It is best to seek the assistance of a fertility specialist if you are younger than 35 and haven’t been successful in achieving a pregnancy in 12 months. For couples older than 35, it is recommended after trying for 6 months.
We know that coming into a fertility clinic for testing can be stressful when you don’t know what to expect. To help, our fertility specialists have put together a blog outlining everything you need to know. We’ll introduce you to the different types of infertility tests and prepare you with a general idea of what constitutes a positive or negative result for each test.
What kinds of tests are there for infertility?
When you visit an RMA fertility clinic, our specialist will want to talk to you about your full medical history and any previous treatments you may have had, including a review of the results from any previous infertility tests.
He or she will also probably want to carry out a general physical examination of both partners where appropriate in order to assess your general health. Not all types of infertility tests will be needed for each individual case so this baseline assessment can provide the specialist an idea of where to start.
Infertility tests fall into two main types. First, there are blood tests: these tests can analyze the presence and/or quantity of different hormones. The second type is imaging which can help the fertility specialist ‘see’ inside your reproductive system to identify what, if any, the problem is.
Blood tests for fertility
The human body naturally produces a whole range of powerful hormones, each of which has a different role to play in the complex system that regulates menstruation, ovulation, and the reproductive cycle including pregnancy. Too much or too little of one can impact the others and upset this delicate balance. Bloodwork helps a physician to assess these hormones. Usually, your doctor will order them before any fertility treatment can be started. Sometimes a test previously carried out within the last 6 – 12 months can be used, but often a fresh test is required.
When considering the results of the various hormone levels it is important to remember that they vary between individuals and can be an indication of different things according to many factors such as age and general health history.
Estradiol is one of the most potent of the group of steroid hormones known as estrogens. It controls the development and maintenance of female sex characteristics and acts on female reproductive organs including the lining of the vagina and fallopian tubes. Estradiol is produced by the growth of follicles, the tiny sacs containing eggs in the ovaries, and results in the production of fertile mucous from the cervix, as well as prepares the lining of the uterus for a fertilized egg, or embryo, to implant.
- Estradiol levels are measured in picograms per milliliter (pg/ml).
- Normal levels vary widely depending on your phase of the menstrual cycle and can range between 30 to 400 pg/ml.
Anti-Müllerian Hormone (AMH)
Anti-Müllerian hormone is produced primarily in a woman’s ovaries.
- AMH blood levels are measured in nanograms per milliliter (ng/ml).
- Normal levels are considered to be at least over 1.0 ng/ml although very high levels may indicate another problem.
Follicle Stimulating Hormone (FSH)
Follicle-stimulating hormone is produced by the pituitary gland in the brain. Its levels in the blood fluctuate according to the menstrual cycle. A rise in FSH during the first half of the cycle stimulates the growth of the egg-containing follicles and as they mature, it acts together with other hormones to trigger ovulation. After ovulation, feedback to the pituitary inhibits the release of FSH, making levels lower.
- FSH is measured in milli-international units per milliliter (mIU/ml).
- A good level for a baseline test, when FSH should be low, is probably less than 10 mIU/ml but results need careful interpretation by a fertility expert as part of the overall hormone balance.
- Abnormally high FSH levels can be an indicator of a low ovarian reserve.
Luteinizing Hormone (LH)
After initial stimulation of the follicles by FSH during the first part of the menstrual cycle, a surge in LH produced by the pituitary gland stimulates the release of an egg from the follicle or the process known as ovulation. A measurement of this surge is often used to predict a woman’s most fertile period.
Progesterone prepares the lining of the uterus by stabilizing it to be ready for the implantation of a fertilized egg, or embryo, following ovulation. If you do become pregnant following ovulation, progesterone levels increase and help to sustain the pregnancy. If you do not become pregnant, levels of progesterone decline, and this helps trigger the onset of a menstrual cycle.
- In a regular menstrual cycle, progesterone levels fluctuate throughout the month.
- You would expect the highest levels in the middle of the luteal phase of your cycle, and usually, concentrations of more than 3 ng/ml suggest that you have ovulated.
- Levels of 8-10 10 ng/ml are desired for pregnancy.
It is normal for small amounts of the ‘male hormones” or androgens, such as testosterone and DHEA-S, to be produced in women. However excess production leading to abnormally high levels could interfere with the development of ovarian follicles and ovulation. Elevated testosterone levels are often found in polycystic ovary syndrome (PCOS), which can be associated with infertility.
- Testosterone in the blood is measured in nanograms per deciliter (ng/dL).
- Normal levels in women are between 15 and 70 ng/dL in most labs.
- Levels that are either lower or higher than this range can cause problems with fertility as well as other symptoms.
Prolactin has many functions but it most commonly is known to stimulate milk production in those who are breastfeeding. It is also elevated in pregnancy. In the absence of pregnancy, the body normally has low levels of this hormone. High levels could be a side effect of some medications or be produced by a small growth in the pituitary gland of the brain and can result in menstrual irregularities.
- A normal level of prolactin for non-pregnant or breastfeeding women in most labs is less than 25 ng/ml.
- Almost all cases of hyperprolactinemia are easily treated with oral medications.
An under-active thyroid is known as hypothyroidism. Recent research by a team from Harvard Medical School has shown that, among women with unexplained infertility, low thyroid function was twice as common as among women without the condition.
Blood tests for thyroid levels normally measure the amount of thyroid-stimulating hormone (TSH) from the pituitary. With low circulating levels of thyroid hormone, the brain works overtime to attempt to restore the optimum level.
- TSH is measured in milli-international units per liter (mIU/L).
- A normal level of TSH is in the range 0.4 to 4.0 mIU/L, with levels above this range usually indicating an underactive thyroid.
