Being fertile — able to conceive and/or sustain a pregnancy — is something we assume we are able to do by default. Consequently, we spend years on contraceptives to avoid pregnancy, thinking we can become pregnant the old-fashioned way at any time and at any point.
However, the fact is that one in six women will experience a fertility challenge in their life and will need medical intervention in order to become pregnant. The realization that fertility is not a default state for many women usually comes as a surprise. It is not until we are unable to naturally become pregnant that we start asking questions such as:
- Do I happen to have a fertility challenge?
- Am I experiencing infertility?
- Why didn’t anyone talk to me before about my fertility?
Fertility Testing with Limitations
The option to test women for their fertility potential has been available for some time. Although, it is important to note that none of the currently available fertility tests can measure the quality of your eggs. Today's fertility tests can thus only indirectly measure your fertility potential by evaluating the following four factors:
- If there is a physical blockage that prevents fertilization.
- If there is an abnormal level of hormones throughout your menstrual cycle that may affect proper egg maturation.
- If there is an underlying medical condition (yours or in your family) that is known to affect fertility.
- If there is a diminished supply (quantity) of your eggs for your age group (independent of their quality).
Different Methods for Fertility Testing
These are the most common forms of fertility testing today:
- Blood work: It measures specific hormones on specific dates of the menstrual cycle. These hormones include: follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and progesterone (P4). Another blood test, anti-mullerian hormone (AMH), indirectly estimates your egg supply.
- Contrast X-ray called hysterosalpingogram or HSG: It looks for potential blockage(s) in the fallopian tubes - where the fertilization of an egg by the sperm occurs.
- Ultrasound of the ovaries: It measures the total number of follicles (egg-producing microscopic cavities) in each ovary to estimate the number of remaining eggs.
Common Questions Regarding Fertility Testing
- What is the purpose of fertility tests? It is done for screening or diagnostic purposes. Meaning, the types of fertility tests ordered and performed are different for someone who has been trying for a few months to conceive (and the diagnosis of infertility is being considered) versus someone who is simply checking (screening) their fertility potential at a random stage in their life.
- Who orders fertility tests? Comprehensive fertility testing is done at fertility clinics which house reproductive endocrinologists. These experts are OB-GYN physicians who have had an extra 3 years of training in order to specialize in diagnosing and treating infertility. In the US, OB-GYNs prefer not to order fertility tests because they are not per se trained for the high-end diagnosis and treatment of infertility. This poses a problem as OB-GYNs are the doctors we visit on a regular basis to discuss contraception, sexually transmitted diseases, and pregnancy but with whom we somehow avoid talking about how to become pregnant when we want to.
- Who pays for fertility testing? Fertility tests are usually not covered by health insurance and thus can be very expensive out-of-pocket costs. While the visit and tests ordered through the OB-GYNs are usually covered by health insurance, visits and treatments (as well as tests) ordered and performed by reproductive endocrinologists at fertility clinics are often not covered by health insurance, making them out-of-pocket expenses.
- How are fertility test results interpreted? As fertility tests are only an indirect measurement of your fertility potential, the types of tests done and their subsequent proper and correct interpretation are crucial to ensure that the correct information and advice is received. An experienced reproductive endocrinologist is the most qualified authority to convey implications from the right testing.
Opionato (www.opionato.com) is your trusted go-to fertility expert accessible at anytime from anywhere. We assess your fertility potential and provide next-step fertility advice so your path to pregnancy is short and stress-free.
Opionato started with one woman’s personal fertility experience and the vision to give others what she lacked. Read Maja’s story here: https://www.opionato.com/blog/what-i-wish-i-knew-my-fertility-journey.