Infertility is diagnosed through a series of tests and exams referred to as a fertility evaluation. This process helps your provider identify a more specific cause of fertility issues so that they can recommend the best treatment. Here’s more on what to expect and how to prepare.
When to seek a fertility evaluation
The recommended timeline for seeking a fertility evaluation depends on your age and personal health factors.
Most experts recommend that women under 35 consult with a fertility specialist if they are unable to conceive after a year of regular unprotected sex. For women ages 35-40, the recommended timeline is typically after six months of regular unprotected sex. If you are older than 40, it is often recommended to seek a fertility evaluation before trying to conceive.
It is possible to experience infertility after previously conceiving and giving birth to a child without fertility treatment. It’s important to be proactive about seeking fertility treatment regardless of your past experience(s) conceiving.
A fertility evaluation is also recommend for anyone with a health history that includes the following, regardless of age:
An irregular menstrual cycle
Cancer treatment that could impact reproductive health
Infertility affects both men and women. If you are trying to conceive as a couple, you and your partner should both be evaluated for fertility issues.
What a fertility evaluation includes
A fertility evaluation involves a combination of a physical exam, medical history review, and testing. Your gynecologist may perform the initial assessment or they may refer you to a specialist called a reproductive endocrinologist — an OB/GYN with extensive training in fertility.
At the initial appointment, your doctor will conduct a physical exam of both you and your partner, if applicable, and ask about your medical histories.
Female partners are asked about their menstrual cycles, specifically:
The date of your last menstrual period
Menstrual cycle length and frequency
Abnormal bleeding, discharge, or pain
Other common questions at a fertility evaluation include:
The duration of your fertility challenges
Your family history of fertility-related health issues that also have a genetic component, such as PCOS and thyroid disorders
Your sexual history, including a history of any sexually transmitted infections (STIs)
Types of birth control you’ve used
Any medications you take
Lifestyle factors including smoking, substance use, and stress
Past pregnancies and complications
Be open and honest with your provider during this conversation. Sharing an accurate and complete medical history will help them make the best recommendations for testing.
Laboratory and imaging tests can help your provider identify the cause of your and/or your partner’s fertility challenges.
Fertility testing for men
For men, the typical first step is analysis of a semen sample. Your provider will check sperm count, sperm movement, and sperm structure, all of which can impact sperm’s ability to reach and fertilize an egg. If sperm abnormalities are detected, additional testing may be recommended. This may include:
Ultrasounds and physical exams that check for issues with the bladder, kidneys, or scrotum
Blood tests that check for levels of male reproductive hormones
Fertility testing for women
A variety of fertility tests check for common causes of female infertility such as ovulation disorders, low ovarian reserve, and structural issues with the uterus, ovaries, or fallopian tubes.
These are some tests a doctor may use to diagnose an ovulation disorder:
A urine test
Blood tests that check levels of hormones related to ovulation such as progesterone and prolactin
Blood tests that check thyroid function
An ultrasound of the ovaries
In some cases it may be possible to confirm if you are ovulating by tracking your basal body temperature (BBT) at home.
These are some tests a doctor may use to diagnose a low ovarian reserve:
Blood tests that check levels of hormones related to ovarian reserve such as follicle-stimulating hormone (FSH), estradiol, and anti-mullerian hormone (AMH)
An ultrasound of the ovaries
Imaging tests are used to diagnose structural issues with the uterus, ovaries, or fallopian tubes, such as fibroids, cysts, or fallopian tube blockage. There are two commonly used imaging tests:
A hysterosalpingogram (HSG) is an x-ray taken to examine issues within the uterus and fallopian tubes. When using an HSG to diagnose fallopian tube blockage, your doctor will inject dye into the uterine cavity through the vagina and cervix. If there is no fallopian tube blockage, the dye will flow through the fallopian tubes.
A laparoscopy is a minimally invasive procedure that inserts a small camera through the abdomen to evaluate reproductive organs.
The diagnosis process may also include a hysterosonography, although this test is less common than those above. A hysterosonography is a specific type of ultrasound that injects salt water into the uterus. This imaging test is able to reveal structural issues that aren’t always apparent in a standard ultrasound, such as uterine fibroid tumors.
Fertility testing varies by individual, and some of the above tests may not be relevant to your fertility challenges.
Timing and next steps
Fertility evaluations vary in duration. Sometimes it only takes one or two appointments to complete relevant testing. In other cases, testing takes place throughout several appointments. In most cases, a fertility evaluation can be finished over the course of several menstrual cycles.
After your evaluation, your doctor will make recommendations for the most effective treatment based on the cause of your and/or your partner’s infertility.
Not all cases of infertility have an identifiable cause. Up to 30% of all couples experiencing fertility challenges are diagnosed with unexplained infertility. While this can be a difficult and frustrating diagnosis, many couples with unexplained infertility go on to have a child. In fact, one study from the National Institute of Health (NIH) found that 92% of couples with unexplained infertility who pursued fertility treatment eventually conceived and had a healthy pregnancy.
Insurance coverage of fertility evaluations and treatment can vary widely from one plan to another, and from state to state, so verify your benefits before scheduling your appointment. We have a resource to support you in navigating your fertility insurance coverage here.
How to prepare
A fertility evaluation can feel overwhelming or nerve-wracking. We suggest preparing a list of questions and gathering your medical history in advance.
If you aren’t going through this process with a partner, consider bringing another support person to your appointment. It can also be helpful to do a relaxing or calming activity beforehand, like meditating or taking a walk.
Choose the right fertility pharmacy
Alto is with you at every step of your fertility journey. We offer same-day delivery of your medications, fertility resources like personalized injection guide videos, and access to fertility-trained pharmacists.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.