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Fertility Testing: What to Expect

If you’ve decided to have a baby and you’ve been trying for a while but it hasn’t happened yet, don’t worry. It can take up to a year for some couples to conceive. If you’ve hit a wall and feel that you need some assistance, the first step is to get to the source of the issue. Fertility testing can help both women and men with that.

While fertility testing may seem a daunting prospect, this guide will introduce you to the common types of testing, the language you will encounter and what to ultimately expect, which usually provides reassurance for those involved.

Below you will find a glossary of relevant terms and procedures.

For Men

Routine Semen Analysis: Although not a precise measure, a routine semen analysis is generally a quick and hopefully easy method of testing fertility. Prior to providing a semen sample, a man must avoid ejaculating for two to three days. The sample can be gathered at home or privately at the clinic or doctor’s office, but the analysis must take place within two hours of collection. Production of the sample is usually achieved by masturbation.

Comprehensive DNA Fragmentation Analysis: More focused than the standard semen analysis, this test concerns the DNA integrity of sperm, which is important for the success of both natural and assisted pregnancy, and also helps with normal development of the embryo, foetus and child. A high level of DNA fragmentation in sperm cells could point to male infertility.

Male Hormone Profile: Hormone imbalances affect men, too. Androgens support the production of sperm and the development of male secondary sex characteristics. A testosterone test checks the level of androgen in the blood, thus assessing possible hormonal causes of infertility.

Chromosome Analysis: An examination of the male chromosome in order to detect chromosome abnormalities and genetic disease. This blood test looks at the number of chromosomes and the general make-up, detecting if a man is missing or has extra copies of chromosomes or large pieces of his genetic code.

Chromosome Analysis + Y Micro-Deletions: If portions of the Y chromosome DNA are deleted or missing, this can affect male fertility. Identifying precisely which portion is absent is essential as this may predict the likelihood of the man actually generating sperm in the testicles.

For Women

Female Fertility Hormone Profile: A series of lab tests including blood tests are involved in order to gauge a woman’s full fertility profile. This early or ‘base line’ test is carried out on day 2/3 of her cycle and searches for hormonal causes of infertility while assessing the overall health of the ovaries.

Progesterone Level: A check on a woman’s levels of the hormone progesterone on day 21 of her menstrual cycle. These levels vary throughout the course of her cycle and this test can determine whether or not a woman has ovulated and when said ovulation (egg release) took place. It can also provide essential information on the early stages of pregnancy.

Anti-Müllerian Hormone: Often referred to simply as AMH, taking a measure of the Anti- Müllerian Hormone is regarded as one of the best ways of assessing the age-related decline in women’s fertility. A chemical produced by granulosa cells in ovarian follicles, anti-müllerian hormone levels are relatively constant and so this single blood test to indicate the ovaries’ residual store of egg cells can be administered on any day of a woman’s cycle.

Follicle Tracking: Follicles are fluid-filled sacs which develop on the ovary and house an egg. This series of vaginal ultrasound scans usually takes just five or 10 minutes to perform and takes place on day 9/10 or 11/12 of a woman’s cycle to demonstrate an egg follicle growing and preparing for ovulation.

Antral Follicle Count: These small follicles are a measure of ovarian activity. Counted via vaginal ultrasound, they are highly regarded as the strongest indicator of the ovaries’ capacity to develop egg cells. This non-invasive test also works out the expected response to ovarian stimulation drugs and the possibility of a successful pregnancy via IVF. This test is carried out on day 2/3 of a woman’s cycle.

HyFoSy: A simple ultrasound examination of the fallopian tubes – which also assesses the uterine structure – is carried out early on in a woman’s cycle and requires no surgery or anaesthetic. This test checks for blocked fallopian tubes and detects problems in the uterus, including shape and overall structure.

Karyotyping: This test identifies and evaluates the size, shape and number of chromosomes found in a select sample of body cells, with blood the most commonly tested. Results can indicate whether a chromosome-related defect is preventing pregnancy or causing miscarriages. A karyotype test can also determine whether or not a chromosome defect is present in a foetus.

The above tests should hopefully provide a clearer picture. Your doctor, consultant or nurse will be able to assist with any specific questions as the tests are carried out, so be sure to avail of their knowledge on this important step of your family-planning journey.

This blog was written in partnership with Mr Declan Keane, founder and Senior Clinical Embryologist at ReproMed.