There are a number of ways to perform infertility test for women. Some of the basic tests can be performed at home, while for others a visit to a medical practitioner or fertility specialist is essential. Infertility tests are recommended for both partners, since fertility problems can be with either female partner or male partner or both. (Click here for more information on infertility test for men)
Fertility testing and investigation can be a lengthy process. Hence, patience and commitment from the couple under investigation is absolutely important. The couple needs to support each other to go through this challenging process.
The video below explains basic infertility evaluations performed for women and men.
Most common methods of infertility test for women are explained below:
Following tests can be done at home. Taking a home test is no replacement for laboratory testing, but it can be considered as a first step in the right direction.
Follicle Stimulating Hormone (FSH) Home Test
Follicle stimulating hormone (FSH) is a hormone produced by the pituitary gland. Abnormal levels of FSH can be a cause of infertility in women.
FSH home test is taken on day 3 of menstrual cycle (follow up tests can be taken on day 4 and day 5 as well). The test measures FSH levels either through a mid-stream urine test or through a test strip that can be dipped in a urine sample.
If test results indicate elevated levels of FSH, it is important to visit a medical practitioner or fertility specialist. On the other hand, if test results show normal FSH levels, please understand that it is not an assurance of normal fertility health (since, a high FSH level is only one of the causes of infertility in women).
Basal Body Temperature (BBT) Home Test
Basal body temperature (BBT) test is another common home infertility test for women. BBT is the lowest temperature attained by human body during rest. It is usually measured immediately after one wakes up in the morning. BBT can be measured using special BBT thermometers or using normal thermometers.
After ovulation, BBT increases by one half to one degree Fahrenheit or one quarter to one half of a degree Celsius. If the basal body temperature does not rise during a menstrual cycle, or if the temperatures are irregular, it can be indicative of conditions such as anovulation (complete lack of ovulation). This can be a cause of infertility.
Luteinizing Hormone (LH) Home Test
A surge in luteinizing hormone (LH) level occurs prior to ovulation. If there is no surge in LH level during a menstrual cycle, then that can be a signal of infertility.
LH home test can be either a midstream urine test or a test strip that can be dipped in a urine sample. To detect rise in LH levels, the test needs to be carried out for several days starting from 11th day of a menstrual cycle, either till a surge in LH levels is detected or till 20th day of menstrual cycle.
OV watch can be worn by women on their wrists while they sleep. It measures chloride ion levels in sweat released by skin. Chloride ion levels in a woman’s sweat rises (usually up to 3 times) a few days prior to ovulation. OV watch detects this surge in chloride ions and predicts four fertile days before ovulation. The watch needs to be worn from 1st, 2nd or 3rd day of menstrual cycle, either till ovulation day or till 20th day of menstrual cycle. If no rise in chloride ion levels is detected, then that can be a signal of infertility.
First steps in a medical infertility diagnosis are a detailed interview and a physical examination. The medical practitioner will gather information from the individual or couple under investigation about health history, sexual habits and history of sexual problems, birth control use, menstrual and pregnancy history, use of prescription medication, surgical history, exposure to chemicals, toxins or radiation, life style factors such as smoking, excessive drinking or use of illegal drugs, reports of prior infertility treatment, family history of reproductive problems etc. This would be followed up with an examination of thyroid, breasts, pelvis and hair growth. A pap smear test (click for more information) might be also done. After this, the doctor may recommend any of the tests listed below.
Laboratory Blood Tests
Following infertility tests for women are performed by collecting and analysing a blood sample of the individual under investigation.
Follicle Stimulating Hormone (FSH) Blood Test
FSH test is performed on a blood sample collected on the 3rd day of a woman’s menstrual cycle. This test verifies whether follicle stimulating hormone (FSH) level is normal. Abnormal FSH level indicates low fertility.
Progesterone Blood Test
Progesterone blood test, usually done 7 days after ovulation, checks for progesterone level in the body. Low progesterone level can cause infertility in women.
Estradiol Blood Test
Estradiol test performed on the 3rd day of menstrual cycle measures estradiol level in the body. A high level of estradiol can harmfully affect egg quality, causing infertility.
Luteinizing Hormone (LH) Blood Test
LH test measures luteinizing hormone (LH) level in the body. It is done on 3rd day of menstrual cycle. Abnormal LH level signals low fertility.
Inhibin B Blood Test
This test is done on 3rd day of menstrual cycle. High level of inhibin B hormone indicates a healthy ovarian reserve (ovarian reserve is the quantity of eggs remaining in a woman) and good fertility. Level of inhibin B usually decreases with age, indicating depletion of ovarian reserve.
Anti-Mullerian Hormone (AMH) Blood Test
AMH test is a modern and effective infertility test for women. Anti-mullerian hormone (AMH) is produced by cells in developing egg sacs (follicles) in the ovary. AMH levels do not vary with the menstrual cycle. Hence, the test can be performed on any day of the menstrual cycle. Normal AMH levels indicate a good ovarian reserve (healthy supply of eggs).
