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Fertility Test - What It Includes And When To Do It

Fertility Test - What It Includes And When To Do It

Fertility tests are an essential step in your pregnancy journey. If you and your partner have been trying to conceive for a while or would like to get an idea of your fertility window, it’s recommended that you take the leap and do a fertility test. It’s always best to know sooner than later if there are any areas of concern when it comes to your fertility.

Is It Time You Did A Fertility Test?

My VMC says that infertility happens to 8% of couples. Despite the low rate, your fertility levels can be a large contributing factor for your problems to conceive. Low fertility or even infertility can be present in both men and women.

If you and your partner are struggling to conceive, you both should take fertility tests in order to determine what’s happening in your reproductive system.

While pregnancy is something that happens inside the woman’s body, conception takes both of you! Statistics show that ⅓ of infertility cases are due to infertility in the woman, ⅓ is due to male infertility and the other third is made up of combined or unknown fertility issues.

Your gynaecologist will be able to do some basic testing or you may be referred to a fertility specialist. Your doctor will then take you through a series of tests to establish what’s hindering your chances of conceiving.

1. When to Take a Fertility Test

It’s never too early to take a fertility test. The sooner you know, the easier it will be to diagnose any issues and treat your fertility accordingly.

While the Royal College of Obstetricians and Gynaecologists explains that women are most fertile when they are between 20 to 35 years old. Women shouldn’t feel pressured to jump into pregnancy before they’re ready just because of the biological clock.

Taking a fertility test will give you a better understanding of your fertility window. Taking a fertility test will help you keep track of your reproductive health.

Whether you are still unsure if you want children, or want children but are simply not in the right place in life a fertility test will give you a realistic timeline. It can tell you whether the decision to have children is something you can continue to delay, or whether you may need to consider your options more urgently.

However, for women, fertility tests can only determine how many eggs are available and not the quality eggs. For this reason, there is some debate around the need of taking a fertility test. Some doctors, like Dr Raj Mathur, suggest that “There’s no evidence that women need to take any fertility test unless they are having trouble conceiving”.

The timing of taking a fertility test largely depends on your preferences and needs. It’s recommended that you take the test earlier than later. Taking a fertility test earlier in your 20s will help your doctor give you an informed timeline of fertility. Luckily, there are many fertility tests for both women and men to take.

2. Before Taking the Test: Your History

Before your doctor performs a fertility test, they will go through your background and family history. For both men and women, you will need to describe your lifestyle choices, sexual practices, discuss any STD’s, and the history of fertility in your family. Your history can give your doctor a clear picture of any possible issues.

Your doctor may ask you questions about:

  • Your medical history
  • Your medication intake
  • If you smoke, drink, or use illicit drugs
  • If you are in contact with harmful chemicals, toxins or radiation
  • Your sexual intercourse frequency
  • If you have had any problems performing in sex

From there, your doctor will take you through the appropriate physical examination. For women, the physical examination involves a pelvic examination and a pap smear. This will determine if there’s anything sinister lingering in your cervix. For men. A testicular examination will be conducted.

On top of this, your doctor may test for sexually transmitted diseases. This involves blood work, urine samples, cervical samples and urethra samples.

3. Fertility Test: Monitoring Hormone Levels

Your hormone levels can determine if your and your partner’s key fertility-related hormones are normal and balanced. With a simple blood test, your doctor can examine your follicle stimulating hormone (FSH), luteinising hormone (LH), oestrogen, progesterone, prolactin, testosterone and thyroid stimulating hormone (TSH).

Further testing may be ordered for women. These blood tests are often taken every day over 10 days to see that their hormones are changing appropriately with ovulation. Unfortunately, blood tests won’t confirm when the egg is released or the quality of the egg. It does, however, confirm that your hormones are functionally normally.

4. Fertility Test: Examining the Pelvis

Pelvic examines may not be new to a women’s gynaecological visit. However, the male partner can have the pelvis examined too for fertility testing.

For women, the ultrasound can be conducted trans-abdominally or trans-vaginally. This type of fertility test checks for pelvic inflammatory diseases. Your doctor will also be able to examine your womb’s size and shape to see if it’s healthy.

The ovaries are checked too in order to see if there are any cysts on them and if they have a healthy amount of eggs. Any issues on the endometrium will be picked up as well.

The pelvic exam is a quick and easy way to determine if you have any fertility-related diseases. Diseases like endometriosis and Polycystic Ovarian Syndrome are key players when it comes to infertility.

During a pelvic exam, your doctor may want to take an endometrial biopsy. It’s mostly a quick and easy process that involves removing a sample of the uterine tissue. This sample will be sent for testing to see if there’s any sinister in the uterine tissue and if the hormones are stimulating the lining effectively.

For men, your doctor will do perform the pelvic ultrasound trans-abdominally and trans-rectally. This will check the condition of the prostate gland and the seminal vesicles.

5. Fertility Test: Hysterosalpingogram (HSG) or Tubogram for Women

This type of fertility test is suited for women as it examines the inside of the womb and fallopian tubes. By using an X-ray, your doctor will check for any blockages in the fallopian tubes or any concerns in the uterine lining. The test is generally taken as soon as your menstrual period has finished.

