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Fertility Assessment Process for Men & Women

Fertility assessments are pivotal in the fertility process, helping healthcare providers develop personalized strategies for couples or individuals struggling with infertility.

As time progresses, medical providers are gathering more ways to assess fertility in men and women. While some assessments are similar, the testing processes are drastically different. In this article, we explore the fertility assessment process for men and women. That way, you will be better prepared to understand what to expect, alleviating some stressors, anxiety, or concerns.

Female Fertility Assessment

Given the location of a woman’s reproductive system, fertility tests can be extensive and involved. A female fertility assessment can include various components, from blood tests that evaluate hormones to procedures that offer a closer look.

Ovarian Reserve Testing

An ovarian reserve test employs various tools to estimate your egg count. Women can have hundreds of thousands to millions of eggs, although this number varies drastically from one woman to the next based on factors specific to her.

Fertility experts use ovarian reserve testing to evaluate the number of remaining eggs. While healthcare providers can’t use ovarian reserve testing as a standalone to determine how fertile you are, it’s a helpful tool in their arsenal for developing a personalized plan for you. To do this, they use several tests to examine FSH levels, AMH levels, and antral follicle count.

FSH Levels

Follicle-stimulating hormones (FSH) regulate the growth of eggs in your ovaries, thus helping control the menstrual cycle. FSH comes from the pituitary gland, which supplies fluctuating levels throughout a woman’s menstrual cycle, achieving the highest levels just before ovulation, when an ovary releases an egg.

When testing FSH levels, providers generally wait until the third day of your menstrual cycle. Day three is commonly regarded as the baseline, as this is the period of stability for FSH and other hormones before they rise.

This test helps determine whether your FSH levels are too high or low, as extremes can make achieving pregnancy difficult.

AMH Levels

The anti-mullerian hormone (AMH) test helps estimate the quantity of eggs you have. The follicles in your ovaries, which store your eggs, produce this hormone. Higher levels of AMH translate to a larger egg supply, which naturally decreases as you age. After menopause, these levels drop to zero, as no eggs are left.

This test can’t determine the health of your eggs or determine pregnancy opportunities, but it can tell you more about the size of your ovarian reserve.

Antral Follicle Count

The antral follicle count (AFC) test entails a transvaginal ultrasound intended to count the number of follicles in your ovaries. It helps predict the number of mature follicles and determine the status of your ovarian reserve.

While each component of the ovarian reserve testing process has limitations, the combined test results can help paint a more accurate picture.

Infertility Blood Work

Many healthcare providers utilize blood work to test for infertility. The tests and methodology may vary based on factors specific to your scenario, but common tests include the following:

  • Prolactin: The pituitary gland makes this hormone, which stimulates milk production and can be used to evaluate infertility.
  • Progesterone:  This hormone comes from the ovaries during ovulation to prepare the endometrial lining for fertilized eggs. Serum progesterone tests can help determine if ovulation occurs, as progesterone levels increase during the luteal phase of the menstrual cycle.
  • Estradiol: As an essential form of estrogen, estradiol plays a key role in fertility testing. Testing is used to evaluate egg quality and ovarian function.
  • Luteinizing hormone (LH): This hormone is connected to egg maturation and ovarian hormone production, so healthcare providers use it to diagnose hormone imbalances that may impact your fertility, like PCOS.

Reproductive System Test

In addition to blood tests, healthcare providers may employ reproductive system testing to evaluate your reproductive organs.

For example, hysterosalpingograms (HSG), or tubograms, are X-rays of your uterus and fallopian tubes. Your doctor will inject a dye into those areas through the cervix, which helps create contrast to identify blockages or other problems.

Hysteroscopies often follow tubograms when abnormalities are identified. Doctors insert a  hysteroscope through the cervix to scan your uterus for abnormalities, growths, and scarring.

Laparoscopies require general anesthesia and help examine the uterus, ovaries, and fallopian tubes for endometriosis, scar tissue, and adhesions. If your doctor finds abnormalities, they can remove them using a laser. This procedure utilizes a fiber-optic telescope inserted into the abdomen, so general anesthesia is required.

