Diagnostic Testing for Female Infertility


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How is Female Infertility Diagnosed.gifAn evaluation of a woman for infertility is appropriate for women who have not become pregnant after having 12 months of regular, unprotected intercourse. Being evaluated earlier is appropriate after six months for women who are older than age 35 or who have one of the following in their medical history or physical examination: 
  • History of irregular menstrual cycles (over 35 days apart or no periods at all)
  • Known or suspected problems with the uterus (womb), tubes, or other problems in the abdominal cavity (like endometriosis or adhesions)  
  • Known or suspected male infertility problems  
Any evaluation for infertility should be done in a focused and cost-effective way to find all relevant factors and should include male as well as female partners.  The least invasive methods that can detect the most common causes of infertility should be done first. The speed and extent of evaluation should take into account the couple’s preferences, the woman’s age, the duration of infertility, and unique features of the medical history and physical examination.

The following tests may be recommended as part of your infertility evaluation: 

Male Partner Semen Analysis: Although the semen analysis is obtained from the male partner, it is an essential part of the infertility evaluation.  A semen analysis should provide information about the number, movement, and shape of the sperm. A semen analysis is necessary even if the male partner has fathered a child before. 

Hysterosalpingogram (HSG): This is an X-ray procedure to see if the fallopian tubes are open and to if the shape of the uterine cavity is normal. A catheter is inserted into the opening of the cervix through the vagina. A liquid containing iodine (contrast) is injected through the catheter. The contrast fills the uterus and enters the tubes, outlining the length of the tubes, and spills out their ends if they are open. 

Transvaginal Ultrasonography:  An ultrasound probe placed in the vagina allows the clinician to check the uterus and ovaries for abnormalities such as fibroids and ovarian cysts. 

Ovarian Reserve Testing: When attempting to test for a woman’s ovarian reserve, the clinician is trying to predict whether she can produce an egg or eggs of good quality and how well her ovaries are responding to the hormonal signals from her brain.  The most common test to evaluate ovarian reserve is a blood test for follicle-stimulating hormone (FSH) drawn on cycle day 3. In addition to the FSH level, your physician may recommend other blood tests, such as estradiol, antimüllerian hormone (AMH), and/or inhibin-B, as well as a transvaginal ultrasound to do an antral follicle count (the number of follicles or egg sacs seen during the early part of a menstrual cycle). 

Ovarian reserve testing is more important for women who have a higher risk of reduced ovarian reserve, such as women who: 
  • are over age 35 years; 
  • have a family history of early menopause; 
  • have a single ovary; 
  • have a history of previous ovarian surgery, chemotherapy, or pelvic radiation therapy; 
  • have unexplained infertility; or 
  • have shown poor response to gonadotropin ovarian stimulation.  

Other Blood Tests: Thyroid-stimulating hormone (TSH) and prolactin levels are useful to identify thyroid disorders and hyperprolactinemia, which may cause problems with fertility, menstrual irregularities, and repeated miscarriages. In women who are thought to have an increase in hirsutism (including hair on the face and/or down the middle of the chest or abdomen), blood tests for dehydroepiandrosterone sulfate (DHEAS), 17-α hydroxyprogesterone, and total testosterone should be considered. A blood progesterone level drawn in the second half of the menstrual cycle can help document whether ovulation has occurred.  

Urinary Luteinizing Hormone (LH): Over-the-counter “ovulation predictor kits” detect the presence of LH in urine and can detect a rise in this hormone that occurs one to two days before ovulation. In contrast to blood progesterone levels, urinary LH tests can predict ovulation before it occurs. Urinary LH testing helps define the times of greatest fertility: the day of the LH surge and the following two days.  However, these tests can be expensive and should only be used by women with menstrual cycles that are consistently 25-35 days in length.

Sonohysterography: This procedure uses transvaginal ultrasound after filling the uterus with saline (a salt solution). This improves detection of intrauterine problems such as endometrial polyps and fibroids compared with using transvaginal ultrasonography alone. If an abnormality is seen, a hysteroscopy is typically done. This test is often done in place of HSG.

Hysteroscopy: This is a surgical procedure in which a lighted telescope-like instrument (hysteroscope) is passed through the cervix to view the inside of the uterus. Hysteroscopy can help diagnose and treat abnormalities inside the uterine cavity such as polyps, fibroids, and adhesions (scar tissue). 

Laparoscopy: This is a surgical procedure in which a lighted telescope-like instrument (laparoscope) is inserted through the wall of the abdomen into the pelvic cavity. Laparoscopy is useful to evaluate the pelvic cavity for endometriosis, pelvic adhesions, and other abnormalities. Laparoscopy is not a first line option in the evaluation of a female patient.  Because of its higher costs and potential surgical risk, it may be recommended depending on the results of other testing and a woman’s history, such as pelvic pain and previous surgeries.

For best results, the infertility evaluation should be individualized based on each woman’s specific circumstances.

Fact Sheets/Booklets

View more fact sheets and booklets written by the ASRM Patient Education Committee.
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Hormonal Contraception

Hormonal contraceptives contain a progestin (progesterone medicine) with or without an estrogen.
Patient Booklet teaser

Third-Party Reproduction

The phrase “third-party reproduction” refers to involving someone other than the individual or couple that plans to raise the child (intended parent[s]) in the process of reproduction.
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Menopausal Transition (Perimenopause): What Is It?

The menopausal transition (perimenopause) is the period that links a woman’s reproductive (childbearing) years and menopause.
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Stress and infertility

It is not clear how exactly stress impacts fertility.

Resources For You

The American Society for Reproductive Medicine (ASRM) is committed to providing patients with the highest quality information about reproductive care.

