Initial Tests in Infertility Evaluation
When pregnancy does not occur despite regular, unprotected sexual intercourse, a medical evaluation can help identify possible contributing factors and guide the next steps. Initial infertility tests are not the same for everyone. The recommended tests depend on factors such as age, medical history, how long the couple has been trying to conceive, and the individual circumstances of both partners.
Initial Infertility Tests: What Tests Are Used to Evaluate Fertility?
1. Medical and Menstrual History
The evaluation usually begins with questions about menstrual regularity, previous pregnancies or miscarriages, medical conditions, past surgeries, and the duration of attempts to conceive. This information helps the clinician determine which tests may be necessary.
2. Hormone Blood Tests
When indicated, blood tests may be used to assess certain reproductive hormones. Follicle-stimulating hormone (FSH), estradiol, and anti-Müllerian hormone (AMH) may be measured to help assess ovarian reserve and plan treatment. Thyroid function or prolactin testing may also be recommended in specific circumstances to investigate possible hormonal conditions affecting ovulation.
These results must be interpreted in context. Hormone tests alone cannot reliably determine whether a person will achieve a natural pregnancy.
3. Transvaginal Ultrasound
Transvaginal ultrasound allows the clinician to examine the uterus, ovaries, and surrounding pelvic structures. It may also be used to count antral follicles and assess aspects of ovarian function.
4. Semen Analysis
Semen analysis is an important part of evaluating male fertility. It assesses characteristics such as sperm concentration, movement (motility), and shape (morphology). Evaluating both partners in parallel, when appropriate, can help avoid unnecessary delays in identifying possible causes.
5. Assessment of the Fallopian Tubes
When indicated, a hysterosalpingography (HSG), commonly known as an X-ray dye test, may be performed to assess the shape of the uterine cavity and whether the fallopian tubes are open.
Not everyone needs every test. Additional investigations or more invasive procedures are generally recommended only when specific clinical findings justify them. The clinician interprets the results alongside the patient's medical history and may request further investigations based on the initial findings.
Key takeaway:
Infertility evaluation is not limited to one partner. Assessing factors affecting both partners, according to their individual circumstances, is an important part of the diagnostic process. Targeted testing can help guide decisions about the most appropriate next steps.
Scientific references
1. American Society for Reproductive Medicine (ASRM). Fertility Evaluation of Infertile Women: A Committee Opinion.
Read the ASRM clinical guidance.
ASRM
2. American College of Obstetricians and Gynecologists (ACOG). Evaluating Infertility.
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