According to studies a fertility evaluation is valid for people who are under 35 and have been unsuccessfully trying to conceive with regular intercourse for 12 months. In addition, in older than 36 years, the threshold moves down to six months of unprotected sex without a pregnancy. The threshold is also six months for those with a history of irregular menstrual cycles, known issues with their uterus or other reproductive organs, or a male partner with fertility issues.
Fertility assessments can include both male and female partners.
The male infertility aspect can be as high as 40-50% therefore requiring a semen analysis. The numerous tests involved can include ovarian reserve testing which indicates the quality and number of eggs remaining in your ovaries, which can be used to estimate the potential for getting pregnant. Checking the ovarian reserve is a key part of a fertility assessment.
FSH levels is another factor to be viewed. A small gland in your brain called the pituitary gland produces a follicle-stimulating hormone (FSH). FSH stimulates your ovaries to produce eggs, and FSH levels reach their highest point right before the ovaries release an egg. An FSH test can show if there is an issue with your ovarian reserve, with a level higher than 10 IU/L indicating there might be a diminished reserve. AMH levels are tiny cells inside the follicles of your ovaries that produce anti- Mullerian hormones (AMH), which are considered essential for fetal development during pregnancy. The AMH level is also a key indicator of ovarian reserve, as it roughly translates to the number of eggs that is left in the ovaries. A high level of AMH means you have more eggs, and a low level means fewer eggs remaining.
Additional bloodwork such as the measurement of progesterone is essential. It is a hormone released by the ovaries that prepares the uterus for implantation and helps sustain the fetus in the early stages. In generality a progesterone level over 3 ng/mL is a sign of ovulation.3Therefore, if the progesterone levels are lower than normal, that could be an indicator that something’s not normal. Other tests to consider is an assessment of estradiol, which is one of several types of estrogen; luteinizing hormone, a hormone produced by the pituitary gland that helps trigger ovulation; and prolactin, a hormone produced by the pituitary gland that stimulates the breasts to produce milk and TSH a thyroid stimulating hormone whereby low levels can interfere with the menstrual cycle making pregnancy
Physical testing to include would be Transvaginal ultrasound utilizing a wand that is inserted into the vagina where images are produced by sound waves to visualize your uterus, fallopian tubes, and ovaries to check for any
abnormalities. Hysterosalpingogram is an X-ray procedure that can determine if something is blocking your fallopian tubes. A thin catheter is inserted through your vagina and cervix, and a contrast fluid is injected into your uterus through the catheter. Sonohysterography is a technique where saline is injected in to the uterus to achieve a clearer view of anything that might impede pregnancy.
Hysteroscopy is another physical test that the provider can perform. A litup instrument called a hysteroscope is inserted through the cervix to verify that there aren’t any uterine fibroids, adhesions, polyps, or other abnormalities that may be interfering with the ability to conceive therefore an important tool for detection. Finally Genetic testing may be recommended in the form of carrier screening. It basically is a test to determine if the couple carries a gene for a particular genetic disorder that you might pass down to a potential child. Most carrier screenings are done for recessive disorders that require two copies for the child to actually get the disease. This format of testing is commonly utilized by most IVF clinics and highly recommended in certain cases.