Should I have infertility testing?
Introduction
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
If you and your partner have been having trouble getting pregnant, it's possible that one or both of you has a medically treatable fertility problem. As you decide whether to look for a cause, you will have various medical and personal questions to consider. Together, you can use this Decision Point to guide your thinking. It offers basic facts about infertility, testing, and when testing is appropriate. You can also use it to define your personal goals, feelings, and values about infertility testing and treatment.
Consider the following when making your decision:
- If you are younger than 30 and trying to conceive, most doctors recommend well-timed intercourse for at least a year before considering testing and treatment.
- If you (woman) are closer to 35, it's reasonable for both you and your partner to consider testing for treatable causes of infertility sooner, before age-related factors make it too difficult to conceive.
- Infertility testing and treatment can be difficult, sometimes traumatic, and expensive. Before starting infertility testing together, discuss how far you would be willing to go with testing and treatment. Only have testing for conditions that you are willing and financially able to have treated or that would help you move on to other options such as adoption.
- Prolonged infertility testing and treatment can intensify the stress of infertility. If you are becoming overly stressed or your relationship is suffering, ask your doctor to recommend a professional counsellor who can help you get through this crisis together.
- As a couple, you have the final word on how to use your infertility test results based on your medical information, goals, and values.
Medical Information
What is infertility?
Infertility is defined as a couple's inability to become pregnant after 1 year of sex without using birth control. However, "normal fertility" is defined as the ability to naturally conceive within 2 years' time.
A man's fertility is not known to be severely affected by age. A woman's fertility gradually drops from her mid-30s into her 40s, due in great part to the natural aging of the egg supply. For any couple, defining infertility is a personal issue—influenced by a woman's age and how much time a couple chooses to try conceiving without medical intervention.
What causes infertility?
In about 35% of couples, testing reveals a male fertility problem, as with sperm production or ejaculation. In about 50% of couples, the primary cause is a female fertility problem with ovulation, fallopian tube function, or other pelvic problems, such as endometriosis. Some couples find that both partners have a fertility problem. In 10% of couples, no cause of infertility is found.1
What types of infertility testing are available?
Testing for causes of infertility can range from simple, inexpensive, and painless to complicated, expensive, and surgically invasive. If you decide to test for a cause of infertility, your doctor will want to check both of you at the same time. Using your fertility awareness information, semen analysis, and blood tests for hormone levels, your doctor can easily check for the most common male and female infertility problems.
- Initial tests of male and female hormone and semen analysis can signal problems with egg or sperm production. Typically, an abnormal sperm analysis will be followed by a repeat analysis. Depending on the problem, abnormal hormone or sperm results are followed up with further testing or treated with medications or hormones.
- Tests using cervical mucus and sperm can identify infection and other factors that interfere with sperm movement into the female reproductive tract.
- Tests that examine the reproductive tract, such as hysteroscopy, hysterosalpingogram, sonohysterogram, endometrial biopsy, ultrasound, laparoscopy, and transrectal ultrasound, can identify disease or structural problems that might be reversible.
Use the following reference as you consider whether to proceed with various types of testing. Initial tests are listed first, followed by other tests that may be recommended, depending on initial testing results.
Infertility tests: Benefits and concerns Which partner is tested and type of testing Reasons to have this testing Potential concerns Female partner, at home:Basal body temperature and other fertility awareness measures
- Not painful or invasive
- Tunes you in to your body's cycles and fertile days
- Provides valuable information for an initial fertility consult with your doctor; can be used with home ovulation test
- Low cost, low-stress, private
- At least 2 cycles of daily temperature charting are needed to provide useful information.
- Daily early morning temperature-taking may be difficult for women with irregular work/sleep schedules.
- Not helpful for exact timing of intercourse
Female partner, at home: Home ovulation test kit for luteinizing hormone (LH)
- Not painful or invasive (urine sample)
- Provides immediate confirmation that you're within 12 to 36 hours of ovulating
- Private
- Requires 2 or more days in a row of testing
- May need more than one kit per cycle (best used with cervical mucus monitoring or basal body temperature chart and other fertility awareness information)
Male partner:Semen analysis
- Not painful or invasive
- Provides necessary data for treatment planning
- May be difficult or embarrassing to produce a sperm sample
Both partners: Hormone tests, including luteinizing hormone (LH), progesterone, follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH), prolactin, and testosterone
- Easily provides key information about possible causes of infertility
- Minimally invasive (require blood samples)
Female partner:Hysterosalpingogram
- Provides clear view of fallopian tubes and uterus without having surgery
- The fluid that is flushed into the uterus and tubes may clear a mild tubal blockage and increase your chances of pregnancy.
