How Fertility Testing Works: A Guide for Women and Men

Many people who wish to build their families tend to begin with natural conception, unless they are in a same-sex coupling family structure. In such cases, alternative family building options are used. However, when people have challenges in conceiving, fertility testing is a process that is used to determine causes of infertility. It helps professional healthcare providers with the insight they need to determine options for treatment. 

Fertility testing is useful for both women and men, because both experience challenges with infertility. Even in sam-sex families, one of the partners will contribute either eggs or sperm for conception. With two members of the same sex, should one partner have fertility challenges, the other partner could contribute their eggs or sperm. Regardless, fertility testing can benefit both women and men trying to build their families, regardless of the family structure. 

In this discussion, we shall address how fertility testing works for both women and men. We shall also look at the actual tests that are conducted and what one can expect during such an evaluation, and what happens after fertility testing. It is vital to note that whether one is actively trying to build their family or planning on doing so in future, it does no harm to have fertility testing done early. Early testing is essential for early diagnosis, which helps with better planning around family building. So let us get into it. 

Female Fertility Testing

Female fertility testing involves examining hormonal levels, ovarian reserves and the physical structure and function of the reproductive system. Hormonal levels are tested using a blood test, ovarian reserves and the structure and function of the reproductive system are evaluated using ultrasound tests. 

Blood Tests for Fertility (AMH, FSH, LH, progesterone)

The body releases reproductive hormones from specific sites in the body, and they are distributed throughout the body via the bloodstream. Aside from estrogen, anti-mullerian hormone (AMH) follicle stimulating hormone (FSH), luteinizing hormone (LH), and progesterone levels are key to evaluating fertility in women. 

AMH triggers the early development of antral follicles to begin their development. The levels of AMH provide insight into how many eggs are developing in a particular cycle as well, the approximate number of eggs in reserve. As the ovarian reserve declines, the amount of AMH in the bloodstream declines. 

FSH is the hormone responsible for the growth of antral follicles to maturity. It is also key in reproduction, with lowered levels pointing to infertility or challenges in becoming pregnant. FSH is typically released simultaneously with LH.

LH is the hormone that regulates the menstrual cycle. It primarily triggers ovulation in the menstrual cycle. It also regulates the production of progesterone in the second half of the menstrual cycle. When LH levels are abnormal, it is often indicative of serious issues with the ovaries. 

Progesterone is a hormone that has a variety of functions. Some of its main functions are to regulate menstrual cycles, to prepare the endometrium for the embryo to implant itself, and to support the pregnancy. Low levels of progesterone can lead to complications such as miscarriages and preterm labor.

Ultrasounds and Antral Follicle Count

In fertility testing, ultrasounds are used to examine the structure of the uterus. A professional healthcare provider is able to see the size and shape of the uterus, ovaries and fallopian tubes. Ultrasounds are also used to examine the ovaries more closely, allowing doctors to determine the number of antral follicles (undeveloped eggs) remaining inside the ovaries. This allows them to determine the likelihood of conception either naturally or using assisted reproductive technologies. 

HSG Test for Fallopian Tube Blockages

One of the reasons that some people may face challenges in building their families is due to blocked fallopian tubes. A person can have a regular menstrual cycle even with blocked fallopian tubes, this is because menstruation occurs when an egg is not fertilized. Therefore one can assume that they do not have fertility challenges because their menstrual cycle may be regular.

The hysterosalpingogram (HSG) test is used to determine if a person has blocked fallopian tubes. It is done using a contrast liquid that is placed into the uterus using a catheter. This liquid is seen to ‘illuminate’ the inner structure of the uterus including the fallopian tubes, when examined using an x-ray. If there is blockage, the liquid will be seen to be pooling around the blockage. 

Male Fertility Testing

For men, reproduction revolves around production of sperm. Male fertility testing is carried out on the reproductive organs and the hormonal levels. As well, the sperm cells themselves are analysed to ensure that they are well formed, being produced in the expected quantities, and functioning as they should. 

Semen Analysis: What It Measures

A semen analysis is also referred to as a sperm analysis and is used to measure the quantity and quality of sperm that a person produces. The quantity is assessed using a sperm sample, which consists of a single ejaculation. Typically, two aspects are evaluated - the volume of the semen, and the number of sperm within that sperm sample. 

