How is infertility tested for?

Not being able to fall pregnant can be upsetting and difficult to deal with. Your doctor will arrange for tests to be done to determine you and your partner’s fertility.

Sometimes, the problem lies with the woman. Sometimes with the man. Sometimes with both. And sometimes, the reason is never found. Your doctor can refer you for fertility tests, which will usually happen in hospital or at a fertility clinic.

Depending on what these fertility tests show, there are a number of treatments available to both of you.

Treatment for infertility can bring hope to people wanting to have a baby, but success is not guaranteed. Infertility treatment also has physical, emotional, and financial costs.

Fertility tests for men

Semen analysis

In about 2 in 5 cases, fertility problems are from the male partner. Sometimes fertility problems are because:

• there are not enough sperm
• the sperm are not moving properly
• the sperm shape is not right

Your doctor can arrange a sperm test (semen analysis).

The male partner will be asked to give a sperm sample and take it for testing. This will probably be at your local hospital or a pathology laboratory.

Hormone tests

Your doctor can arrange a blood test to check the levels of male hormones that control fertility, like testosterone.

Imaging tests

Images (pictures) of your body can be taken by:

• ultrasound
• MRI
• x-rays

These check for problems in your testicles and for tumours on the brain. Both of these can affect how your body makes hormones.

Testicular biopsy

Testicular biopsy involves removing a small piece of your testicle tissue to test for conditions that can cause infertility.

This is a rare test because most of the time a diagnosis can be made using other tests.

Genetic testing

Sometimes the reason for infertility is a genetic defect.

Your doctor may refer you for a genetic test. These will see if there are any genetic issues that might be causing infertility.

Fertility tests for women

Ovulation testing

A blood test can be done to measure hormones that will show if you are ovulating. Ovulation is when the ovaries release an egg into the fallopian tubes.

The levels of hormones in a woman’s blood are closely linked to ovulation. Hormone issues can cause ovulation problems.

Going through a phase of not having periods or having irregular periods, can also be signs of ovulation problems. The most common reason for ovulation problems is polycystic ovary syndrome (PCOS).

Ovarian reserve testing

The level of a hormone called anti-Mullerian hormone (AMH) is measured by a blood test. This test helps find out how many eggs you have for ovulation.

Other hormone tests

Blood tests can be done to check how your thyroid gland is working. If the thyroid gland makes too much or too little thyroid hormone, it can lead to infertility.

Other hormones can also be measured by blood tests to check if their levels are affecting your fertility.

Test for chlamydia

Chlamydia is the most common sexually transmitted infection STI in Australia. It can cause pelvic inflammatory disease and fertility problems.

Your doctor can refer you for a test for chlamydia. This can be:

• a urine test
• a swab from your cervix (this can be self-collected)

Ultrasound scan

Doctors can look for diseases by doing an ultrasound scan on a woman’s ovaries, uterus (womb) and fallopian tubes.

Usually, a transvaginal ultrasound scan is done, where a small ultrasound probe is put in your vagina.

Certain conditions that affect the womb, like endometriosis and fibroids, can stop pregnancy from happening.

The scan can also check for blocks in your fallopian tubes (the tubes that connect the ovaries and the uterus). These could stop your eggs from travelling along the tubes and into the uterus.

Imaging of your fallopian tubes

Blockages can stop eggs moving down your fallopian tubes to the uterus and stop you getting pregnant. Your doctor will arrange imaging to see if this is a problem for you. This may be done by x-ray or ultrasound.

A dye is injected through your cervix while you have an x-ray. The dye will help your doctors to see if there are any blockages in your fallopian tubes. This is called a ‘hysterosalpingogram’ (HSG).

Sometimes an ultrasound technique called HyCoSy (hystero-salpingo contrast sonography) is used to look at your fallopian tubes.

Laparoscopy

If you have a known pelvic problem like pelvic inflammatory disease (PID) or endometriosis, laparoscopy (keyhole surgery) may be done.

This involves making small cuts in your abdomen (tummy). A thin tube with a camera (laparoscope) is used to look at your uterus, fallopian tubes, and ovaries.

What fertility treatments are available?

Fertility treatments try to either:

• fix your infertility issue
• use an assisted reproductive technology like IVF

Your treatment options depend on your cause of infertility. Treatments vary in how much they cost and how well they work.

Hormones

Hormone medicines like clomiphene can help stimulate ovulation.

Surgery

Surgery can be done to treat a blocked or damaged fallopian tubes. Surgery can also be used to remove growths like endometriosis or fibroids.

Intrauterine insemination (IUI)

Intrauterine insemination is where semen is collected and injected into the woman’s uterus by a doctor or nurse. It’s also called IUI or artificial insemination.

IUI is done close to the time that the woman is going to ovulate.

IUI is suitable when:

• there is an issue with the man’s sperm quality or quantity
• the mucus in the cervix is too thick to allow sperm to pass through

It is a simpler, easier, and cheaper form of fertility treatment.

Ovulation induction (OI)

Ovulation induction (OI) involves the woman taking different medicines. These make some of her eggs grow, mature, and be released from the ovaries.

OI is suitable when the woman has ovulation issues but has normal fallopian tubes.

Depending on your situation, you will either:

• start timed sexual intercourse
• attend your fertility clinic for intrauterine insemination — this is when semen are injected into the uterus by a doctor or nurse

In vitro fertilisation (IVF)

IVF is a well-known form of pregnancy treatment that is used for many types of fertility issues.

IVF is more invasive and expensive than IUI or OI because it has more steps.

Firstly, the woman is given medicines. These make some of her eggs grow, mature, and then be released from the ovaries. These eggs are collected by a minor surgery. The eggs are then mixed in a dish with sperm to fertilise them. The fertilised eggs are then tracked to see if they develop into embryos. An embryo is then injected into the woman's womb by a doctor using a fine tube.

IVF may also be suitable:

• for fertility issues
• if you are in a same sex relationship and want to have a child.
• if you are single and want to have a child
• if you or your partner have a genetic disorder which you do not want to pass on to your child

Preimplantation genetic testing can be done on the embryos from IVF before they are transferred to the woman's womb.

Intracytoplasmic sperm injection (ICSI)

ICSI is similar to IVF, but with one difference. For ICSI, a single sperm is injected into the egg to fertilise it by an expert using a needle.

ICSI is usually used if there are male fertility issues like low sperm numbers.

Sperm harvesting procedures

If there is no sperm in the semen (obstructive azoospermia), sperm can be collected from the testicles using a needle. These can be used for IVF or ICSI .

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What other treatment options are available?

Donor conception may be another option to get pregnant. Donor sperm, donor eggs, or donor embryos can all be used to help you become pregnant.

People who can’t get pregnant may also consider surrogacy or adoption.