Abnormal (low or high) AMH levels are not desirable. Low AMH level implies less quantity of eggs remains in ovary. This point to a decline in fertility. Higher than normal AMH level can be a sign of polycystic ovarian syndrome (PCOS).
Measurement of AMH levels can be also helpful to determine the best dose of fertility drugs to stimulate ovaries during an in vitro fertilization (IVF) treatment.
Clomiphene Citrate Challenge Test (CCCT)
Clomiphene citrate challenge test (CCCT) also known as clomid challenge test is used to measure follicle stimulating hormone (FSH) and estradiol levels in the body. On day 3 of menstrual cycle, a blood sample is drawn from the individual under investigation and FSH and estradiol levels are measured. From day 5 to day 9 of the menstrual cycle, 100 mg (two 50 mg tablets) clomid is prescribed. Then, a blood sample is drawn again on day 10 or day 11 of the menstrual cycle and FSH and estradiol levels are measured. Higher than normal FSH and estradiol levels detected on day 3 and day 10 (or day 11) can be a signal of infertility. Results of CCCT can also be an indicator of an individual’s responsiveness to in vitro fertilization (IVF)treatment.
Post Coital Test (PCT)
Post coital test is not a commonly used infertility test for women. This test is usually performed when all other factors that can influence a successful pregnancy seem to be normal, and the doctor feels that problems with cervical mucus or immune system may be causing infertility. The test is done on a sample of woman’s cervical mucus taken within 8 to 12 hours after the couple had sexual intercourse. The test is usually performed 1 to 2 days before ovulation. It checks for normal sperm motility and presence of live sperm in cervical mucus, two important factors that influence successful conception. Post coital test can be useful to determine the need for Intrauterine Insemination (IUI).
Chlamydia and Thyroid Tests
Chlamydia (a sexually transmitted disease) and problems with thyroid gland can cause infertility. Hence, tests are performed to detect chlamydia or thyroid infection.
Advanced Infertility Test for Women
If the doctor or fertility specialist feels that there is a need for a more detailed diagnosis, he/she might recommend any of the following advanced infertility tests for women. Before performing these tests, it is important to confirm that the individual under investigation is not pregnant (as these tests can harmfully affect an embryo).
Pelvic Ultrasound Test
In this method, an ultrasound scan is used to check health of ovaries and uterus. Factors such as follicle development, antral follicle count, presence of fibroids or ovarian cysts and thickness of the lining of the uterus can be checked.
If the pelvic ultrasound test (explained above) suggests that the uterus lining (endometrial lining) is thicker than normal, a sonohysterogram test might be recommended. Sonohysterogram test would help to confirm or rule out presence of fibroids and would also help to assess the size and contour of uterine cavity. The test is performed just after a menstrual period has finished (usually between day 7 and day 10 of a regular 28 day menstrual cycle). In this method, an ultrasound scan is performed after infusing a sterile saline solution (that aids in a better visualization of the uterus) into the uterus through a soft plastic catheter placed in the cervix.
This advanced infertility test for women is particularly helpful for those who had one or more miscarriages. A small sample of tissue of the uterus lining (endometrial lining) is collected from the individual under investigation prior to menstruation (usually after 21st day of a regular 28 day menstrual cycle). The sample is then analysed to verify whether the uterus lining is thick enough for successful implantation of a fertilized egg.
Hysterosalpingogram (HSG) Test
This test is useful to find out whether there is any blockage in fallopian tubes and to evaluate the size and contour of uterine cavity. Test is performed after a menstrual cycle has finished (usually between day 6 and day 13 of a regular 28 day menstrual cycle). A special liquid dye is injected through cervix and vagina into the uterus and X rays of uterus and fallopian tubes are taken and analysed.
If the fertility specialist identifies any abnormalities in a hysterosalpingogram (HSG) test explained above, he/she might suggest for a hysteroscopy. In hysteroscopy, a thin fiber optic telescope like instrument in inserted through the cervix and vagina into the uterus. This would help to have a more detailed look at the abnormalities, growths or scarring in the uterus and tissue samples can be collected if needed.
This is similar to hysteroscopy (explained above). A thin telescope like instrument inserted through cervix and vagina allows the fertility specialist to have a more accurate diagnosis of problems in fallopian tubes such as blockages. This test is helpful to determine a more precise treatment for problems related to fallopian tubes.
This procedure is a bit more invasive than other advanced infertility tests for women explained above. Laparoscopy is done under general anaesthesia. An illuminated fiber optic telescope is inserted through a small incision made beneath the navel of the individual under investigation. This would allow the doctor to have a detailed view of ovaries, fallopian tubes and uterus, to check for any scarring, blockages, endometriosis (click for more information) or other abnormalities. The main advantage is that, laparoscopy not only helps to identify problems more accurately, but also allows the doctor to fix these problems (with the aid of laser or other small medical tools).
Genetic tests are simple blood tests usually performed for both male and female partners. These tests are performed to check whether genetic problems in one or both partners are preventing successful conception or causing recurrent miscarriages. Genetic tests can detect problems such as DNA fragmentation, chromosomal defects etc.