Fertility assessment is the first step in addressing and understanding infertility. Individuals or couples who want to become pregnant but are experiencing infertility can undergo a physical exam and medical history evaluation to determine the potential cause of infertility. Once the fertility assessment reveals information about the patient’s fertility health, the preferred physician, reproductive endocrinologist, or obstetrician-gynecologist will advise on the best treatment options available to combat the cause of infertility and result in a successful pregnancy.

Infertility affects both men and women for a variety of common reasons. Infertility in women can be caused by hormonal imbalances, irregular or absent ovulation, endometriosis, and damage, scarring, or blockage in the fallopian tube.  For men, causes of infertility includes low sperm count, low sperm motility, and irregularities in sperm shape & function. Age, lifestyle, and pre-existing health and/or medical conditions are additional factors that can also affect infertility. Unexplained infertility may occur in some cases if no cause of infertility is discovered following a fertility assessment. When this occurs, successful infertility treatment may still be possible.

It is commonly recommended to consult a reproductive endocrinologist or an obstetrician-gynecologist for fertility assessment if any of the following apply to you:

• Are 35 or younger and have not become pregnant after twelve months or more of trying

• Are older than 35 and have not become pregnant after six months or more of trying

• Have signs of endometriosis, such as severe pain during sex

• Had past surgery in the abdomen or uterus

• Had more than one miscarriage

• Had past cancer treatment

• Have a family history of early menopause before age 40

• Are considering freezing eggs/ sperm/ embryos for future use

• Are over 40 and considering starting a family

• Have physical problems, such as inability to release sperm, inability to ovulate, or irregular menstrual cycles

• Personal reasons

Male Testing – Semen analysis is a fundamental tool used to diagnose male infertility. This fertility evaluation may include CASA (computer assisted sperm analysis, anti-sperm antibody screen), DNA fragmentation assay, scrotal ultrasound, testicular biopsy, and genetic testing. An initial detailed medical history, a general physical exam, blood tests, and infectious disease screening are all part of male fertility assessment.

Female Testing – Female fertility assessment typically includes a detailed medical history, a general physical exam, and a range of tests including blood work to check hormone levels associated with ovulation, such as luteinizing hormone (LH) and progesterone. Additional hormone tests may be performed to determine the number of eggs available. Based on the results of the fertility assessment, a fertility test such as an ultrasound, sonohysterography, hysterosalpingography, hysteroscopy, and genetic testing may be performed.

Ovulation Induction – This procedure uses medication to increase the number of eggs ovulated per cycle. Ovulation induction can increase the chances of pregnancy by producing more than one mature follicle per menstrual cycle and can also be used as part of an egg retrieval cycle. Through blood tests and ultrasounds, patients undergoing ovulation induction are monitored for two to three weeks. Medications used in ovulation inductions include clomiphene citrate and injectable gonadotropins (FSH).

Embryo Testing – Preimplantation genetic testing for aneuploidy (PGT-A), a genetic test performed on embryos, detects any abnormal chromosome numbers. PGT-A is performed on a developing embryo prior to embryo transfer in IVF treatment.

Male Testing – Semen analysis measures several key indicators of male infertility, including the number of sperm cells in the sample, the shape of the sperm, and the sperm motility. The semen sample may also be tested for ejaculation volume, viscosity, fructose levels, PH levels, and any signs of infection. Due to the constant production of sperm in the testes, each semen analysis will yield a unique set of results. Several tests are typically performed to obtain a complete diagnosis. Assisted reproductive technology (ART) such as IUI, IVF, and ICSI-IVH may be recommended based on the results of the semen analysis.

Female Testing – Types of fertility testing for females include, but are not limited to:

• Ultrasound – The uterus and ovaries are examined for abnormalities such as fibroids and ovarian cysts. Additionally, ultrasounds are used to measure the thickness of the uterine wall throughout the menstrual cycle as part of cycle monitoring.

• Sonohysterography (uterine cavity check) – Intrauterine problems, such as endometrial polyps, fibroids, and scar tissue are detected using a special solution within the uterus.

• Hysterosalpingography – An x-ray is used to examine the inside of the uterus and fallopian tubes for blockages or abnormalities in the size or shape of the uterus.

• Hysteroscopy – This minimally invasive procedure involves passing an endoscope through the uterus and inspecting the uterine cavity for any abnormalities.

• Genetic Testing – Genetic testing identifies genetic mutations causing problems with fertility and reveals mutations that could be passed on to future generations.

Ovulation Induction – Generally, medications used in ovulation induction include clomiphene citrate and injectable gonadotropins (FSH).

• Clomiphene citrate – By stimulating the pituitary gland, this oral medication causes the release of more follicle stimulating hormones (FSH). This medication is typically prescribed for five days and is taken in the early part of the menstrual cycle.

• Injectable gonadotropins (FSH) – This medication is injected by the patient and directly stimulates the ovaries to increase the number of developing follicles. Injections are administered on a daily basis until the developing eggs are mature and ready to ovulate.

Embryo Testing – PGT-A is a quick, non-invasive biopsy of trophectoderm (TE) cells over a day-five blastocyst. When tested, TE cells, the outer cells that develop into the placenta, will reveal the precise number and DNA content of each chromosome in each embryo sample.

Every individual and/ or couple has a unique history, circumstance, and goal, so every treatment plan will be different to reflect the specific fertility care needs. The cost of fertility assessment is determined by factors such as treatment recommendation, geographic location, physician and clinic experience/technique, and medical factors such as appointments, screenings, medications, and assisted reproduction technology (if applicable).

In general, there are no risks associated with fertility assessments. However, there may be side effects with medications used in fertility assessment, such as:

• Pain inflammation & swelling

• Bruising and/or welts at site of injection

• Multiple pregnancies

• Development of conditions such as ovarian hyperstimulation syndrome (OHSS)