Most cases of infertility can now be understood and a plan for dealing with the situation formulated. When undertaking fertility testing it important that both the female and male partners are tested in order to diagnose the causes of infertility as an infertility issue is almost as likely to be due to the male partner as to the female.
We offer some introductory diagnostic packages with the aim of saving you time and money and as a way of guiding you through the plethora of diagnostic tests now available. So what fertility tests should I have?
Female Fertility Testing
These are performed by our doctors using a transvaginal ultrasound probe which produces an image of the physiology the doctor needs to check. They have to be performed at a certain time in a woman’s menstrual cycle unless she is not having regular cycles, in which case they can usually be done at any time. Most people prefer to schedule these scans immediately prior to a consultation. That way one less visit is required and the doctor who performs the scan can immediately follow on with a full consultation which will include the implications from the scan.
This is a tubal patency test carried out under 3D ultrasound. It shows whether or not a woman’s fallopian tubes are clear for the egg and sperms to meet, and to transport her embryo to her womb. This is crucial if the proposed treatment is ovulation induction or artificial insemination. However, in IVF and ICSI the eggs are removed directly from the ovaries so if these are the planned treatments there is usually no point in having a HyCoSy first.
These check for physical anomalies in the uterus. Newly-formed embryos tumble along the fallopian tubes and land on the walls of the uterus where they implant. If there are any physical impairments such as scarring, fibroids or polyps where the embryo tries to implant, the doctor will need good information from the scan to assess whether these can be ignored or whether surgery is required to improve the chances of a successful pregnancy.
These can also be undertaken in 3D. These are used to assess a woman’s ovarian reserve by counting the small follicles produced each month. This scan gives a woman valuable information about her chances of success with any treatment as influenced by her ovarian age. If she is younger the test can, as interpreted by a doctor, suggest to a woman that she has some time yet before her natural fertility starts to decline.
Blood test results, particularly AMH, can also give valuable information about hormone levels and how they reflect ovarian age and the reproductive cycle. They are also useful if the woman has a known medical condition where her blood test levels are likely to affect her fertility.
Male Fertility Testing
The main fertility test for men is the semen analysis. Embryologists perform these and check various factors including count, motility and morphology. Sperm quality can vary over time and it is sometimes useful to repeat the semen analysis. However, as sperms take 3 months to form, it is best to leave this long between tests.
Other investigations for men include blood tests. Whilst age does not affect men nearly as much as women, there are still certain hormonal conditions that can be diagnosed by blood testing and, as with women, known medical conditions can make it sensible to check certain blood test levels.
Some people ask about Sperm DNA fragmentation but we suggest that it is not often a factor and you should not worry about this unless a fertility doctor recommends it. Despite suggestions that sperm DNA fragmentation could be a marker of sperm quality and predictor of fertility treatment outcome, this has not generally been supported by the evidence so far.