Female Fertility Test
If you are a couple who has been trying to get pregnant for at least a year or at least 6 months if you are a woman over the age of 35, you may want to consider fertility testing. Fertility testing can and should be done on both the male and female trying to get pregnant. Male factors account for half of all infertility cases, so a sperm test should be done. See a urologist about getting a male fertility test, which usually means having a sperm analysis under the microscope.
Testing the Female for Fertility
Testing a woman for her fertility is harder than it is for men. You should see a specialist and have a medical history and complete physical examination, looking for things that might be interfering with getting pregnant. Your doctor will ask you about your past use of birth control, previous pregnancies, and menstrual cycle history. Any medications you take or any past pelvic or abdominal surgeries should be asked about.
The doctor will do a Pap test and will evaluate your thyroid gland as a low thyroid condition can be a cause of infertility in females. Your breasts and hair growth will also be evaluated as there are conditions that cause excessive hair growth in a woman that will impact her ability to get pregnant, such as polycystic ovarian disease.
After a physical exam, the doctor may wish to do some tests to see if you are ovulating. You may be asked to track your cycle and do a home ovulation test kit. An ovulation test kit evaluates your luteinizing hormone (LH) surge. This is a hormone released during the menstrual cycle on about day 14 and is usually an indication of ovulation. An ultrasound may be done to see if follicles are growing on your ovaries during your menstrual phase.
There are several steps to evaluate whether or not you are ovulating:
- Ovulation test kit. This is the test for the LH surge mentioned above. You can also track ovulation through blood tests looking for an LH surge or an ultrasound.
- Luteal Phase Testing. Your doctor may wish to see if you are making enough progesterone in the latter half of the cycle. A blood test can show this after you have ovulated. If it is not sufficiently elevated, it may mean you can’t get pregnant without having progesterone supplementation during the last half of your cycle.
- Measuring the ovaries. Blood tests of your hormones may be done at different states of the pregnancy. For example, on day 3, an FSH (Follicle Stimulating Hormone) level may be drawn to see if you are adequately making enough to stimulate your ovaries to make an egg. An Estradiol level may be done at the same time in order to see if there is enough estrogen from the ovaries to stimulate the uterine lining to ready itself for an embryo to imbed in it.
- Luteal Phase Testing. Your doctor may wish to take a biopsy of the lining of the uterus in the latter half of the cycle, to make sure that the uterine lining is adequate to support a pregnancy.
- Hormone testing. The doctor may wish to check all of the various reproductive hormones to make sure the pituitary gland, the hypothalamus, and the ovaries are doing their job.
Testing the Hormones
The doctor will likely check the following hormones as part of evaluation for female fertility:
- FSH (follicle stimulating hormone)—secreted by the pituitary gland
- LH (luteinizing hormone)—secreted by the pituitary gland
- Progesterone level—secreted by the ovaries
- Estradiol level—secreted by the ovaries
- Free T3—secreted by the thyroid gland
- Prolactin level
- Total and free testosterone levels—secreted by the adrenal gland and the ovaries in small amounts.
- Androstenedione—secreted by the adrenal gland.
Other Female Fertility Tests
There are a couple of tests that can help determine if the woman is suffering from infertility and why. These include:
- Cervical Mucus Testing. This involves checking the cervical mucus after sex to see if the sperm are swimming adequately in the cervical mucus. At the time of ovulation, the woman’s cervical mucus should be clear and stringy in order to facility sperm transfer to the uterus and Fallopian tubes.
- Ultrasound testing. The doctor may wish to know if the uterine lining is thick enough to support a pregnancy. They may also do an ultrasound of the ovaries, looking for a growing follicle (there is usually more than one although only one usually releases an egg in any given cycle).
- Hysterosalpingogram. This is a dye study of the uterus and Fallopian tubes. Dye is injected into the uterus to see if the dye can pass through the Fallopian tubes and to see what the inside of the uterus is like. An abnormally-shaped uterus can contribute to infertility.
- Hysteroscopy. In this test, doctor uses a thin tube and inserts it into the cervix. A camera at the end of the tube can look for growths on the uterine lining or scar tissue in the uterus that is interfering with implantation of the embryo.
- Laparoscopy. In this test, the doctor uses a flexible tube and a camera to look at the ovaries more carefully as well as the uterus, Fallopian tubes, and other pelvic structures. There may be scar tissue or endometriomas from endometriosis that are interfering with the woman’s fertility.
- Endometrial biopsy. In this test, the doctor will take a sampling of the uterine lining just before you have your period to see if the uterine lining is thick enough to support a pregnancy and to make sure the cellular structures in the uterine lining are adequate for implantation.