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Nobody prepares you for infertility. If you suspect, for any reason, that you might have a problem and are wondering how to test your fertility status, you can get some of these tests to get a better idea of your situation.
Here are some common fertility tests for women:
Basic investigations for infertility
Blood tests for STIs
If you have any history of STIs or lingering infections that can affect your fertility, you must get tested. Residual inflammatory tissue and scarring from previous infections can block your fallopian tubes and cause hindrance to conception.
Hormone tests for infertility
Hormones are a big indicator of the reproductive function in your body as the levels of certain hormones can tell if you have ample ovarian reserve and if you are ovulating easily.
Listed below are the hormones that can help determine your fertility status:
- Anti-mullerian hormone (AMH) – This can be checked on any day of your menstrual cycle and the level of AMH will tell you about your ovarian reserve. It tells the doctor about the number of growing follicles you still have, which indicates if you are still producing viable eggs. However, this does not give any idea about the quality of eggs.
- Follicle-stimulating hormone (FSH) – FSH is responsible for stimulating growth of your ovarian follicles—the fluid filled cavities in the ovaries that contain eggs. It is responsible for maturing a follicle so an egg is released during ovulation.With rising FSH a number of follicles are stimulated, so they start to grow and produce estrogen. Normally one follicle grows larger than the rest and the ripened egg inside it is released.FSH levels increase until you ovulate and drop after that. It continues to increase in women who don’t ovulate and high levels of FSH are an indication that your body has to work extra hard to help in ovulation and that the ovarian reserve is diminishing.
- Luteinizing hormone(LH) – LH works synergistically with FSH. It surges right before ovulation. LH surge only lasts for 24 to 48 hours and it triggers the release of the egg. Raised LH levels at any other stage of the cycle indicate polycystic ovaries or reduced ovarian reserve.Low levels of LH are also bad for your fertility because they indicate problems with your menstrual cycle.
- Estradiol – It is a form of estrogen that regulates your menstrual cycle. Increased estradiol levels indicate a lowered ovarian reserve as your body is producing more of this hormone to bring about the ovulation.
Lowered estradiol can be an indication of PCOS. - Prolactin – Prolactin is associated with your thyroid and pituitary glands. It inhibits FSH and and gonadotropin-releasing hormone (GnRH), prompting them to stop the stimulation of follicles.
Increased Prolactin levels can indicate PCOS, but this could also be because of Hypothyroidism.The level of Prolactin should be weighed against other clinical findings because if your periods are regular and progesterone levels are normal, an increase in Prolactin could be irrelevant.Extremely high levels of Prolactin could be an indication of pituitary tumor. - Progesterone – After an egg is released, the remaining cells of that follicle stop producing estrogen and start producing progesterone, which prepares the uterine lining to receive the embryo.
Progesterone levels peak after a week of ovulation and fall sharply before the next period is due, so they can be an indication of positive ovulation.However, if your periods are irregular, the blood test can be mistimed and inaccurate levels of progesterone may be recorded. So this is not considered a very dependable measure of ovulation and fertility. - Thyroid levels (TSH) – Thyroid problems can mess with your fertility because this is the gland that regulates many hormones in your body. Hypothyroidism or hyperthyroidism may be the reason behind your fertility problems and if you suffer from this, the doctor may decide to correct the levels of Thyroid hormones before offering any fertility treatment.
Scans
A pelvic or TVS ultrasound scan can be very helpful to determine your fertility status. The doctor can look at the follicles on your ovaries and get an idea of your ovarian reserve.
Large numbers of primordial follicles indicate you have good ovarian reserve and one growing follicle means ovulation is happening.
Ultrasounds are also used to check for polycystic ovaries, cysts, uterine fibroids, etc.
These tests are also performed before the doctor starts your IVF treatment.
Advanced tests for infertility
- Cervical mucus test – A cervical mucus test can help your doctor to see if there are any antagonistic antibodies in there that might be killing the sperm.
The mucus also should be of the ideal consistency (raw egg white appearance) to create a sperm-friendly environment. - Hysterosalpingogram (HSG) – HSG is a special X-ray that is performed after injecting small amount of a radio-opaque dye in your uterus. It helps the doctor check the patency of your tubes and the inside of your uterus.
- Saline hysterogram (SHG) – Also known as the water ultrasound or sono hysterogram, this is done to check for fibroids or polyps inside the uterine wall. It is done by first injecting a saline solution into your uterus to expand its walls and then checking for abnormal growths with the ultrasound.
- Hysteroscopy – A hysteroscopy uses a small camera that is inserted into your uterus through the vagina to check for any fibroid or polyp growth or any kind of scarring.
- Laparoscopy – This is performed under general anesthesia. A small camera is inserted into your abdominal cavity through small holes made near the pubic hairline. This allows the surgeon to get a clear view of all your reproductive organs—the ovaries, the uterus, the fallopian tubes and also check for endometrial growths over any other organs.
Scarring in the abdomen or adhesions around other organs can be checked and removed through this laparoscopic surgery. - Endometrial biopsy – Endometrial biopsy involves taking a small piece of the uterine lining to examine under a powerful microscope to check for signs of its proper development as response to progesterone. It is usually done between day 18 and 28 of the cycle.
- Magnetic resonance imaging (MRI) – It is an expensive test that can provide useful information about the uterine wall. It can be helpful in cases of adenomyosis—the condition of endometrial growth over the uterus, as well as pelvic cysts, which are suspected in some cases of infertility, IVF failures, and painful periods.
MRIs are a great diagnostic test because they are non-invasive and unlike the x-rays they are not harmful for the patient, but they are quiet expensive and not often used in cases of infertility.
A female, at birth, has over 6 million eggs, but these are reduced to only about 400,000 by the time she reaches puberty. Of these only 300-400 are actually released during the reproductive years.
But it does not mean all females have about 300 perfect chances at conception because fertilization largely depends upon the quality of the eggs. Given a chance, most women I know, would want to get an analysis of their reproductive health and egg quality. However, there is no do-it-yourself kit for that.
Age is a big factor affecting female fertility. At 30 years of age, a woman is believed to have only 12% of her ovarian reserve and at 40 years, she has only 3% of it. Given you have healthy eggs, doctors believe, it is best to try to start your family before 35 or consider egg freezing.