The quality in a semen analysis is measured in two aspects - the morphology and motility. Morphology has to do with the structure of sperm cells. Normally, a sperm cell is made up of the head, which contains the DNA material necessary in fertilization; the mid-section, which contains the mitochondria that provide energy for the sperm to swim; and the tail, which propels the sperm’s movement. 

Motility has to do with the movement of the sperm and is measured in two ways. The first is general movement, which assesses whether the sperm is able to move at all or not. The second aspect is movement in a forward direction, which is crucial as this is what gets the sperm from the vagina to the fallopian tube for fertilization. 

Sperm DNA Fragmentation Testing

Sperm DNA fragmentation testing is a very specific test used to examine the integrity of the DNA within sperm cells. Studies have shown that when DNA is fragmented, or damaged, it can cause fertility challenges for men. When it comes to male fertility, the higher the DNA damage, the lower the fertility levels. This can be observed in cases whereby the couple trying to conceive is experiencing repeated pregnancy loss. 

Hormonal Testing for Men

Hormonal testing for men is done as a blood test, and it examines the levels of testosterone, follicle stimulating hormone (FSH), luteinizing hormone (LH). Testosterone is the most crucial hormone in a man’s reproductive system, as it regulates the development of primary and secondary sexual characteristics in males. It is also key to sperm production and when testosterone levels are low, it could result in fertility challenges.

In males, FSH is vital in the growth of testicles, as well, the development and maturation of sperm cells. High levels of FSH are indicative of issues in testicular function, and when they are low, it results in lowered sperm production. LH stimulates the production of testosterone inside the testicles. When LH levels are unusually high, it could indicate issues in testicular function, while low levels will result in lowered testosterone production. 

What to Expect During a Fertility Evaluation

As we have seen, female fertility testing varies from male fertility testing. Therefore what one can expect is based on which evaluation they are doing. Typically, a professional healthcare provider will first have a consultation where they will obtain information from you regarding your physical health, medical history, diet and lifestyle. 

For men, a physical exam may be conducted where the penis, scrotum and testes will be checked for any anomalies. For women, the doctor may also ask about your menstrual cycle and menstrual cycle history. If further testing is required, the doctor will order the tests according to what they are seeking to evaluate. A basic evaluation could take a few hours, while a comprehensive evaluation could take a couple to several days. 

Next Steps After Your Test Results

After your results come out, the healthcare professional will walk you through what the results are, what they mean, and the options for treatment that are available. They will also walk you through the benefits, side effects and risks as well. It is important to note that because each case is different, treatment options will also vary. At this point, you will also be able to ask questions and seek further clarification on any issues that may arise. 

FAQs:

How do I know if I need a fertility test?

You may need fertility testing If you have been trying to conceive for 12 months (or 6 months, if you are over 35 years old) without success; or you have a history of reproductive health conditions, pelvic infections, STDs, or previous reproductive surgeries. If you have had multiple miscarriages, or you or your partner have known fertility risk factors, such as low sperm count, prior chemotherapy, or lifestyle factors affecting fertility.

What does an AMH test show?

An AMH test is used to measure a woman’s ovarian reserve. It shows the quantity of eggs in your ovarian reserve, giving an indication about the time left until menopause. It can also indicate how well you are likely to respond to fertility treatments. As well, it can be used to potentially diagnose polycystic ovarian syndrome (PCOS). 

Is male fertility testing painful?

No, male fertility testing is not painful. The primary test, a semen analysis, is non-invasive, requiring a person to provide a sperm sample. Hormone tests which require a blood draw may have some minor discomfort. In rare cases, testicular biopsies may be conducted and this may have some minor discomfort as well.  

How long do fertility test results take?

Test results vary in duration, depending on the test that has been conducted. Blood work and semen analyses may take a few days to a week. Ultrasounds and imaging tests could be immediate or take a few days, and genetic tests or advanced fertility evaluations may take two to three weeks. 

Can lifestyle changes improve fertility test results?

Yes! Studies have shown that positive lifestyle changes such as maintaining a healthy BMI, reducing alcohol intake and quitting smoking, limiting exposure to toxins, eating a balanced diet that is rich in folate, omega 3s and antioxidants, stress management and regular exercise all contribute to improved sperm quality, egg health, and healthy hormone production.