Fertility Testing

If you have been having regular, unprotected sex for 12 months or more, or 6 months for women over 35, without becoming pregnant, it may be time to see a doctor for a thorough fertility assessment.

Tests for Women

A comprehensive fertility assessment may include the following:

A discussion of your medical and sexual history:

Previous pregnancies, children, or miscarriages
Length of time trying to conceive
Sex, including frequency and if you experience any difficulties or discomfort
The type of contraception you previously used and when you stopped
Past and present medical conditions, including sexually transmitted infections (STIs)
Your menstrual cycle including if you have regular periods and whether you experience bleeding between periods or after sex
Medications that you’re taking, including prescription and non-prescription medicines, herbal remedies and supplements
Lifestyle factors including your weight, alcohol and drug use, history of smoking, sleep, stress, and exercise

Physical examination of your heart, lungs, breasts, and abdomen

Pap Smear if this hasn’t been done within the last 2-3 years, to check for abnormalities in the cervix

Transvaginal Ultrasound to check for

Fibroids
Endometriosis, though this is most commonly diagnosed by a laparoscopy
Polyps or cysts in the uterus or on the ovaries

Antral Follicle Count, a specialised transvaginal ultrasound performed so the physician can visually count the number of egg-containing follicles that are developing on both ovaries and measure ovarian reserve

Hysterosalpingo-contrast sonography (HyCoSy) or Hysterosalpingogram (HSG) to determine if the fallopian tubes are open or blocked and for a more detailed examination of the uterine cavity.

Blood tests

HIV
Hepatitis B and C
Thyroid function
Hormones
- Anti-Müllerian Hormone (AMH)
- Follicle Stimulating Hormone (FSH)
- Luteinising Hormone (LH)
- Estradiol
- Testosterone
- Prolactin
- Progesterone
- Dehydroepiandrosterone Sulfate (DHEA-S)

Tests for Men

A discussion of your medical and sexual history

A physical examination of the testis, penis and scrotum as well as heart, lungs and blood pressure

A Urinalysis to look for infection

Semen Analysis to evaluate the characteristics of the semen and sperm, including

Concentration (the number of sperm present)
Morphology (the size and shape of the sperm)
Motility (the amount of sperm moving and how well it moves)
The volume, colour, odour, pH, viscosity and liquification of semen

To achieve the most accurate results, your doctor may suggest that the semen analysis is repeated two to three times with an interval of seven days to three months between them

Hormone blood tests including

Testosterone
Follicle-stimulating hormone (FSH)
Luteinizing hormone (LH)
Prolactin

If the above assessments are normal, most doctors do not recommend any additional testing. However, there are further tests that you can ask your doctor about, including

Sperm DNA fragmentation test to look at the quality of the sperm, or the percentage of sperm containing genetic damage.

Ultrasound to detect varicoceles or obstructions in the prostate, scrotum, seminal vesicles, and ejaculatory ducts

Anti-Sperm Antibodies Test to identify the presence of antibodies that can kill or damage sperm

Genetic Testing to rule out mutations in one or more gene regions of the Y chromosome