As if infertility isn’t overwhelming enough on its own, keeping track of fertility testing names, schedules, and results can leave you completely befuddled.

“Which tests? Are these blood tests or ultrasounds? This dye goes where, now?”

And how do you keep track of which blood draws need to take place on which days of your menstrual cycle?

We’re here to demystify this process for you!

Why would I need all these tests?

The results of these labs can help your provider determine the reasons that you’ve been struggling to conceive or maintain a pregnancy. And if you’re considering growing your family with fertility treatments, the results can also help determine what your next steps will be.

Important fertility tests

Here are 10 of the most common tests your provider may order when trying to assess the reasons behind your infertility.

  • Anti-mullerian hormone (AMH) level. AMH level is assessed through a blood draw, and it evaluates ovarian function. A low AMH level can indicate a low egg count, which could be the cause of your fertility struggles. But this isn’t always the case! AMH might be most useful in helping your doctor predict how you might respond to certain fertility medications.
  • Prolactin level. Prolactin is a hormone made in the pituitary gland in the brain. It’s the hormone that’s primarily responsible for breast milk production after birth. But unusually high levels of prolactin can be linked with infertility and irregular or absent periods as well, so this level can help pinpoint if that might be causing your difficulties conceiving. A normal prolactin level in a female who is neither pregnant nor lactating is less than 25 ng/mL.
  • Day 3 follicle-stimulating hormone (FSH) level. As its name indicates, FSH stimulates the ovarian follicle to be produced. FSH is the primary hormone responsible for selecting which follicle will be released. This follicle production then proceeds to ovulation. By testing this level very early in the menstrual cycle, your provider can get an idea of how hard the body is trying to stimulate follicle production. Simply put, an elevated FSH level can indicate that the body is having to do extra work to produce a follicle. FSH levels typically increase with age.
  • Day 3 estradiol level. This level is closely related to FSH, so it’s typically drawn along with the FSH test discussed above. If estradiol is elevated but FSH is normal, this can signal problems with the response of the ovary. Estradiol level less than 80 is considered normal at this point in the menstrual cycle.
  • Progesterone level. Progesterone is a hormone that rises in response to ovulation. A rising progesterone level can help confirm that ovulation is occurring, so this test is timed for about a week after suspected ovulation. Your progesterone levels will need to be interpreted by your care provider, of course, but low levels may suggest that ovulation didn’t occur or that post-ovulatory progesterone levels may be too low to sustain a pregnancy.
  • Hysterosalpingogram (HSG). Whereas a lot of these other tests look at your hormone levels, the HSG evaluates the patency (openness) of your fallopian tubes. The physician performing the HSG will pass a very small catheter through the opening of your cervix and insert dye into the uterus. After inserting the dye, a pelvic x-ray is taken. If the uterus fills abnormally, there might be a polyp, fibroid, or malformation of the uterus. If both fallopian tubes are unblocked, the dye will spill out through the fallopian tubes. If there are any blockages in the tubes, the dye will stop at the blockage.
  • Antral follicle count (AFC). This count is performed by vaginal ultrasound. Egg count and quality decrease as women age, and this test evaluates ovarian reserve. Your antral follicle count can give your provider an idea of where your fertility ranks in relation to your age. Because egg count decreases as you age, this number will be lower the closer you come to menopause.
  • Thyroid testing. Hypothyroidism (low levels of thyroid hormones) can prevent the release of the mature egg from the ovary, leading to difficulty conceiving. There are several blood tests that can help evaluate thyroid function, but one of the most common is thyroid-stimulating hormone (commonly referred to as TSH). Healthy levels of TSH can vary based on your specific case.
  • Diabetes testing. Fasting blood sugar levels can help determine if further testing for diabetes is warranted since diabetes can be associated with infertility.
  • Semen analysis. All of the tests above have been primarily performed on the female partner, but semen analysis is vital to the fertility treatment process! This is because male factor infertility can be the cause of up to half of cases of infertility. Semen analysis is normally one of the first fertility tests performed, as it is less invasive than others. Semen analysis is most accurate when it follows 24 to 72 hours of abstinence. It’s also important that the sample be examined within an hour after collection. The semen is examined under a microscope and the number, shape, and movement of the sperm are observed.

You might not need all these tests!

Though these tests are important, every case is different! Not every test on this list will be required before starting treatment for each patient. It’s vital that you discuss the specifics of your situation with a fertility specialist to understand which could benefit you!

Fertility treatments can be confusing, and it’s easy to become overwhelmed with the testing process. We understand the overwhelm and are here to walk you through the process! We also know that you may still have questions about some of these tests.

Regardless of the specifics of your fertility case, we consider it an honor to accompany you on your journey. Contact us today to consult with Dr. Salem about which of these tests would be best for you!

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