Ancient time-tested natural medicine

Testing Your Fertility Home

Female Fertility Tests
Male Fertility Tests

Why are we not getting pregnant? We are doing everything right, I think? Maybe one or both of us are facing fertility problems. What do we do now?

Go to your doctor and discuss fertility tests.

The general rule would be if you are between the ages of 20-30, try to conceive for 1-1.5 years. If you are between the ages of 30-35, try for 1 year. If you are over 35, try for six months. When these times have been met with no success, it is time to go for testing, time to find out why.
Many problems with fertility are small and can be dealt with quite easily.

The longer you try to conceive, the more worrisome and stressful it becomes. Stress gives way to an array of emotions, all of which, when in excess, have a detrimental effect on fertility. If you catch yourself saying things like 'I never thought this would happen to me', 'What if I never become pregnant?', 'We waited too long', 'This is what I was built to do, am I broken?', 'I've let my partner down', 'All our friends are having babies', 'Why is god doing this to us?', and 'Fertility treatments are so expensive, how can we afford that', you have started on the roller coaster of infertility.

Some things to start with would be coming to an understanding between you and your partner, that you are both on the same page, want the same thing, and will go through this together.
Get on the internet, go to infertility websites, join chat groups, and talk with other people that have been through or are going through the same things you are.

Look into your past, are there things that you have set aside that may be playing a role in your conception difficulties, 'skeletons in the closet', sexual trauma or abuse issues. For the first time start to explore what could be lingering more strongly than you thought.

Most importantly, you and your partner started this journey for what reason?, because you love each other so much that you have decided to make a family. Your relationship is the single most important part of this entire process. Make an effort to keep it alive, enjoy sex with one another, schedule weekend getaways, go for romantic picnics, sit by the fire and watch your favorite film. Anything you practice you get better at, so practice making your relationship shine! This may be the single most important concept of the whole infertility experience. Your healthcare providers will seem like they are doing everything they can to take the magic out of making a baby, it will seem systematic and sterile. Keep focused on each other and the other parts of your lives together that make you smile.

Look at taking this step into the land of fertility testing as an empowering one. You are taking control of your life, your fertility, your right to be informed and make wise choices that effect you very profoundly. Know your options, always step back and look at the big picture, and never push each other into territories that are uncomfortable.

Fertility testing takes time. There are numerous steps and options to understand. Start today, you will be happy that you have.

Female Fertility Tests

Hormone Assessment
Tubal and Uterine Assessment
Immunological Screening

Hormone Assessment

Blood tests on days 1-3 of your cycle check on your egg potential, estradiol, prolactin, and thyroid levels.
Day 21 +/- blood tests check on progesterone levels and determine if you have ovulated.

FSH
This hormone stimulates the growth of ovarian follicles. Checking these levels on day 1-3 establishes ovarian reserve and quality of eggs. Perimenopausal and menopausal women have elevated FSH.

Estradiol (E2)
The main estrogen secreted by the ovarian follicles. This hormone causes the endometrium to thicken and keeps FSH levels from getting too high. These levels drop in perimenopausal women, this is why the FSH rises. Both FSH and E2 should be low, high levels may indicate an ovarian cyst.

LH
A surge of Luteinizing hormone mid cycle is released to stimulate ovulation, form the corpus luteum, and synthesize progesterone in the ovaries. High levels on day 1-3 may indicate Polycystic Ovarian Syndrome.

Prolactin
This controls milk production after childbirth, and the production of progesterone. This is tested if PCOS is a possibility. High prolactin can interfere with ovulation, or result in reduced progesterone which makes it hard to maintain a pregnancy.

Thyroid hormones
Thyroid stimulating hormone controls the thyroid and therefore regulates metabolic functions of all the body's systems. Low levels of T4 with high levels of TSH make the thyroid gland underactive which can cause infertility. When TSH is at good levels and T4 is below what is should be, the pituitary could be the problem.

Androgens
High levels of male hormones might mean PCOS. The pituitary may be secreting excess LH which prevents ovulation and causes the ovaries to secrete higher amounts of male hormones.

Progesterone
The corpus luteum secretes progesterone. Checking levels around day 21 determine if you have ovulated. It is also used to detect a Luteal Phase Defect. If there is not enough progesterone in the luteal phase, the endometrium will not be ready for implantation.

Tubal and Uterine Assessment

Blocked tubes account for 20% of female infertility. It can be caused by an infection from an STD, Pelvic Inflamatory disease (caused by STD's, IUD's) or adhesions caused by surgery.

Hysterosalpingogram (HSG)
A small tube is inserted into the cervix and dye is released into the uterus. Via X-ray, this dye allows the doctor to see any structural abnormalities.

Laparoscopy
This requires general anesthetic and a short hospital stay. A small incision is made near the belly button and carbon dioxide is pumped into the abdomen. The laparoscope (small camera) is inserted into the abdomen so the doctor can see with more detail where a blockage may be, if it is a fibroid, endometriosis, lesions, or anything else unusual.