- Invasive (small tube inserted via the vagina), with slight risk of infection or uterine or tubal damage
- May cause cramping during or after the procedure
- Uses X-ray
Female partner:Ultrasound
Hysterosonogram with transvaginal ultrasound to evaluate the uterus and fallopian tubes (also known as sonohysterogram)
- Abdominal test is not painful or invasive; no X-ray is used.
- Provides view of follicle development, and reproductive organs; used to guide egg retrieval
- Hysterosonogram is invasive and potentially embarrassing (thin tube and larger ultrasound transducer inserted via the vagina).
- Compared to laparoscopy, it is not sufficient for evaluating some conditions.
Female partner:Laparoscopy
- Allows inspection of reproductive organs when a problem, such as endometriosis, is suspected
- Simple tubal repairs can be performed during same procedure if necessary.
- Invasive (surgical procedure requires small abdominal incision) with slight risk of injury or infection
- Operating room-based; may require hospitalization or missed work days
- Requires general anesthesia, which has risks and prolongs recovery time
Male partner:Sperm antibody test
- Not painful or invasive
- Shows whether sperm impairment is caused by antibodies
- Sometimes used after sperm analysis reveals clumped-together sperm (agglutination) and poor sperm movement (motility); may also be used when no other cause of infertility can be found
- May be difficult or embarrassing to produce a sperm sample
- Many doctors no longer use this test, citing questionable usefulness. Sperm problems require insemination or in vitro fertilization with intracytoplasmic sperm injection (ICSI) regardless of these test results.
Female partner:Hysteroscopy
- No incision necessary.
- Provides view of uterine growths or defects that cannot be seen during other tests, such as ultrasound.
- Small uterine growths or biopsy samples can be removed during the same procedure.
- Invasive (scope is inserted through vagina to uterus).
- Not usually used if hysterosalpingogram results were normal.
Male partner:Testicular ultrasound
- Not painful or invasive; no X-ray used
- Provides view of testicles, epididymis, and varicocele if present in testes
- None
Male partner:Testicular biopsy
- Collects sperm for evaluation or for assisted reproductive procedures
- Further evaluates sperm when male hormone levels are normal, yet sperm in semen are abnormal or dead
- Invasive (requires small incision)
- Slight risk of infection
Both partners:Karyotype, other genetic testing
- Evaluate possible genetic causes of conception, miscarriage, or stillbirth problems
- Can identify possible genetic problems that a couple could pass on to their offspring
- Slightly invasive; uses blood samples
- Used only in select cases, such as repeat in vitro fertilization failures or miscarriages, or when there are known genetic risk factors
Both partners:Culture of semen and cervical mucus
- Not painful or invasive (but requires woman to have cervical mucus sample taken and man to provide semen sample)
- Evaluates for infection as cause of infertility
- May be difficult or embarrassing to produce a sperm sample
How can you and your partner use the information from infertility tests?
Based on your unique test results, your doctor can give you the best possible information about your next testing or treatment options. At each point in the testing process, pause and assess what you have learned and decide what you want to do next.
Here is a general example of how a couple and their doctor might use information from infertility tests.
- If a couple's initial tests are normal, finding no reason for their difficulty conceiving (unexplained infertility), they can:
- Continue trying to conceive naturally, having sex just before ovulation to increase their chances of pregnancy.
- Continue testing for an infertility cause. Further testing checks the fallopian tubes to be sure that eggs can enter the tubes, be fertilized, and implant in the uterus. These tests are more invasive, uncomfortable, and risky.
- Try treatment with intrauterine insemination (IUI), with or without superovulation medication.
- If a sperm analysis shows a sperm problem, a woman may not need any tests. However, to conceive a pregnancy, the sperm problem may require insemination or assisted reproductive technology (ART) treatment, which intensively involves the female partner. ART uses medication, tests, and procedures to produce, collect, fertilize, and implant multiple eggs.
