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Diagnostic Testing for Infertility

Revised 2023


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When is fertility testing recommended?

Fertility testing is typically recommended for heterosexual couples who have not become pregnant after 12 months of trying to conceive. Earlier evaluation is appropriate after six months for over the age of 35, or for younger people with known health concerns that may make it more difficult to get pregnant, for example:

    • History of irregular menstrual cycles (over 35 days apart or no periods at all)
    • Known or suspected problems with the uterus (womb), tubes, or other problems in the abdominal cavity (like endometriosis or adhesions)
    • Known or suspected male infertility problems
    • History of cancer treatment in either partner
    • Individuals or couples planning treatment with donor sperm, donor egg, donor embryo or a gestational carrier.

Any evaluation for infertility should be done in a focused and cost-effective way to find all relevant factors and should include both partners.

The least invasive methods that can detect the most common causes of infertility should be done first.

The speed and extent of evaluation should take into account the couple’s preferences, age, the duration of infertility, and unique features of the medical history and physical examination.

The following tests are recommended:

Semen Analysis

The semen analysis is an essential part of the infertility evaluation. A semen analysis should provide information about the number, movement, and shape of the sperm. A semen analysis is necessary even if the partner has had children before. 

Hysterosalpingogram (HSG) or Saline Infusion Sonogram

This is an X-ray or ultrasound procedure to see if the fallopian tubes are open and to if the shape of the uterine cavity is normal. A catheter is inserted into the opening of the cervix through the vagina. A liquid is injected through the catheter. The contrast fills the uterus and enters the tubes, outlining the length of the tubes, and spills out their ends if they are open.

Transvaginal Ultrasonography

An ultrasound probe placed in the vagina allows the clinician to check the uterus and ovaries for abnormalities such as fibroids and ovarian cysts.

Ovarian Reserve Testing

The best indicator of egg quality is the age of the ovaries. Young patients typically have eggs that contain the correct number of chromosomes that have a high chance of achieving pregnancy, while older patients, particularly patients over 40 years of age, have eggs with incorrect chromosome numbers that make it harder to get pregnant and also lead to a higher risk of miscarriage.

When testing ovarian reserve, the clinician is trying to predict how well the ovaries will respond to a hormone called Follicle Stimulating hormone (FSH). One of the most commonly used tests for ovarian reserve is a blood test called Antimullerian hormone (AMH). Another common test is to count the small follicles resting in the ovary by ultrasound. This is called an antral follicle count; these small follicles make AMH, and thus the AMH level is a good indicator of how many of these small follicles are in the ovary. Another common test to evaluate ovarian reserve is a blood test for follicle-stimulating hormone (FSH) drawn in the beginning of the menstrual cycle (typically days 2 to 5).

Ovarian reserve testing is more important when the patient is 1) over age 35 years; 2) has a family history of early menopause; 3) has a single ovary; 4) has a history of previous ovarian surgery, chemotherapy, or pelvic radiation therapy; 5) has endometriosis or unexplained infertility; or 6) has shown poor response to gonadotropin ovarian stimulation in prior treatment cycles.

Other Blood Tests

Thyroid-stimulating hormone (TSH) and prolactin levels are useful in identifying thyroid disorders and hyperprolactinemia, which may cause problems with fertility, menstrual irregularities, and repeated miscarriages. When excess hair growth is present (called hirsutism) on the face and/or down the middle of the chest or abdomen, blood tests for dehydroepiandrosterone sulfate (DHEAS), 17-α hydroxyprogesterone, and total testosterone should be considered. A blood progesterone level drawn in the second half of the menstrual cycle can help determine whether ovulation has occurred.

Urinary Luteinizing Hormone (LH)

Over-the-counter “ovulation predictor kits” detect the presence of LH in urine and can detect a rise in this hormone that occurs one to two days before ovulation. In contrast to blood progesterone levels, urinary LH tests can predict ovulation before it occurs. Urinary LH testing helps define the times of greatest fertility: the day of the LH surge and the following two days. However, these tests can be expensive and are most effective when menstrual cycles are regular, and 25-35 days in length.

For best results, the infertility evaluation should be individualized based on each person’s specific circumstances.

Fact Sheets/Booklets

View more fact sheets and booklets written by the ASRM Patient Education Committee.
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Menopausal Transition (Perimenopause): What Is It?

The menopausal transition (perimenopause) is the period that links a woman’s reproductive (childbearing) years and menopause.
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Osteoporosis

Osteoporosis and osteopenia are conditions of having low bone mass (density).
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Hyperprolactinemia (High Prolactin Levels)

Prolactin is a hormone produced by your pituitary gland which sits at the bottom of the brain.
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Stress and infertility

It is not clear how exactly stress impacts fertility.

Resources For You

The American Society for Reproductive Medicine (ASRM) is committed to providing patients with the highest quality information about reproductive care.

Female Fertility

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SART Fertility Experts - Fertility Myths and Realities for Black Women

Black women are more likely to experience infertility and less likely to seek and receive timely treatment. Listen to the Episode
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SART Fertility Experts - Wellness and Fertility: Diet, Sleep and Exercise

Drs. Timothy Hickman and Rashmi Kudesia discuss the links between lifestyle and fertility. Listen to the Episode
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Female Fertility Journey

If you've been trying to get pregnant for more than a year, you may have infertility. Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children.

