What Happens During Infertility Testing?

The first question that I wanted an answer to before scheduling any appointments was, “What happens during infertility testing?” Infertility is scary! You are emotionally and physically drained by the time you start wondering when to seek infertility treatment. But you also have NO IDEA what to expect emotionally and physically during it! What all will you have to endure???

What happens at your first infertility appointment?

Your first appointment will be a “get to know you” appointment. You will more than likely start out in an office setting rather than an exam room. During this time the doctor will:

Look over your gynecologic/medical history with you. If there are any red flags that may be causing your infertility, they will be discussed.
Ask about your sexual history (i.e. miscarriages, partners, protection, STDs, etc…).
Ask about your menstrual cycle (flow, days between cycle, cramps, etc…).
He/she will also ask about family history of infertility on either side.

After this discussion there will probably be a quick physical exam that will include:

Urine sample.
Blood test.
Breast and pelvic exam (to check your cervix).
Height/weight/blood pressure (be aware that there might be BMI restrictions before treatment can occur).
Ultrasound to check your uterus lining, fallopian tubes and ovaries for any abnormalities.

The doctor, at this point, will decide on a POA (plan of action). As our doctor explained it to us, the male is the easier one to weed out during infertility testing. So if the female seems to be in relatively good health with no glaring medical reasons to be infertile, they will usually test the male first.

What happens during male infertility testing?

Semen analysis. He will be asked to ejaculate in a cup. (Men, if you are wondering, my husband said it was super weird and there is just a bunch of 80s porn in the small room.) The sample will then be looked at under a microscope for count and morphology (how the semen look and move).
If the semen analysis looks fine, then they start testing the woman. If not, they will have the male change his lifestyle a bit to see if the issue can be rectified. He may be asked to:

Wear certain underwear
Not use a laptop on his lap
Not keep his phone in his front pocket
Eat certain foods
Avoid certain foods
Abstain from alcohol
Quit smoking
Abstain from sex/masturbation
Avoid certain activities (ex. Heavy lifting)

After making those lifestyle adjustments, the male will produce another semen analysis. If the result is still not what they were hoping for they may continue this cycle of adjustments and testing. (We did this for about a year.)
If the semen analysis improves the doctor may suggest IUI or IVF depending on how many healthy sperm can be obtained.
If the analysis does not improve, the doctor will more than likely perform a testicular biopsy. This is a surgical procedure in which they go into each lobe of the testicles to extract a sample and test for semen. This procedure will look for semen that is being produced but for some reason is not making it into the ejaculate. They will start with one lobe during this procedure. If it contains semen and they can get a large enough sample to use for IVF they will stop. If not they will continue through each lobe (in our case, no semen were found in any lobe).

If the male is found to be infertile, there are two options:

Using donor sperm (which is what we used to try the rounds of IVF and IUI with).
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However, if the male is not a factor or you have chosen to use donor sperm, the woman will be tested next.

What happens during female infertility testing?

Blood Tests: Checking for hormone levels throughout the female’s menstrual cycle. In order for the ovaries to release a mature egg, the hormone levels must be balanced. Hormones tested for:

FSH (follicle-stimulating hormone)
LH (luteinizing hormone)
Estradiol
AMH (anti-mullerian hormone)
Androgen
Progesterone
Prolactin

Sonogram: An ultrasound to diagnose any abnormalities of the uterus or ovaries.
Sonohysterogram: Inter vaginal ultrasound that involves saline being injected into the uterus. Helps to get a better picture of the uterus and look for any abnormalities.
Hysterosalpingogram (HSG): An x-ray test to look at the uterus and fallopian tube structure and function. Dye will be inserted into the vagina and observed via the x-ray.
Ovarian Reserve tests: Ovarian reserve is how many eggs are in a woman’s ovaries. You are born with all of the eggs you will ever have and one is released each month. This test will determine how many are left. Testing for this includes:

ultrasounds
blood tests

Hysteroscopy: A surgical procedure in which a camera is inserted in the cervix. This helps to view and diagnose any issues causing your infertility and can also repair any slight abnormalities, such as:

scar tissue
polps
fibroids
etc…

Laparoscopy: Surgical procedure in which they make an incision in the naval, insert a balloon to expand the abdominal cavity and insert a small camera to evaluate the condition of the uterus, tubes and ovaries. (During my laparoscopy they found a small amount of endometriosis that was not seen through ultrasound. They were also able to scrap the excess tissue off during this procedure.)

At some point during this testing they will hopefully find the reason for your infertility. If they do, then your doctor will determine a PAO (plan of action) to correct the issue and decide upon the best method (IUI/IVF) to obtain a viable pregnancy. If you are found to have unexplained infertility, like I was, then you can also try both methods.

If you are considering or already in the infertility testing process, I wish you all the best! Baby dust all around!

The struggle with infertility is usually such a silent struggle. DO NOT struggle alone! Please find a support local support group or a group on Facebook. Also feel free to comment or email me if you need to talk to someone about your struggle with infertility!