In some cases, doctors conduct endometrial biopsies, which entails scraping tissue from the endometrium. This procedure, done before menstruation, helps gauge the lining of the uterus to determine if it’s thick enough for successful egg implantation.

Genetic Testing for Infertility

Specific genetic tests can play a role in testing for infertility. These tests can help determine whether you carry a genetic change that may impact your fertility. This helps healthcare providers create a more well-rounded plan based on your unique case.

For example, they might use genetic carrier screening, which looks for the fragile X syndrome gene. Women carrying this gene have an increased risk of experiencing primary ovarian insufficiency (POI), which can significantly impact fertility. POI occurs when the ovaries cease normal function before age 40, leading to a lack of ovulation that complicates natural pregnancy.

However, a diagnosis of primary ovarian insufficiency doesn’t automatically mean you cannot get pregnant. Around 25% of those who experience POI may still experience ovulation at least once following the diagnosis. This test is simply another piece in the fertility assessment puzzle that aids your healthcare provider in crafting a plan tailored to you.

Male Fertility Assessment

Fertility assessments tailored to men share some similarities to women’s, such as bloodwork to test hormone levels. Aside from hormone testing, semen analysis testing is pivotal in male fertility assessments. Ultrasounds and additional tests might be necessary, although this hinges on your specific plan.

Semen Analysis Test

Healthcare providers often use semen analyses to determine male fertility. These analyses check for sperm in the semen, including the volume, concentration, morphology, and motility. In addition, it measures the time to liquefaction or how quickly semen converts from a sticky substance to a liquid.

It measures vitality, which is the percentage of live sperm in the sample, and the pH level, which can affect sperm health. Lastly, it checks for white blood cells, which can indicate an infection or inflammation that requires attention.

Each factor helps your healthcare provider develop a well-rounded understanding of your current fertility levels. In some cases, men need to provide multiple samples spaced several weeks apart, as sperm counts can vary from day to day.

Scrotal or Transrectal Ultrasounds

Healthcare providers often use ultrasounds to help pinpoint problems causing infertility. The high-frequency sound waves create images that allow doctors to view the inside of your body.

During scrotal ultrasounds, doctors look for a varicocele, which is the enlargement of the veins transporting oxygen-depleted blood away from the testicles or other problems associated with the testicles and surrounding structures.

In transrectal ultrasounds, doctors use small ultrasound wands inserted into your rectum to check the prostate for abnormalities and blockages in the tubes that transport semen.

Blood Tests

Bloodwork can be a necessary step during fertility assessments. Doctors may test your blood testosterone, FSH, LH, and prolactin levels. In men, the follicle-stimulating hormone stimulates testicular growth and aids in producing proteins crucial to male fertility.

Leutinizing hormone aids by stimulating testosterone production from interstitial Leydig cells. This is a crucial part of spermatogenesis, so abnormalities with luteinizing hormone levels can contribute to infertility.

Prolactin can contribute to male infertility when levels in the body climb too high, as this condition, called hyperprolactinemia, can inhibit pulsatile gonadotropin releases from the pituitary gland. This has a direct impact on spermatogenesis and can contribute to infertility.

Fertility Assessment Costs

The costs of fertility assessments are highly dependent on factors specific to your scenario, as every situation is different. For example, while one man may undergo a single round of semen analysis testing, another may undergo hormone testing on top of semen testing.

Location, treatment protocol, and budget are key contributing factors behind the cost of your fertility assessment. While the price can be high, some fertility clinics offer financing programs to help you manage assessment pricing. Options vary based on the fertility clinic you choose.

Start Your Fertility Journey Today

The fertility assessment process and following the treatment plan can be overwhelming. At ELITE IVF, we believe in supporting you right from the start.  Our medical team would be happy to provide you with a first or second opinion on your fertility status. We also offer performance based clinical outcome guarantees following fertility assessments with ELITE IVF, such as our Live Birth Guarantee. Contact us today to learn more about what we can do for your fertility future, today.

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