Fertility testing shouldn’t be scary – here’s everything you need to know

For many experiencing problems conceiving, fertility testing can offer valuable health insights. Here Tess Cosad, CEO and co-founder at Béa Fertility, explains everything you need to know.

Around one in seven couples will have difficulties conceiving. Fertility problems can be caused by a number of factors, including health conditions like endometriosis and fibroids, having a low sperm or egg count, or lifestyle factors such as smoking.

For one in four couples, a specific cause cannot be identified. Nevertheless, the best place to start if you’ve been struggling to conceive for over a year is to undergo fertility testing.

What is fertility testing?

Fertility tests are investigations designed to help determine if there’s an underlying cause as to why you’re not getting pregnant.

You can undergo fertility testing via your GP, or you can order tests online using companies such as Hertility (female hormone and fertility testing) and ExSeed (sperm testing).

Based on the results of your tests, your GP should be able to advise on next steps to help you conceive.

There are different tests available to determine male factor infertility, female factor infertility or unexplained infertility.

What to expect when undergoing fertility testing?

The fertility testing process will differ slightly depending on whether you order tests online, or seek testing through your GP.

If you are going through your GP, they will usually ask questions about your menstrual cycle, your medical history, if you take any medications, how long you’ve been trying to conceive for and when and how often you have sex. These questions will help your doctor work out what investigations to perform.

Most commonly, these investigations will often involve blood tests to establish if you’re ovulating, an ultrasound to assess your uterus, fallopian tubes and ovaries and a semen analysis which will show the quantity and quality of semen and sperm.

It’s important to be honest and transparent when answering your GPs questions. Although the questions may feel personal, responding honestly will help them make well-informed decisions on best next steps.

What are the different types of fertility tests?

When you first approach your GP for fertility testing, they will perform some initial investigations using blood tests.

If you order a fertility testing kit online, you will usually be asked a series of questions to help the company determine which tests to send you.

The exact tests you undergo will depend on your specific circumstances, but will typically involve tests to assess menstrual cycle hormones, thyroid hormones and indicators of ovarian reserve.

• AMH (anti-müllerian hormone) test – AMH is produced by the follicles in your ovaries, little sacs. Just as women’s egg count decreases with age, so do our AMH levels. An AMH test can give a good indication of egg quantity, and can also help signal some reproductive health conditions like polycystic ovaries.

• P21 or progesterone test – This is a blood test that is performed in the middle of the luteal phase, which is after ovulation and before your period begins. The test is scheduled for seven days before your period begins, so the timing is based on the length of your cycle. In a 28 day cycle, this test would commonly be performed on day 21. The test measures progesterone levels to assess if ovulation has taken place.

• FSH (follicle stimulating hormone) test – FSH stimulates the growth and production of eggs in the first part of the menstrual cycle. This blood test may be used to give an indication of the ovarian reserve – how many eggs you have in your ovaries.

• LH (luteinising hormone) test – LH should reach a peak before ovulation: a rise in the hormone signals to the ovaries to release an egg. If LH levels are overly high, this can have an abnormal effect on the ovaries. The LH test is used to assess LH levels and their impact on egg release.

• E2 (oestradiol) test – High levels of oestradiol may suppress other reproductive hormones that are responsible for ovulation, so an elevated E2 could mean that you’re not ovulating each month. The E2 test assesses E2 levels to understand whether this hormone is impacting ovulation.

Depending on your circumstances, your GP may also arrange the following tests:

• Prolactin test – Elevated levels of prolactin may suppress ovulation, so prolactin may be checked if periods are absent.

• TSH (thyroid stimulating hormone) – Both an overactive and an underactive thyroid gland can have an impact on ovulation. Measuring TSH levels would give an indication as to whether this is the cause of any fertility issues.

• Testosterone – Raised levels of testosterone in women can disrupt the menstrual cycle and may lead to irregular cycles. In men, low levels of testosterone can impact sperm production.

An ultrasound may also be performed to examine the uterus, fallopian tubes and ovaries and identify abnormalities.

Testing for male factor infertility

During early fertility investigations, a semen analysis is often performed to check if there are any issues with the sperm, such as a low sperm count or low motility (movement of the sperm). They will test for the following factors:

• Semen volume

• Sperm concentration (concentration of sperm per millilitre of semen)

• Sperm count (total number of sperm number)

• Sperm motility

• Sperm morphology (whether majority of sperm are ‘normal’ or abnormal forms)

If the result comes back abnormal, a semen analysis would usually be performed again in three months’ time.

The term infertility can sound scary, but it doesn’t mean you’ll never become a parent.

Fertility testing is the first step to help doctors identify the potential root of the problem, and they will use this information to recommend treatments and next steps.

Even if you are diagnosed with ‘unexplained infertility’, there are lots of brilliant fertility treatment options out there to help you on your journey to starting a family.

If you choose to seek fertility testing using a private company, rather than going through your GP, do your research to ensure you’re ordering your tests from a reputable source with a track record of accurate and actionable results.