Diagnosis

Before infertility testing, your health care team or clinic works to understand your sexual habits. They might make recommendations to improve your chances of getting pregnant. But in some infertile couples, no clear cause is found. That is called unexplained infertility.

Infertility testing can involve uncomfortable procedures. It can be expensive too. And some medical plans may not cover the cost of fertility treatment. Also, there’s no guarantee that you’ll get pregnant — even after all the testing and counseling.

Tests for men

Male fertility relies on the testicles making enough healthy sperm. The sperm needs to be released from the penis into the vagina, where it has to travel to the waiting egg. Tests for male infertility try to find out whether there are treatable problems with any of these steps.

You may have a physical exam that includes a check of your genitals. Specific infertility tests may include:

• Semen analysis. Your health care team may ask for one or more samples of your semen. Often, you collect semen by masturbating or by stopping sex to ejaculate into a clean container. Then a lab checks your semen sample. In some cases, urine may be tested to find out if it contains sperm.
• Hormone testing. You may get a blood test to check your level of testosterone and other male hormones.
• Genetic testing. This may be done to find out whether a genetic defect is the cause of infertility.
• Testicular biopsy.This procedure removes a small amount of testicle tissue so a lab can check it under a microscope. It’s not common to need a biopsy during infertility testing. Rarely, it may be done to find out whether there is a blockage in the reproductive tract that keeps sperm from leaving the body in semen. Most of the time, this diagnosis can be made based on your history, physical exam and lab tests. Other times, a biopsy may be done to find conditions that contribute to infertility. Or it may be used to collect sperm for assisted reproductive techniques, such as in vitro fertilization (IVF).
• Imaging. In some cases, your health care team may recommend tests that make pictures of the inside of your body. For example, ultrasound can check for problems in the scrotum, in the glands that make fluids that become semen or in the tube that carries sperm out of the testicles. A brain MRI can check for tumors of the pituitary gland that are not cancer. These tumors can cause the gland to make too much of the hormone prolactin, which could lead the body to make less sperm or none.
• Other testing. In rare cases, other tests may be done to check the quality of your sperm. For example, a semen sample may need to be checked for problems with DNA that might damage sperm.

Tests for women

Fertility for women relies on the ovaries releasing healthy eggs. The reproductive tract must let an egg pass into the fallopian tubes and join with sperm. Then the fertilized egg must travel to the uterus and attach to the lining. Tests for female infertility try to find problems with any of those steps.

You may have a physical exam, including a regular pelvic exam. Infertility tests may include:

• Ovulation testing. A blood test measures hormone levels to find out whether you’re ovulating.
• Thyroid function test. This blood test can be done if your health care team thinks your infertility might be related to a problem with the thyroid gland. If the gland makes too much or little thyroid hormone, that could play a role in fertility trouble.
• Hysterosalpingography. Hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fee) checks on the condition of the uterus and fallopian tubes. It also looks for blockages in the fallopian tubes or other problems. Special dye is injected into the uterus, and an X-ray is taken.
• Ovarian reserve testing. This helps your care team find out how many eggs you have for ovulation. The method often begins with hormone testing early in the menstrual cycle.
• Other hormone tests. These check the levels of hormones that control ovulation. They also check pituitary hormones that control processes involved in having a baby.
• Imaging tests. Pelvic ultrasound looks for diseases of the uterus or ovaries. Sometimes a test called a saline infusion sonogram is used to see details inside the uterus that can’t be seen on a regular ultrasound. Another name for the saline infusion test is a sonohysterogram (son-o-his-ter-OH-gram).

Rarely, testing may include:

• Hysteroscopy. Depending on your symptoms, your health care team may use a hysteroscopy (his-ter-os-ko-pee) to look for a disease of the uterus. During the procedure, a thin, lighted device is placed through the cervix into the uterus to check for any irregular signs. It also can help guide minor surgery.
• Laparoscopy. Laparoscopy (lap-u-ros-kuh-pee) involves a small cut beneath the navel. Then a thin viewing device is placed through the cut to check the fallopian tubes, ovaries and uterus. The procedure may find endometriosis, scarring, blockages or other issues with the fallopian tubes. It also might find treatable problems with the ovaries and uterus. Laparoscopy is a type of surgery that can treat certain conditions as well. For example, it can be used to remove growths called fibroids or endometriosis tissue.

Treatment

Infertility treatment depends on:

• The cause of the infertility.
• How long you’ve been infertile.
• Your age and your partner’s age, if you have a partner.
• Personal preferences.

Some causes of infertility can’t be corrected.

If pregnancy doesn’t happen after a year of unprotected sex, couples often can still become pregnant through infertility treatments called assisted reproductive technology. But treatment can involve big financial, physical, emotional and time commitments.

Treatment for men

Men’s treatment for general sexual problems or a lack of healthy sperm may include:

• Lifestyle changes. Your health care team may recommend that you take the following steps. Have sex more often and closer to the time of ovulation. Get regular exercise. Drink less alcohol or give up harmful substances such as tobacco. Stop taking medicines that can affect fertility, but only if your health care team tells you to.
• Medicines. Your team may prescribe medicines to improve sperm count and boost the chances of a successful pregnancy. These prescription drugs may help the testicles function better too.
• Surgery. Sometimes, surgery may be able to reverse a sperm blockage and restore fertility. In other cases, repairing a large varicocele may improve the overall chances for pregnancy.
• Sperm retrieval procedures. These techniques can collect sperm if you can’t ejaculate, or if no sperm is in your semen. Sperm retrieval procedures also may be used when assisted reproductive techniques are planned and sperm counts are low or irregular.

Treatment for women

Some women need only one or two treatments to improve fertility. Others may need a few types of therapies to become pregnant.

• Fertility medicines. These are the main treatments for infertility that’s due to ovulation trouble. They can help the ovaries release an egg if ovulation is irregular or stops happening. Talk with your health care team about your options. Ask about the benefits and risks of each type of fertility medicine.
• Intrauterine insemination (IUI). With IUI, healthy sperm are placed directly in the uterus around the time that the ovary releases one or more eggs to be fertilized. Depending on the reasons for infertility, IUIcan be timed with your menstrual cycle or with the use of fertility medicines. Your partner or a donor provides the sperm.
• Surgery to restore fertility. Some conditions of the uterus can be treated with hysteroscopy. These include polyps, scar tissue and some fibroids. Laparoscopic surgery with small cuts or traditional surgery with a large cut in the stomach area may be needed to treat conditions such as endometriosis, pelvic adhesions and larger fibroids.