When couples have been struggling to get pregnant over a year and are facing infertility, there are several simple tests and examinations they can go through to try to diagnose the problem. If these initial trials don’t produce results, then a doctor or fertility specialist might recommend further steps to take in additional tests.

If these tests come back normal, doctors may choose to further investigate the cause of these fertility issues by suggesting additional procedures. The following is a brief rundown of tests for infertility that a couple may undergo:

Tests for Infertility in Women

Many tests for infertility measure levels of various hormones important to fertility, including luteinizing hormone (LH), follicle stimulating hormone (FSH), and progesterone. While there are at-home infertility tests that measure LH for tracking ovulation, you will need to give a blood or urine sample for proper laboratory testing when trying to measure hormone levels and their impact on infertility.

HSG

An HSG ( which is short for hysterosalpingogram) is an X-ray of a woman’s uterus and fallopian tubes. It is used to identify potential blockages, anomalies, tumors, or scar tissue that could be causing conceiving issues. Before the X-ray is taken, the uterine cavity is filled with dye. If the fallopian tubes are clear, this dye will pass through them and into the abdominal cavity, which will show up on the X-ray.

If there is a blockage, the radiologist will be able to identify it. The procedure is very quick (around 5 minutes) and pretty painless. She might experience cramping from the insertion of the dye, but capturing the images is easily performed right afterward.

Hysteroscopy

If the HSG shows any issues, the doctor might recommend a hysteroscopy which will involve a tiny camera that is inserted into the uterus, through the cervix. The goal is to closely examine the lining of the uterus (also known as the endometrium) to determine what issues might be present. It can help detect abnormal bleeding or growths that could be preventing pregnancy. This viewing tool also analyzes whether the size and shape of the uterus could be causing infertility issues. Most women who are trying to get pregnant will have this test performed prior to ovulation.

Depending on preference, a doctor has the option to dispense a mild sedative beforehand, or even use anesthesia. Just like a gynecological exam, you will be required to lie on an examination table and a speculum will be used to insert the hysteroscopy. You could experience cramping, but the overall procedure is relatively simple and should take around 30 minutes.

Laparoscopy

Similar to a hysteroscopy, a laparoscopy is another method of viewing a woman’s reproductive organs more closely. Unlike the former procedure, though, a laparoscopy is done under general anesthesia and is a mildly invasive process. It is used to help locate cysts or other growths that could be contributing to infertility. A small incision is made in the belly and a lighted tube is inserted to examine the organs.

In some circumstances, a doctor will want to take a biopsy for further inspection, or may even want to drain cysts or use laser treatments to correct scar tissue damage. Depending on what needs to be done during the procedure, it could take around 30-90 minutes.

Endometrial Biopsy

Depending on the situation, a doctor might decide to take a sample of the uterine lining for testing if he or she believes it might be the cause of conceiving issues. This procedure is called an endometrial biopsy, and is a pretty quick procedure. A woman will need to lie on an examination table, where a speculum is used to help administer numbing medication to the cervix. Once the cervix is numb, a tool is guided into the uterus to collect a sample that will be studied in a lab to determine if the cells are normal. The whole process should take between 5-15 minutes.

Other tests for infertility use different types of imaging to identify the condition of the ovaries, uterus, and other organs. Sonohysterograms and pelvic ultrasounds use sound waves to create an image of the reproductive system. These can reveal masses or scarring in the uterus that can affect fertility.

A hysterosalpingogram is an X-ray test using contrast dye injected into the uterus and Fallopian tubes. It can show problems like blockages in the Fallopian tubes or abnormal structure of the uterus.

Tests for Infertility in Men

The first test of male fertility is generally a semen analysis. A sample of semen is examined for a sperm count as well as sperm motility and morphology — the movement and shape of the sperm. These metrics are the most common factors involved in male infertility.

Hormone Tests

Hormone tests for men generally check on levels of testosterone. Testosterone is closely connected to sperm production and controls the production of LH and FSH in a predictable cycle. In most cases, this is the only hormone test performed on men, but in cases of extremely low sperm count, tests for LH and FSH may also be necessary.

Urine Tests

A urine test may be conducted immediately after ejaculation. If sperm are found in the urine, it can mean that semen is flowing up into the bladder rather than out through the urethra — a condition known as retrograde ejaculation. This can be the result of surgery or even medications for conditions including high blood pressure or depression.

Ultrasound

An ultrasound test can detect abnormalities in the testicles. Masses, swelling, twisting, and other disturbances of the testicles can all impact sperm production and lower fertility. An ultrasound can also be used to guide a testicular biopsy.

Testicular biopsy

In the rare case when semen tests show no sperm but hormone tests come back in the normal range, you may need a testicular biopsy. A small tissue sample from the testicle is sent to a pathologist for examination. If the sample looks normal, it could indicate a blockage in the vas deferens, the tubes that lead from the testicles to the urethra.

As you can see, there are many ways to discover the cause of fertility problems. Consult with your doctor about which tests for infertility may be right for you.

Learn more about male fertility:

Male fertility testing

Male hormones and fertility 

How to improve male fertility

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