Most fertility experts recommend that young, healthy couples engage in unprotected intercourse for one year before seeking testing; women aged 35 and over should have unprotected sex for 18-24 months typically, unless factors have already been identified that are preventing them from conceiving naturally.
The first step is a basic physical, including a pelvic exam to identify possible abnormalities or below normal hormone levels. You should be prepared to answer questions concerning puberty and sexual development, menstrual irregularities, and sexual history.
Additionally, your doctor should ask you about any serious illnesses and surgical procedures you have had, medications you take or have taken in the past, and any exposure to environmental hazards, including alcohol, cigarettes, recreational drugs, radiation, steroids, pesticides and other chemicals, including chemotherapy, to which you may have been exposed.
Some fertility tests a doctor might suggest for the woman include:
- Hormone Testing—these blood and urine tests are designed to essentially determine whether or not you’re actually ovulating, that is, releasing eggs. Some tests can be performed at home with an over the counter ovulation prediction kit that you can purchase at your local pharmacy. Doctors will perform tests that check lutropin levels, a luteinizing hormone (LH) that surges as you approach ovulation or, alternatively, progesterone levels, a hormone released after you ovulate. Tests may be performed several times during a woman’s menstrual cycle in order to more effectively track surging and declining levels of hormones. Your doctor may also test your blood for FSH (follicle-stimulating hormone) and prolactin levels. The at-home kits test LH and FSH levels.
- Ovarian reserve testing—these blood and imaging tests are often performed on women having difficulty conceiving whose egg levels may have declined, either due to age, smoking or autoimmune disease. Blood tests check estrogen levels and other indicators, while ultrasounds reveal follicle count and ovarian volume.
- Genetic testing—blood tests may be performed if your doctor suspects that chromosome or genetic abnormalities may be preventing you from becoming pregnant. If a genetic defect is shown to exist, your doctor may recommend genetic counseling to discuss the pros and cons of transferring such a genetic abnormality to your child and whether such transmission can be prevented.
- Hysterosalpingography—this is an x-ray procedure that examines the uterus and verifies there are no blockages that are preventing pregnancy. The test takes place with you lying on your back beneath an overhead x-ray machine with your feet in stirrups, the same as for any basic gynecological exam. A thin tube is placed into the cervix through which a contrast (dye) is flushed, filling the uterus and fallopian tubes. (The dye highlights in the x-ray whether any blockages exist to prevent the dye from passing through as it should. Typically, this test is scheduled at the end or just after your period to ensure you are not, in fact, already pregnant and to limit risk of infection. You may also be prescribed antibiotics to take beforehand as a precaution. In some cases, the test itself has improved fertility by flushing out the fallopian tubes.
- Hysteroscopy—this involves a small tube with a light source at the end inserted through the cervix and up into the uterus to permit the doctor to view the uterine lining and fallopian tube entrance. Air or liquid is injected into the uterus to expand it, permitting the doctor to see inside. This procedure is typically done on women whose uterus is suspected to be abnormal based on previous tests such as ultrasound and hysterosalpingogram, and is typically performed in a doctor’s office without need of sedation or anesthesia.
- Pelvic ultrasound—performed vaginally, the ultrasound probe is inserted without need of anesthesia or sedation. This provides a clearer picture than from ultrasounds performed through the abdomen. The size and shape of the uterus can be measured, and the ovaries and fallopian tubes can be examined for signs of abnormalities, such as cysts or fibroid (benign) tumors.
- Laparoscopy—this is an outpatient surgical procedure, performed under general anesthesia, where the doctor inserts a surgical, illuminated scope just below the navel to view the uterus, fallopian tubes and ovaries, searching for signs of any irregularities, including scarring, blockages and signs of endometriosis. Laparoscopy as an infertility test is expensive, invasive and considered by some to be controversial. It should not be undertaken casually, unless the woman has been diagnosed with endometriosis, a history of pelvic inflammatory disease (PID), pelvic surgery, chronic pelvic pain or has experienced ectopic pregnancy.