It’s important to remember that with all of these blood tests, a single measure of a particular hormone cannot be considered diagnostic of fertility or infertility as hormones are constantly fluctuating. For some hormones, the day in the menstrual cycle that the measurement is taken is critical; in others, there may be reasons for abnormal results that are unrelated to fertility. A skilled and experienced fertility specialist is essential to interpret blood test results and make recommendations for treatment.
Imaging tests for infertility
Some fertility tests allow the physician to form a picture of the inside of the reproductive system and are important in reaching a diagnosis. Ultrasound, hysterosalpingogram, and saline sonogram are examples of such tests and may be needed depending on your individual case.
Ultrasound scan: what is it?
The technique of ultrasound uses high-frequency sound waves to create a real-time picture of the internal organs on a monitor.
It can be used to monitor ovulation, detect early pregnancy, and check for pelvic masses or other problems. It is also commonly used in fertility treatment for monitoring a patient’s response to follicle-stimulating hormones, and in IVF treatment where ultrasound is used to guide the retrieval of oocytes, or eggs.
Hysterosalpingogram (HSG): what is it?
The hysterosalpingogram test is a 15-minute office procedure. It can show abnormalities in the uterus such as polyps, fibroids, or reveal scar tissue blocking the fallopian tubes.
What happens during an ultrasound?
- During the test, the patient lies on an adjustable table with her feet in stirrups.
- X-ray is positioned above the pelvis.
- The physician places a speculum in the vagina, like when you have a pap-smear, and inserts a small catheter, or tiny tube, through the natural opening of the cervix.
- Contrast is a liquid that will be passed through the catheter into the uterus and flows into the fallopian tubes.
- The real-time X-ray image produced by fluoroscopy will display on a screen so the physician can see the outline of the uterus and tubes and to determine whether there is any evidence of blockage preventing the flow of liquid.
- This test may produce slight cramping when a blockage is present, but when normal, the test may cause no discomfort at all.
What do the results mean?
Having seen the shape of the inside of the uterus and determined the patency of the fallopian tubes, the physician will be able to discuss the results immediately with the patient and make recommendations for how to proceed with fertility treatment.
Saline Sonogram: what is it?
A saline sonogram, also known as a sonohysterogram, is also a 15-minute office procedure. It is similar to the hysterosalpingogram in that it allows the physician to see an image of the inside of the uterus, but in this case, the image is produced by ultrasound.
How accurate are infertility tests?
No single test can give a definitive diagnosis of infertility or the reasons for it. However, when our fertility specialists at RMA have completed all the necessary testing and evaluations, they will have all the information they need for an accurate diagnosis and an optimal treatment plan.
Blood tests measuring levels of FSH, AMH, and estrogen will provide important conclusions about egg quality and quantity, while a transvaginal ultrasound can assess follicle count and identify any structural abnormalities. A hysterosalpingogram will determine whether your fallopian tubes are functioning normally or are blocked, and a saline sonogram gives more information about your uterine cavity.
Combined, these tests, with the benefit of the fertility specialist’s accumulated knowledge and experience, will provide an accurate assessment of your diagnosis and aid in treatment planning.
How much do infertility tests cost?
Rates for infertility testing vary a good deal according to the type of test and from clinic to clinic, and so it really is not possible to give a list of prices applicable. The Society for Assisted Reproductive Technology (SART) explains that costs for fertility treatment vary according to the treatment center, patient profile in that center, and insurance coverage.
The most significant factor of these is insurance coverage. For example, a popular price checker site gives an estimate of between zero and $30 or more for blood tests for patients with insurance, or from $700 to $2,589 without.
Our financial counselors at RMA can help to answer queries about cost and insurance coverage and guide you through the complexities of the financial process.
Here are some key points to consider with regard to funding fertility tests and any subsequent fertility treatment:
Understanding the cost breakdown
An online search for the cost of fertility treatment will return a lot of information about IVF, the best known and most successful fertility treatment, but it can be hard to separate out what your initial investment will be if you only want to clarify the costs associated with the infertility testing stage.
Some clinics offer an à la carte-style service, with each process identified in the cost breakdown. For example, the first four steps of any fertility treatment are likely to be:
Cost vs. value
If you intend to go ahead with fertility treatment and your test results show it is needed, it is vital that you think hard about the cost/value ratio when choosing your clinic.
For example, if your fertility center has a state-of-the-art embryology lab, an outstanding medical team, and excellent success rates, it may be more expensive. But in terms of value in achieving one healthy baby in as few cycles as possible along with the lowest possible risk to both mother and child, it could work out a lot better.
Here’s Dr. Richard Scott on CBS News explaining how new genetic testing techniques underpin our RMA policy of single embryo transfer and how it can improve success rates and reduce risk significantly.
Fertility insurance coverage
The good news about the cost of infertility tests is that the prices you get from a prospective clinic will not necessarily reflect your actual cost. Everything will come down to your insurance coverage. We at RMA strongly recommend that you talk to your insurance carrier and get clarity on the exact extent of your coverage. Here are a few points you need to cover with regards to infertility testing:
- What are the exact details of your coverage?
- What diagnostic tests are included?
- Are any diagnostic tests excluded?
- Is ultrasound imaging covered?
- Are there any medical criteria to be met before approval for testing or treatment?
Have a look at our article on the cost of fertility treatment for more specific pricing information. There’s a lot of useful information on the RESOLVE state fertility scorecard, options for fertility financing, and tips on how to evaluate the cost/quality ratio of your intended clinic.
We at RMA strive towards our goal of making the path to parenthood ever safer and more successful. We do this through our investment in research, resources, staff, and advanced technologies that lead the way in the field of reproductive medicine. Living, joyful evidence of our success is the 40,000 babies born to loving families across the US and abroad. If you’d like to find out more, and discuss your fertility options with us, just get in touch through our online contact form.