Infertility Testing 101
- Jess
- Jan 9, 2019
- 4 min read
Updated: Jul 11, 2024
I’ve always been very open about my challenged lady parts and infertility. I’m really an open book; nothing is off limits. I’ll share as much or as little as someone requests. My hope is that my story will help someone… even if it’s just one person. I’ve had many people ask what they should do if they’re having trouble getting pregnant. I even had people ask me BEFORE I even had a baby (weird… I know). So with that, I wanted to share my knowledge about infertility testing (at least some of it anyway). This is not medical advice as I am NOT a doctor. This is merely what I’ve learned on my baby-making journey. I have included links throughout this post in case you want to do more research.
From what I understand, someone isn’t labeled as medically “infertile” until after 12 months of trying to conceive AND it resulting in a successful pregnancy (for a female under 35); 6 months for females over the age of 35. I say “successful pregnancy” because recurrent miscarriages can be a sign of infertility. Technically, I conceived for the first time after 7 months of trying, but it wasn’t a successful pregnancy; I lost the baby around 6 weeks.
After 12 or 6 months of trying (depending on age) with no success, the next step is to run a battery of tests on both the male and female involved in the baby-making to help determine a diagnosis and, subsequently, a treatment plan or protocol. It was explained to me that there are typically 4 potential causes for infertility:
Hormonal
Anatomical
Semen
Unknown
To check hormones, ladies will have cycle day 3 blood work done. The blood work will test things like AMH (egg reserve), FSH (ovarian function), luteinizing hormone (LH), TSH (thyroid), estrogen, progesterone, etc. In addition, the doctor will likely do a transvaginal ultrasound to look at the uterus and ovaries. During the ultrasound, the doctor will count the antral follicles on each ovary (aka antral follicle count or AFC). Antral follicles are where eggs can potentially grow within the ovaries; typically, the more antral follicles you have on each ovary, the better. The male will likely have blood drawn to check his testosterone levels.
To check the anatomy, a few other tests and/or examinations will be conducted. For both the male and female, the doctor will conduct a pelvic examination. In addition, I had a sonohysterogram to make sure my Fallopian tubes were open, an HSG (a type of x-ray evaluation) to look more at my tubes and the shape of my uterus, and a hysteroscopy to look at my cervix and even more closely at my uterus. During the HSG, it was discovered that I have a slight septum (heart shaped uterus). Because a septum can prevent an embryo from implanting in the uterus, the hysteroscopy was used to determine if the septum was severe enough to warrant removal; luckily, it wasn’t.
To test semen, you guessed it - the male’s swimmers need to be tested for count, morphology (shape), and motility (movement).
There are other tests that may also be necessary like:
genetic screening of the male and female
Embryo genetic testing (if the female is having recurrent miscarriages)
Evaluation of lifestyle choices
History of past surgeries, STDs, etc.
After all of these tests are conducted (and possibly more), then the doctor can try to diagnose what’s causing the infertility. If all of the tests come back “normal,” then you’ll likely be diagnosed as having “unexplained infertility.”
Some other possible diagnoses:
In my opinion, there’s no reason to speculate as to why you’re not getting pregnant until ALL of the necessary tests and exams are conducted. How can a doctor create a treatment plan or protocol without knowing the full story? That’s why it’s so important to advocate for yourself (and your partner) to keep searching for answers. Educate yourself and ask questions. Insist on having tests, exams, and procedures until you find the answers needed for a diagnosis. Knowledge is power!
I know someone who went through 2 rounds of IVF only to discover later that she actually had a pretty severe uterine septum that was likely preventing an embryo from implanting. She had surgery to remove the septum and the next round of IVF was successful! Imagine what might have happened if they would have discovered the septum prior to the first round of IVF. But often times on this journey, you don’t know what you don’t know. Educating yourself HAS to be a priority. Don’t solely depend on your doctor to give you all of the information. Afterall, they’re human too. And it’s ok to seek a second and third opinion if needed. Do what you have to do!
In case you’re interested, I was diagnosed with diminished ovarian reserve/premature ovarian aging. This was determined by my AMH level (0.52 ng/ml) and my AFC (10) -- I essentially had the egg reserve of a 41+ year old… at the age of 29. We also found out that my FSH was slightly elevated meaning that the few eggs I have may not be the best quality.
Fortunately, the protocol my doctor recommended based on my diagnosis worked, and we now have a beautiful 19 month old baby girl with a baby boy on the way (due April 2019) - both thanks to IVF. We had one egg retrieval in August of 2016 (resulting in 7 embryos, 3 PGS normal) and 2 successful FETs (Sept 2016 and Aug 2018). All of the tests, procedures, exams, blood work, ultrasounds, and early morning appointments were worth it! The financial burden really sucked (because our health insurance covered NOTHING), but it all worked out. It wasn’t easy by any means, but it was all SO WORTH IT!
As you can probably tell by the links in this post, this website is a great resource. There’s a lot of information here and it can be overwhelming. Please please reach out to me if you have any questions or need help navigating your next steps.