- If a sperm analysis is normal but a woman's basal body temperature and hormone tests suggest that she isn't ovulating, she may not need further tests. She may choose to try medication that stimulates her ovaries to produce and release eggs.
- If test results show a problem with the fallopian tubes, a couple may choose a fallopian tube procedure or in vitro fertilization (IVF) to conceive a pregnancy.
- When successful, a fallopian tube procedure can enable a woman to have more than one pregnancy without ongoing fertility treatment and repeated use of IVF.
- Tubal surgery does not work for tubal problems that are severe.
At any point in the infertility testing and treatment process, a couple has the freedom to stop or take a break. Many couples find that a break in the intensity is necessary for them to maintain their physical and mental health.
If you need more information, see the topic Fertility Problems.
Your Information
If you decide to test for a cause of infertility, you can then decide how much or how little testing you are willing to pursue. Although you don't need to make all your decisions about testing and treatment at the outset, take some time together to talk about your hopes, values, and limits. The following worksheet will help you evaluate and communicate with each other and your doctor.
Your choices are:
- Start or continue with testing for a cause of infertility, then use the results to help make your family planning decisions.
- Decide against starting or continuing to have infertility testing, and make your family planning decisions with the information you currently have.
The decision whether to have testing for a cause of infertility takes into account your personal feelings and the medical facts.
Making a decision about infertility testing Reasons to have infertility testing Reasons to not have infertility testing Consider infertility testing if you:
- Haven't become pregnant after several months of having sex during the 5 days before and the day of ovulation (this is your "fertile window," which you identify using fertility awareness methods).
- Are willing to undergo treatment for the condition you would be tested for, or would be better able to make family planning decisions with that test result.
- Have the financial resources or health insurance necessary for infertility testing.
- Are younger than 35, have regular menstrual periods, and have had sex within your fertile window for at least 12 months.
- Are age 35 or older or you have irregular periods and have had sex within your fertile window for at least 6 months.
- Are high-risk for fertility problems and have had sex within your fertile window for a few months.
- Have had several miscarriages.
Are there other reasons you might want to proceed with infertility testing?
Do not consider fertility testing if you:
- Have not spent several months to 1 year having sex during the 5 days before and the day of ovulation (this is your "fertile window," which you identify using fertility awareness methods).
- Have no known infertility risk factors, nor a history of repeat miscarriages, and you are within the first year of trying to get pregnant.
- Do not have the financial resources or health insurance needed for testing and treatment.
- Are not willing or able to proceed with treatment for the condition being tested for, or would not benefit from knowing you have that condition.
Are there other reasons you might not want to proceed with infertility testing?
These personal stories may help you make your decision.
Wise Health Decision
Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about starting or continuing with infertility testing. Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
We have spent at least 6 months having intercourse during our "fertile window" before and including the day of ovulation.
Yes No Unsure I want to continue trying to conceive naturally before thinking in terms of infertility.
Yes No Unsure It important to me that we have a biological child.
Yes No Unsure I consider adoption as a possible family planning choice.
Yes No Unsure I would consider using donor eggs or sperm to conceive.
Yes No Unsure We have the financial resources to afford infertility testing, treatment, pregnancy care, and child-related expenses.
Yes No Unsure We have health insurance that covers some of our costs.
Yes No Unsure If a semen analysis and blood tests revealed no problems, I would be willing to continue with potentially uncomfortable or invasive tests.
Yes No N/A I know what kinds of treatment options I would be willing to consider.
Yes No Unsure We have a plan for how long we would want to look for and treat a cause of infertility.
Yes No Unsure We have determined the best way to periodically evaluate our testing and treatment plan.
Yes No Unsure *NA=Not applicable
Use the following space to list any other important concerns you have about this decision.
What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have testing for a cause of infertility.
Check the box below that represents your overall impression about your decision.
Leaning toward proceeding with infertility testing
Leaning toward NOT proceeding with infertility testing
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| Author: | Shannon Erstad, MBA/MPH Carrie Henley | Last Updated: August 16, 2006 |
| Medical Review: | Adam Husney, MD - Family Medicine Joy Melnikow, MD, MPH - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology Femi Olatunbosun, MB, FRCSC - Obstetrics, Gynecology and Reproductive Medicine | |
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