To take the test, you will usually have to go to a radiology clinic. A dye solution will be injected into your uterine cavity so that your doctor can pick up where the blockages or problems are. After the procedure, you may need to wear a sanitary pad. Some spotting and mild cramping may occur.

6. Fertility Test: Hysterosonogram for Women

This fertility test is a less invasive procedure that can be compared to a hysteroscopy procedure. In most hysteroscopy cases, you might be put under anaesthesia whereas a hysterosonogram can be done without.

A hysterosonogram is a trans-vaginal procedure that looks inside the womb by inserting a small plastic tube through the vagina.

By looking into the womb, your doctor can see if there are any growths, blockages or cysts that may be hindering your fertility. Luckily, this only takes a few minutes and is not usually painful. Some mild cramping may be experienced.

It’s best to do this test between the end of your period and before ovulation. This is called the Follicular Phase. During this phase, your uterine lining has yet started to swell with blood vessels which makes it easier to navigate.

7. Fertility Test: Laparoscopy for Women

While most fertility tests are not too invasive, your doctor may need to conduct a laparoscopy to seek further information. Laparoscopy is often turned to as a last resort. Your doctor will usually take you through the other, less invasive tests first.

Laparoscopic surgery usually requires a day in the hospital. The aim of the surgery is to see if there are any growths or signs of endometriosis that can’t be picked up on scans. A small incision is made in the abdomen for the laparoscope to pass through the incision.

The laparoscopy is similar to a telescope and examines the ovaries, fallopian tubes and womb.

Once the procedure is done, you may feel some pain and discomfort. You may even experience a few days of spotting or bleeding.

8. Fertility Test: Fertility MOT

If you’re looking for an accurate and non-invasive fertility test then the fertility MOT might be best. The aim of the female Fertility MOT is to provide an accurate assessment of your remaining egg reserve which provides crucial information about your biological clock and the ability of your ovaries to ripen eggs.

Ultrasound technology allows doctors to examine the ovaries and identify follicles - the egg sacs containing immature eggs. The greater the number of follicles, the greater number of eggs remain.

By using a colour Doppler during the ultrasound scan the doctor can measure blood flow to individual follicles and to the ovaries, which allows for an assessment of reproductive health as better blood flow to follicles is a marker for better quality eggs.

By also looking at the number and size of follicles in the ovaries, the doctor will be able to assess how your body might react to stimulatory drugs and whether you may be at risk of Ovarian Hyperstimulation Syndrome (OHSS) during fertility treatment.

A full assessment of the uterus is also carried out including an analysis of blood flow to the uterus and lining of the womb, as this can affect the likelihood of embryo implantation and ongoing survival.

If blood flow to your uterus and womb lining is good then this suggests that you may be more likely to implant embryos and less likely to miscarry.

The scan will identify conditions such as Polycystic Ovary Syndrome (PCOS) and endometriosis and also highlights polyps, fibroids or any other factors that can affect implantation and may cause miscarriage.

Using such a non-invasive scanning method ultimately reduces the need for a hysteroscopy for diagnosis – a much more invasive procedure.

The process takes around 20 to 30 minutes. You can also have this fertility test done at any stage in your menstrual cycle.

9. Fertility Test: Semen Analysis

For men, the fertility testing process can be less invasive than the tests women go through. One of the main ways to determine a man’s fertility is through a semen analysis or sperm count.

For a fertility test to be conducted, semen will have to be collected from the male after several days of ejaculation abstinence. Semen samples can vary and be affected by environmental factors so two or three samples may be requested over a few months to get a consistent result.

To test the semen, your doctor with examine the quality and quantity of the sperm. The total volume, amount of sperm, the concentration of them, the shape of the sperm, the sperm’s movement and the pH levels of the semen will be examined.

The samples are usually tested within three hours. Your results will follow quickly after.

10. After the Tests

After going through the fertility tests, you will get a clearer picture of your fertility. Your doctor will sit down with you and talk you through your results. They will be able to tell you if they were able to find any traces of infertility diseases like endometriosis or PCOS.

If there are any infertility concerns, your doctor will recommend the best way forward. Whether it be medication or potential surgery to remove blockages, they will discuss all of the options and risks with you.

Doctors usually recommend that if there are concerns about your fertility that you should try earlier in your reproductive years than later. For women, most doctors will recommend trying for a baby before they’re 26.

 

An important thing to consider with fertility testing is to remember that the results aren’t entirely conclusive. Even though your sperm count is low or you have a low ovarian reserve, there is still a chance for you to conceive.

Likewise for high sperm counts and ovarian reserves, just because you have tested for higher fertility does not mean that you will be able to conceive.

Article By

Dr Beverley (MBChB, MRCGP) is a qualified GP. She works in a GP practice in Manchester and also helps in the out of hours GP service. She has experience in both obstetrics & gynaecology and paediatrics and has three children of her own.

to read more articles by Dr Beverley Sanders

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