Hysteroscopy
Very similar to a laparoscope except that the device is inserted vaginally into the uterus and only local anesthetic is used. This is only used to look into the uterus with great presicion.

Immunological Screening

this should be done if there have been repeat miscarriages, or the cause of infertility is still a mystery. These tests determine if your immune system is attacking your partners sperm, or the fertilized egg. Repeat testing through early pregnancy is necessary to pinpoint some of these immunological reactions that may be compromising full gestation.

If you have had 2 or more miscarriages, have unexplained infertility, or have good embryos that fail to implant via IVF, immunological screening is the next option for you.

Thickened blood as a result of antibodies present increases the risk of miscarriage. Antiphospholipid, anticardiolipin are the most common antibodies that will cause this.

Antinuclear antibodies cause inflamation in the uterus.

Maternal blocking antibodies or natural killer cells cause embryo rejection.

Male Fertility Tests

Semen Analysis & Physical Exam
Hormone Assessment
Other tests that may occur

Detailed personal, medical, and sexual history will need to be given to your doctor. Similar to women, the diagnositc process is threefold; semen analysis & physical exam, hormone assessment, and a third step of further testing if necessary, such as genetic tests, and biopsies.

Semen Analysis & Physical Exam

Physical examination consists of checking for normal testicle size and shape, looking for varicocele, undescended testes, or any other evidence of physical abnormalities.

For the semen analysis, the man is asked to ejaculate into a sterile container,...masturbation on demand is not so easy, mentally prepare for this part. They can also send you away with a special condom that can be brought back at a later time. It is important to refrain from ejaculation for 3-4 days before the sample is required. A urine sample after ejaculation may also be asked for to check for retrograde ejaculation.

Illness that has happened in the last 3 months should also be offered to the doctor, it takes 100 days for sperm to mature, so problems at anytime in the last 3 months could effect the semen sample. Other factors that may effect the quality of the sample are medication, excess heat, alcohol, smoking, and other important things to avoid can be found at Improving Sperm Quality.

Also, be sure and have your tests done at a fertility lab, or a lab specially designed for male testing. Regular labs that do not understand the importance of the accuracy and timing of these tests may disregard the little things. It would be worth spending as little extra money if it is necessary. It is also worth doing more than one test because semen results can vary a lot depending on stress, illness, and many other factors.

Understanding the results
Appearance: normal semen is opalescent and grayish. Yellowish semen may show high intakes of vitamin supplements, abstinence, or jaundice. An infection may show some red in the semen.
Volume: total volume can range from 1-5ml. Too much can mean it is diluted. Low volume may show past infection blocking the tubes, retrograde ejaculation, or problems with accessory glands such as the seminal vesicles or the prostate. Sometimes there is an abscence of the vas deferens.
Liquefaction: after about 10 minutes semen becomes very runny (to swim better), if this does not happen within an hour, assisted techniques may need to be employed.
Acidity: semen has a pH between 7.2 and 8.
Agglutination: when sperm stick to one another it usually means there is anti-sperm antibodies that coat the sperm and bind to cervical mucus preventing proper movement and difficulty fertilizing the egg.
Antibodies: these tests are usually only done when all else has been ruled out.
MAR (mixed agglutination reaction): if the immunobead test shows less than 50 percent binding, antibody levels should not affect fertility.
Round Cell Concentration: immature sperm or white blood cells. Too many of these in a sample may indicate infection.
Sperm Concentration (count): 20 million sperm per ml of semen is normal. It may be too low, or sperm may be completely absent. Excess ejaculation may lower concetration. Caffeine, tobacco, alcohol, drugs, diet, exercise, and stress can also effect this. If it is very low there may be a genetic chromosomal defect.
Motility: swimming capabilities, fast and straight percentage is what is measured here. Too little or too much ejaculate can adversely effect motility. It is said that one big drinking binge can effect sperm for up to 3 months.
Morphology: shape of the sperm. Big or small heads, small or coiled tails. At least 15% of the sperm should be normal in shape. Avoiding things that are toxic to sperm are very important with morphology.

Hormone Assessment

FSH, LH, Prolactin, and Testosterone. LH stimulates the production of testosterone (necessary for the healthy production of sperm), Prolactin can interfere with LH induced testosterone production. FSH is essential for sperm development.

If there are high FSH and LH, and low testosterone, this may show testicular failure. Low levels of testosterone and FSH may indicate hypothalamic dysfunction.

Further Testing

Cell Culture: inflammation of the testes can reduce or totally obstruct sperm and testosterone production.
Ultrasound: this will show physical problems such as infection, tumors, surgical lesions in the testes, scrotum, prostate, seminal vesicles, epididymis, or absence of vas deferens. Varicocele can also be found this way.
Testicualr biopsy: this shows if sperm are even being made.
Chromosome testing: if counts are lower than 5 million per ml this should be explored. This could represent the possible passing on of cystic fibrosis, Young's syndrome, Kartagener's syndrome, or Klinefelter's syndrome to the offspring.