View the Patient Journey
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Stress and infertility

It is not clear how exactly stress impacts fertility. Read the Fact Sheet
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Optimizing Natural Fertility

Before attempting pregnancy, a woman should make sure she is healthy enough for pregnancy by adopting a healthier lifestyle and taking prenatal vitamins. If she has a medical or genetic condition or risk of one, she should seek advice from a medical professional before conceiving (becoming pregnant) View the fact sheet
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Am I Ovulating?

Ovulation is the release of an egg from a woman’s ovaries and is essential for getting pregnant. View the Fact Sheet
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Abnormalities of the Female Reproductive Tract (Müllerian Anomalies)

Sometimes the uterus and fallopian tubes may not form like they should. These malformations are called müllerian anomalies or defects. Müllerian anomalies may make it difficult or impossible to become pregnant. View the Fact Sheet
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Conditions Treated with Surgery on the Fallopian Tubes and Ovaries

Surgery can be used to treat problems with the ovaries or fallopian tubes, such as cysts, endometriosis, or infections. View the Fact Sheet
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Diagnostic Testing for Infertility

An evaluation of a woman for infertility is appropriate for women who have not become pregnant after having 12 months of regular, unprotected intercourse. View the Fact Sheet
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Dilation and Curettage (D&C)

“Dilation and curettage” (D&C) is a short surgical procedure that removes tissue from your uterus (womb). You may need this procedure if you have unexplained or abnormal bleeding or if you have delivered a baby and placental tissue remains in your womb. View the Fact Sheet
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Evaluation of the Uterus

If you haven’t been able to get pregnant after trying for 6 months, some tests can be done to help find the reason. Your doctor may test your hormone levels, your partner’s sperm, and your reproductive organs (ovaries, fallopian tubes, and uterus [womb]). View the Fact Sheet
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Female Cancers, Cryopreservation, and Fertility

Yes! New technology lets your doctor remove and freeze eggs, fertilized eggs (embryos), or ovarian tissue before treating your cancer. This way, you may be able to have children after your treatment. View the Fact Sheet
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Fertility Drugs And The Risk of Multiple Births

Infertility treatments that cause multiple eggs to develop make it more likely that you will become pregnant with twins, triplets, or more. This is called multiple gestation. View the Fact Sheet
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Hypothyroidism and pregnancy: what should I know?

Hypothyroidism (underactive thyroid) is when the thyroid gland produces less  thyroid hormone than it should. View the Fact Sheet
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Ovulation Detection

Ovulation, the release of an egg from its follicle in one of a woman’s two ovaries, is one of the most important factors in conceiving a child. View the fact sheet
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Weight and fertility

One of the easiest ways to determine if you are underweight or overweight is to calculate your body mass index (BMI). View the fact sheet
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SART Fertility Experts - Endometriosis

Endometriosis is a condition that can affect many facets of a person’s life, from pelvic pain to struggles with infertility.   Listen to the Episode
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SART Fertility Experts - IVF: Cycles of Hope and Heartbreak

Does stress cause infertility or is it the other way round?  Listen to the Episode
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What is Recurrent Pregnancy Loss (RPL)?

This is a condition when a woman has 2 or more clinical pregnancy losses (miscarriages) before the pregnancies reach 20 weeks. View the fact sheet
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SART Fertility Experts - Fibroids and Fertility

Fibroids and their impact on fertility are discussed in this episode featuring Dr. Elizabeth Stewart, interviewed by host Dr. Brooke Rossi.  Listen to the Episode
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Infertility: an Overview (booklet)

Infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. View the booklet
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Infertility

Infertility is the result of a disease (an interruption, cessation, or disorder of body functions, systems, or organs) of the male or female reproductive tract which prevents the conception of a child or the ability to carry a pregnancy to delivery.  Watch Video
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Basic Infertility Evaluation

Dr. Roger Lobo of the American Society for Reproductive Medicine discusses the various methods to evaluate infertility. Watch Video
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Fibroid Tumors

An educational video that answers patient questions about the causes, symptoms, diagnosis and management of uterine fibroids. Watch Video
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Infertility Treatments

Dr. Roger Lobo of the American Society for Reproductive Medicine discusses the various treatments for infertility. Watch Video
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Understanding Fertility

In this video series, Dr. Roger Lobo explains the basics of infertility, including causes, treatments and coping methods. Watch Video
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Surviving the Roller Coaster Emotions of Infertility Treatment

The experience of infertility is a rollercoaster of hope and disappointment. Treatment presents an opportunity for hope as well as a new set of challenges. Watch Video
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Endometriosis (booklet)

Women with endometriosis may experience infertility, pelvic pain, or both. This booklet will describe options for diagnosing and treating pain or infertility that may be attributed to endometriosis. View the Booklet
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Causes of Female Infertility

Dr. Roger Lobo, of the American Society for Reproductive Medicine explains the causes of female infertility. Watch Video
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FAQ About Infertility

Infertility is not an inconvenience; it's a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction. Learn the facts
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Female Fertility Infographics

ASRM has prepared infographics to illustrate the subject of Female Fertility better. View the Infographics
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Ovarian Reserve Infographics

ASRM has prepared infographics to illustrate the subject of Ovarian Reserve better. View the Infographics

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