Fertility is the natural ability to produce a child. For women, being fertile means being able to get pregnant. For men, fertility is having sperm that can fertilize an egg inside a woman's body. Many factors affect a person's fertility, including age, medical condition, genetics, environment, lifestyle, and a variety of other things.
Fertility professionals recommend seeking infertility treatment after a woman has been trying to conceive for approximately 1 year.
However, it is important to note that early evaluation should be sought by women with a history of menstrual irregularity, STDs, pelvic surgery, endometriosis, or autoimmune conditions. Women suffering from any of these conditions may benefit from consulting a medical professional before trying to conceive, as their risk of infertility is potentially greater. For women over 40, seeking a fertility evaluation before 1 year of trying (usually 6 months) may be warranted given the limited number of reproductive years remaining.
Women who have had or will have treatment for cancer should also consult with a fertility expert (prior to cancer treatment if possible), as some forms of cancer treatment may cause either temporary or permanent infertility. Many cancer patients choose to utilize oocyte preservation (egg or embryo freezing) prior to receiving cancer treatment- to be used later, either when the cancer patient has fully recovered, or through the use of a gestational surrogate.
Fertility Testing
Ovulation evaluation may be broken down into types:
- Ovulation testing — to confirm if ovulation is occurring by looking through your temperature charts, using ovulation predictor kits and blood tests and ultrasound .
- Ovarian function tests –These tests are looking to see how the hormones are functioning and working during your ovulation cycle. Tests include the Day 3 FSH (measuring follicle stimulating hormone), Day 3 Estradiol (measuring estrogen), ultrasound (to confirm ovulation occurred) and blood tests to determine the levels of inhibin B.
- Luteal Phase testing – Testing will evaluate progesterone levels, more extensive hormone testing, and possibly a endometrial biopsy ( see below for more info on this procedure.)
- Hormone tests: Most all of this testing will revolve around thorough hormone tests.
These hormone tests include the following:
- Luteinizing Hormone
- Follicle Stimulating Hormone
- Estradiol
- Progesterone
- Prolactin
- Free T3
- Total Testosterone
- Free Testosterone
- DHEAS
- Androstenedione
The following tests are also commonly used in the first evaluated cycle:
- Cervical mucus tests: This involves a post coital test (PCT) which determines if the sperm is able to penetrate and survive in the cervical mucus . It also involves a bacterial screening.
- Ultrasound tests: This is used to assess the thickness of the lining of the uterus (endometrium), to monitor follicle development and to check the condition of the uterus and ovaries. An ultrasound may be conducted two to three days later to confirm that an egg has been released.
If both the semen analysis and the above testing return normal results, there is also additional testing that your fertility specialists may recommend.
These tests include any of the following:
- Hysterosalpingogram (HSG): This is an x-ray of your uterus and fallopian tubes. A dye is injected through the cervix into the uterus and fallopian tubes. The dye enables the radiologist to see if there is blockage or some other problem.
- Hysteroscopy: This is a procedure that may be used if the HSG indicates the possible presence of abnormalities. The hysteroscope is inserted through the cervix into the uterus, which allows your fertility specialist to see any abnormalities, growths, or scarring in the uterus. The hysteroscope allows the physician to take pictures which can be used for future reference.
- Laparoscopy: This is a procedure done under general anesthesia, that involves the use of a narrow fiber optic telescope under. The laparoscope is inserted into a woman’s abdomen to provide a view of the uterus, fallopian tubes, and ovaries. If any abnormalities such as endometriosis , scar tissue or other adhesions are found, they can be removed by a laser. It is important to confirm that you are not pregnant before this test is performed.
- Endometrial biopsy: This is a procedure that involves scraping a small amount of tissue from the endometrium just prior to menstruation. This procedure is performed to determine if the lining is thick enough for a fertilized egg to implant in and grow. It is important to confirm that you are not pregnant before this test is performed.