A fertility evaluation is nothing to be nervous about, says Aaron Styer, M.D., reproductive endocrinologist and co-medical director of CCRM Boston, and usually begins with a long talk between you, your partner (if you have one), and your fertility doctor. The doctor will go over your medical histories, and ask about any conditions that might impact fertility (like diabetes, hormone imbalances, sexually transmitted infections, and thyroid disease), as well as any medications that you are currently taking or have taken in the past. Then comes the part that might make you blush: You’ll also talk about the timing and frequency of intercourse, and your parents and siblings’ reproductive histories. (But seriously, there’s nothing to be embarrassed about!)
According to Dr. Styer, the causes of infertility are typically 40 percent female-related, 40 percent male-related, and 20 percent unknown—something many people don’t realize. That’s why it’s essential that your reproductive endocrinologist see both members of the couple.
In addition to giving a detailed medical history, men can expect to have their hormone levels checked via a blood test and provide a sperm sample. (Yes, that means masturbating into a cup.) The sample will then be analyzed for sperm count, as well as the appearance, shape, and motility (i.e. ability to move) of the sperm.
For women, a fertility assessment will begin with a baseline ultrasound to evaluate the uterus and check the number of “resting eggs” (antral follicles that contain immature egg cells) in her ovaries. Blood tests will check reproductive hormone levels, which can indirectly demonstrate the quality and number of eggs in a woman’s ovaries.
Depending on your symptoms, medical history, and the results of these initial tests, your fertility specialist might order the following additional tests to assess a woman’s fertility:
Anti-mullerian hormone (AMH) blood test
AMH is a hormone produced in the ovaries by tiny early-stage follicles as they grow to a stage at which they can potentially produce eggs for ovulation. AMH levels can indicate whether or not there is still a significant number of growing follicles.
Thyroid levels (TSH) blood test
Thyroid disorders, including hyperthyroidism (an overactive thyroid), hypothyroidism (an underactive thyroid) or thyroid autoimmune diseases can impact many other important hormones in your body, causing numerous problems related to fertility and ovulation.
Follicle-stimulating hormone (FSH) blood test
FSH is one of the most important hormones involved in a woman’s menstrual cycle. Its job is to stimulate the growth and development of follicles so that an egg is produced and released during ovulation. FSH production is ongoing until you ovulate; if you don’t, FSH levels will continue to rise. An FSH level test can indicate how much effort your body is exerting to help you ovulate. High levels are a sign of diminishing ovarian reserve (i.e. reduced egg numbers and lower egg quality).
Luteinizing hormone (LH) urine or blood test
LH works alongside FSH and regulates both the menstrual cycle and ovulation. Levels of LH rise quickly just before ovulation, about halfway through your cycle (called the “LH surge”). Depending on the stage of your cycle, a urine test can tell if you’ve ovulated, or indicate issues with menstruation or ovulation. High LH levels outside of the LH surge are correlated with problems such as polycystic ovary syndrome (PCOS), which may suggest premature menopause and diminished ovarian reserve or a genetic or congenital condition that affects the production of hormones. Low LH levels are associated with irregular or absent menstruation or problems with the pituitary gland.
Estradiol blood test
Secreted by maturing follicles, estradiol is a form of estrogen, the major female reproductive hormone. High levels of estradiol can be a sign that your body is working especially hard to produce eggs, and can mean that your ovarian reserve is getting low. Elevated levels can also interfere with the function of FSH and the ovulation process. Low levels of estradiol can point to PCOS or pituitary issues.
Prolactin blood test
Prolactin is related to your thyroid and pituitary function. It's a hormone that regulates and inhibits FSH and gonadotropin-releasing hormone (GnRH), the hormone that controls the release of FSH and LH in the body. If your prolactin levels are elevated, you may have problems with ovulation. High levels can also indicate hypothyroidism or problems with your pituitary gland and are sometimes related to PCOS.
“For many women, these tests are enough to determine the state of their ovarian reserve and their current level of reproductive function,” Dr. Styer explains. “If the tests do indicate a problem, your fertility specialist is likely to order further testing to establish a clear diagnosis and help you formulate a plan of treatment or fertility preservation.”
Still have questions about getting pregnant? Check out our fertility FAQ here.
Editors’ note: We use the terms “woman” and “female” in this article to refer to people with internal reproductive organs; however we understand that not everyone with internal reproductive organs identifies as a woman or a female. We use the terms “man” and “male” to refer to people with external reproductive organs; however we understand that not everyone with external reproductive organs identifies as a man or a male.