According to the American Society for Reproductive Medicine, if you are under the age of 35 you should consider seeing a specialist to help diagnose infertility if you have been actively trying to conceive after 12 months of unprotected intercourse. 6 months for women over 35.

If you are experiencing irregular or painful periods, inovulation, multiple miscarriages or you and your partner had multiple STD’s you should seek the advice of a specialist earlier. 

How do I find a specialist?

Depending on where you live, your health system may require you to see your General Practitioner/Family Doctor or Gynecologist as a first step to a diagnosis. 

Your ultimate goal should be to be seen by a Reproductive Endocrinologist. 

In the U.S. REs do not require a referral as they work in the private medical sector, but you should see your OB/GYN as well in case parts or all of your medical diagnostic tests can be covered by your health provider. 

More on how to find a specialist and questions to ask your RE can be found here.

How is the cause of my infertility diagnosed?

Once you’ve gone to a specialist, multiple physical and diagnostic tests will be performed to determine you and your partners general, hormonal and reproductive organ health.

With infertility, you’ll often find the below “base” tests, with additional tests being administered as you continue treatment if there’s no success. 

Finding a specialist who is willing to go deeper than the base tests earlier in your diagnosis process is crucial as it could save you so much time, money and heartache on this journey. 

Infertility diagnostic testing can include, but are not limited to the below:

For the woman:

Hormonal Profile on Day 3-5 of your menstrual cycle:

  • Estrogen (E2)
  • Progesterone (additional test on day 21 of cycle)
  • FSH
  • LH
  • TSH
  • Testosterone
  • DHEA-S
  • Prolactin
  • AMH (Done on day 2 or 3 of your cycle)

Uterine Health:

  • Hysterosalpingogram (HSG) 
  • Sonohysterogram
  • Ultrasound to check for AFC, Cysts, Fibroids and Ovaries.
  • MRI (if cysts, endometrioma or Large fibroids are found)

For Both Partners:

General Health Blood & Urine Tests:

  • SMAC
  • CBC / Blood Count
  • Glucose 
  • PTT & PT
  • CMV IgG+IgM
  • Toxoplasmosis
  • VDRL
  • Urine Analysis 
  • Blood Type + RH
  • Some Vitamin deficiencies such as Vitamin B and D.

Sexual Health:

  • Pap (Woman only)
  • HIV
  • Hepatitis B
  • Hepatitis C
  • STD Profile

Genetics:

  • Tested based on family history and ethnical background. 

Autoimmune and blood disorder tests are normally ordered down the road, but they are worth bringing up to your doctor if you or your partner suffer from a related issue or have a family history with them.

For Men:

Sperm Health:

  • Sperm Analysis 
  • DNA Fragmentation and Antibodies (if sperm analysis returns with a severe issue)

Hormonal Panel:

  • Testosterone
  • Estrogen
  • LH
  • FSH
  • TSH

Your RE will analyze the results of these tests to determine an initial cause of infertility and treatment path, which we discuss here. 

Unfortunately, 1 in 5 couples will receive an initial unexplained infertility diagnosis. This is when all baseline tests seem to return as normal, and no specific cause can be determined at that time.

Note that egg quality and certain diseases such as endometriosis can only be diagnosed with more invasive procedures. 

If any of the above tests for male related infertility return abnormal, we recommend you seek the opinion of a Urologist who specialises in male infertility, beyond your RE.