Fertility testing & diagnosis for women at a glance
- If a woman is unable to become pregnant after more than one year of trying or if she has an existing infertility condition, she should consider fertility testing.
- Because age can affect a woman’s fertility, women age 35 or older should consider fertility testing if they are unable to become pregnant after six months of trying.
- Fertility testing to diagnose the cause of infertility in women may involve discussion of medical history, blood tests and minimally invasive procedures.
- When testing fails to identify a specific cause, the diagnosis is “unexplained infertility,” which affects approximately 15 to 30 percent of infertile couples, according to the National Institutes of Health.
What is fertility testing and infertility diagnosis for women?
A woman should consider fertility testing if she has been actively trying to get pregnant, by having unprotected intercourse on a regular basis with her partner, for more than one year. If a woman is age 35 or older, she should consider fertility testing after six months of trying to get pregnant. According to the American Society for Reproductive Medicine, infertility affects men and women equally, so both partners should be tested.
Fertility tests for women help identify the cause(s) of infertility so the condition can be properly treated and the couple can have the best chance to conceive. Fertility tests for women often involve:
- Medical history discussion, especially to check for ovulation or menstrual cycle issues.
- Blood tests to check hormone levels and ovarian reserve (the number of potential eggs remaining in a woman’s ovaries).
- Pelvic examination.
- Minimally invasive procedures, such as ultrasound imaging (sonogram) and surgery, to check for structural causes of infertility.
Which women should consider fertility testing?
In addition to women unable to get pregnant for a year (six months if over age 35), women with the following conditions should consider fertility testing:
- Diagnosed reproductive system issues of the fallopian tubes, ovaries or uterus.
- Menstruation that is heavy, irregular (more than 35 days between periods) or absent.
- Recurrent miscarriages.
- History of pelvic inflammatory disease, pelvic pain or endometriosis.
- Partner with suspected or identified male infertility.
Fertility tests for women
The following tests for female infertility are performed by providers at Women & Infants’ Fertility Center:
Medical history assessment
At the initial visit, the fertility specialist will ask questions about the woman’s health and sexual history. Learning about the patient’s history is an essential part of how the physician diagnoses the cause of infertility. For example, the physician may learn of a prior sexually transmitted infection or infrequent ovulation/menstrual periods that may be the cause of infertility. The first appointment will provide information for the doctor to determine if further testing should be conducted.
Sonogram (ultrasound imaging)
After the initial consult, the fertility specialist may perform a sonogram (image produced by ultrasound echo) of the woman’s pelvic area to determine any issues affecting her fertility. The pelvic ultrasound can diagnose such problems as an abnormally shaped uterus or cysts in the ovaries.
Hormone blood tests
Blood tests are done at different times during a woman’s menstrual cycle to measure hormone levels in the blood. For an egg to reach maturation and the ovaries to release an egg, a woman must have balanced hormone levels. The doctor performing the blood hormone test will determine if the woman is producing high quality eggs and if the brain is properly sending hormonal signals to the ovaries. An evaluation for follicle-stimulating hormone (FSH) levels drawn on cycle day three (three days after a woman’s period starts) is a common test for women. Other possible blood tests for hormones include anti-Müllerian hormone (AMH) and estradiol.
Ovarian reserve test
Testing for ovarian reserve assesses the potential number of eggs a woman has in her ovaries. Ovarian reserve testing may involve an ultrasound or blood tests.
These tests are recommended if a woman is at high risk of having a depleted ovarian reserve. These risks include:
- Unexplained infertility diagnosis.
- Age 35 or older.
- Family history of early menopause.
- Previous reproductive surgery.
- Having only one ovary.
- Previous gonadotropin ovarian stimulation.
- Previous treatment with toxic agents such as chemotherapy.
Laparoscopy is a minimally invasive surgery in which the doctor inserts a camera and small surgical instruments into the abdominal cavity through a small incision in the belly button. Laparoscopic surgery is used to evaluate and treat endometriosis and to remove uterine fibroids, ovarian cysts and scar tissue.
Sonohysterogram uses a saline solution to fill the uterine cavity and a transvaginal ultrasound to create a clear image of the uterus. The procedure helps diagnose uterine lesions and irregular growths including fibroids or polyps.
A hysterosalpingogram is a procedure using an X-ray image of a woman’s fallopian tubes and uterus. The fertility specialist will insert a catheter (small tube) containing dye into the cervix that will help the structure of the uterus and fallopian tubes show up on the X-ray. This procedure can help locate obstructions in the fallopian tubes or uterine cavity, such as polyps and fibroids, and detect an unusually shaped uterus.
This minimally invasive surgical means of viewing and diagnosing polyps and fibroids in the uterus involves a small camera inserted in the cervix. Hysteroscopy can also be used to repair abnormalities in the uterine cavity, such as polyps, fibroids, uterine septa (divided uterus), and scar tissue inside the uterine cavity.
A noninvasive way to examine a woman’s reproductive system, an ultrasound helps diagnose anatomic problems such as uterine fibroids and ovarian cysts. At Women & Infants’ Fertility Center, this procedure will most commonly be performed transvaginally.