Female Fertility

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SART Fertility Experts - Fertility Myths and Realities for Black Women

Black women are more likely to experience infertility and less likely to seek and receive timely treatment. Listen to the Episode
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SART Fertility Experts - Wellness and Fertility: Diet, Sleep and Exercise

Drs. Timothy Hickman and Rashmi Kudesia discuss the links between lifestyle and fertility. Listen to the Episode
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SART Fertility Experts - Preconception Counseling

This podcast episode covers the topic of preconception counseling.  Listen to the Episode
Patient Ed Icon

Female Fertility Journey

If you've been trying to get pregnant for more than a year, you may have infertility. Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children.

View the Patient Journey
Patient Ed Icon

Stress and infertility

It is not clear how exactly stress impacts fertility. Read the Fact Sheet
Patient Ed Icon

Hypothyroidism and pregnancy: what should I know?

Hypothyroidism (underactive thyroid) is when the thyroid gland produces less  thyroid hormone than it should. View the Fact Sheet
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SART Fertility Experts - Endometriosis

Endometriosis is a condition that can affect many facets of a person’s life, from pelvic pain to struggles with infertility.   Listen to the Episode
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SART Fertility Experts - IVF: Cycles of Hope and Heartbreak

Does stress cause infertility or is it the other way round?  Listen to the Episode
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SART Fertility Experts - Fibroids and Fertility

Fibroids and their impact on fertility are discussed in this episode featuring Dr. Elizabeth Stewart, interviewed by host Dr. Brooke Rossi.  Listen to the Episode
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Infertility: an Overview (booklet)

Infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. View the booklet
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Optimizing Natural Fertility

Before attempting pregnancy, a woman should make sure she is healthy enough for pregnancy by adopting a healthier lifestyle and taking prenatal vitamins. If she has a medical or genetic condition or risk of one, she should seek advice from a medical professional before conceiving (becoming pregnant) View the fact sheet
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Infertility

Infertility is the result of a disease (an interruption, cessation, or disorder of body functions, systems, or organs) of the male or female reproductive tract which prevents the conception of a child or the ability to carry a pregnancy to delivery.  Watch Video
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Basic Infertility Evaluation

Dr. Roger Lobo of the American Society for Reproductive Medicine discusses the various methods to evaluate infertility. Watch Video
Videos Icon

Fibroid Tumors

An educational video that answers patient questions about the causes, symptoms, diagnosis and management of uterine fibroids. Watch Video
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Infertility Treatments

Dr. Roger Lobo of the American Society for Reproductive Medicine discusses the various treatments for infertility. Watch Video
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Understanding Fertility

In this video series, Dr. Roger Lobo explains the basics of infertility, including causes, treatments and coping methods. Watch Video
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Surviving the Roller Coaster Emotions of Infertility Treatment

The experience of infertility is a rollercoaster of hope and disappointment. Treatment presents an opportunity for hope as well as a new set of challenges. Watch Video
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What is Recurrent Pregnancy Loss (RPL)?

This is a condition when a woman has 2 or more clinical pregnancy losses (miscarriages) before the pregnancies reach 20 weeks. View the fact sheet
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Female Cancers, Cryopreservation, and Fertility

Yes! New technology lets your doctor remove and freeze eggs, fertilized eggs (embryos), or ovarian tissue before treating your cancer. This way, you may be able to have children after your treatment. View the Fact Sheet
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Weight and fertility

One of the easiest ways to determine if you are underweight or overweight is to calculate your body mass index (BMI). View the fact sheet
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Am I Ovulating?

Ovulation is the release of an egg from a woman’s ovaries and is essential for getting pregnant. View the Fact Sheet
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Dilation and Curettage (D&C)

“Dilation and curettage” (D&C) is a short surgical procedure that removes tissue from your uterus (womb). You may need this procedure if you have unexplained or abnormal bleeding or if you have delivered a baby and placental tissue remains in your womb. View the Fact Sheet
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Evaluation of the Uterus

If you haven’t been able to get pregnant after trying for 6 months, some tests can be done to help find the reason. Your doctor may test your hormone levels, your partner’s sperm, and your reproductive organs (ovaries, fallopian tubes, and uterus [womb]). View the Fact Sheet
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Causes of Female Infertility

Dr. Roger Lobo, of the American Society for Reproductive Medicine explains the causes of female infertility. Watch Video
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Abnormalities of the Female Reproductive Tract (Müllerian Defects)

Sometimes the uterus and fallopian tubes may not form like they should. These malformations are called müllerian anomalies or defects. Müllerian anomalies may make it difficult or impossible to become pregnant. View the Fact Sheet
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Conditions Treated with Adnexal Surgery

Surgery can be used to treat problems with your ovaries or fallopian tubes such as cysts, endometriosis or infections. Adnexal surgery involves any of the organs that are on the sides of (“next to”) the uterus (womb), such as the fallopian tubes and ovaries.

  View the Fact Sheet
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Endometriosis (booklet)

Women with endometriosis may experience infertility, pelvic pain, or both. This booklet will describe options for diagnosing and treating pain or infertility that may be attributed to endometriosis. View the Booklet
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Fertility Drugs And The Risk of Multiple Births

Infertility treatments that cause multiple eggs to develop make it more likely that you will become pregnant with twins, triplets, or more. This is called multiple gestation. View the Fact Sheet
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Ovulation Detection

Ovulation, the release of an egg from its follicle in one of a woman’s two ovaries, is one of the most important factors in conceiving a child. View the fact sheet
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FAQ About Infertility

Infertility is not an inconvenience; it's a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction. Learn the facts
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Female Fertility Infographics

ASRM has prepared infographics to illustrate the subject of Female Fertility better. View the Infographics
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Ovarian Reserve Infographics

ASRM has prepared infographics to illustrate the subject of Ovarian Reserve better. View the Infographics

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