

  1. On day 3 of your menstrual cycle, you’ll have bloodwork to determine egg supply. According to Yale Medicine, the levels of certain hormones—like follicle-stimulating hormone (FSH) and anti-mullerian hormone (AMH)—are associated with egg quality and quantity, and can be screened in your bloodwork. This also gives your doctor a good idea of the window of fertile time she’s working with.
  2. One week later, you may have a hysterosalpingogram (HSG), a simple procedure performed by a radiologist to check the anatomy of your uterus, ovaries, and fallopian tubes. This allows your doctor to see if your tubes are open, and that’s important because blocked fallopian tubes can make natural conception difficult.
  3. Finally, a male semen analysis. Your doctor will look at how many sperm are in the sample, how well they’re moving around, and what they look like (yep, some sperm are better-looking than others).

Your doctor might also want to check your thyroid level, since a low-functioning thyroid can make a successful pregnancy difficult. They’ll likely ask you about your overall diet and nutrition, too, as well as your genetic history, to rule out other health issues that could affect conception.

Dr. Frederick notes that all of these tests can be done within one month’s time, so you don’t have to worry about losing precious conception time diagnosing a potential problem (because you’re stressing enough as it is, right?).

What are the test results going to tell me?

Basically, the testing will tell your doctor what the next steps are. Most doctors (and patients, honestly) prefer what Dr. Frederick calls “low-tech” options over “high-tech” ones. These are the more affordable, less invasive procedures. So if you can get away with something like ovarian stimulation or artificial insemination, that’s usually preferable to jumping straight to in vitro fertilization (IVF).

There are times, however, when your doctor might look at your test results and recommend skipping the line to IVF—do not pass go, do not collect $200. If your bloodwork shows a low egg reserve, if your tubes are super blocked, or if your male partner is suffering from severe male factor infertility, IVF is probably your best option (because you may not get pregnant otherwise). Of course, age is also an exception and may affect how aggressive your treatment might be.

Now, for the slightly more uplifting news: sometimes your doctor will look at your results and offer you some other choices. If you have a solid egg reserve, minor tubal disease that can be corrected surgically, or moderately useable sperm, you might be a candidate for one of those low-tech options.

I want to know about my fertility prospects…but I also don’t want to know.

It can be pretty scary to think about not being able to get pregnant on your own. But a) everything might be fine and b) even if it isn’t, your situation isn’t hopeless. If you’re just boarding the #ttc train, you can probably give it some time before getting a fertility workup.

If you’re older, or you have a pre-existing reproductive issue, or you’ve been trying for a while already, go ahead and start the testing process. It’s not easy having an infertility diagnosis, but it can be even harder not having any answers at all. In the #ttc world, answers mean possible solutions, and that’s always good news.

Sarah Bradley

Sarah Bradley is a freelancer writer from Connecticut, where she lives with her husband and three sons. Her reported features and personal essays in the parenting and women's health spheres have appeared at On Parenting from The Washington Post, Real Simple, Women's Health, Parents, Lifehacker's Offspring, and Romper, among others.