Over 186 million individuals globally struggle with infertility, according to World Health Organization data. In India, around 15% of couples face infertility issues, leading to emotional and physical turmoil.
Infertility in couples can rise due to male and female factors and can result from chronic illness, lifestyle choices, poor diet, and a myriad of complications.
If you have trouble conceiving, a complete fertility workup is what the specialist will suggest you undergo. This pinpoints the exact of behind infertility and also allows the patients to opt for the next step in the treatment – surgical or non-surgical.
We will discuss everything you need to know concerning a complete fertility workup and the steps involved in the testing and treatment.
What is a Fertility Workup?
A fertility workup is the first step that your specialist doctor will advise to determine the cause of infertility. It is done in both men and women to:
- Determine who is infertile
- Determine what is causing the infertility
Typically, a fertility workup involves a series of tests, including blood tests and imaging tests, to determine the physiological functions and ensure that there are no issues with the reproductive anatomy of the patient in question.
Generally, a reproductive endocrinologist or an infertility specialist will prescribe these tests to assess everything related to your fertility before coming to a conclusive diagnosis and then proposing a relevant treatment.
A complete fertility workup is extremely thorough to nit-pick the big and the small issues that potentially contribute to the patient’s infertility. Which tests are prescribed will depend on what your specialist suspects are wrong with your reproductive functions.
Why is Fertility Work Important?
A fertility workup is crucial for couples who are trying to conceive naturally but aren’t able to. Sometimes, infertility is a primary sign of a severe chronic illness or complication in the body that goes undiagnosed.
If you and your partner have been trying to get pregnant after engaging in unprotected sexual intercourse for 12+ months and failing to conceive, that’s where fertility work comes into play.
Getting a fertility workup doesn’t always guarantee a diagnosis of infertility. Sometimes, the inability to conceive could be due to other factors.
Instead, the focus of a fertility workup is to confirm any potential:
- Hormonal imbalance in the body
- Anomalies in the reproductive organs
- Potential risks of cancer
- Polycystic ovarian syndrome (PCOS) in females
- Obstruction in the reproductive tracts
- Genetic abnormalities
- Systemic or neurological diseases
- Active infection in the body
- Underlying chronic illness that hasn’t been diagnosed
The list of potential help is quite long. Getting a comprehensive fertility workup cannot just determine what’s preventing you from getting pregnant but also help diagnose something worse, chronic, or even terminal.
Test for Men in Fertility Workup
The diagnostic tests for determining male infertility are quite diverse. From analyzing the quality of the sperm to determining good reproductive anatomy and health, there are multiple factors at play.
Some of the most important tests for men in the fertility workup include:
1. Semen Analysis
Studies indicate that around 2% of men suffer from suboptimal sperm measurements and quality, which is a leading reason behind male infertility worldwide.
A semen analysis conducts comprehensive testing of the sperm in the semen sample of the male patient. Ideally, a semen analysis can help understand the following:
- Potential signs of infection in the body
- The volume of semen in the sample provided by the patient
- Classify the total sperm count in the semen sample (over 15 million sperm per milliliter of semen is considered normal)
- Determine the vitality of the sperm in the sample
- Determine the motility of the sperm in the sample
- Determine the shape, size, and structure of the sperm in the sample
Depending on the results of the semen analysis, the specialist will be able to determine the potential reason behind infertility better.
In some cases of fertility workup in men, the semen analysis comes out normal, showing no abnormalities in the reports. But, in hindsight, the male patient is still unable to conceive a baby with their partner.
If there are no fertility concerns with the female partner, the next step in the workup involves a urinalysis.
A thorough urine analysis can better confirm infertility in men if the semen analysis reports are normal. This test also identifies any potential biomarkers that could indicate issues with kidney functions, reproductive functions, or even an infection in the body.
3. Hormone Testing
When it comes to hormone testing in a fertility workup, many individuals think that it’s specifically for women, which isn’t the case.
Hormone testing is equally important for men since they play a crucial role in male fertility. Hormones like follicle-stimulating hormone (FSH) and luteinizing hormone (LH) play a key role in male fertility, alongside testosterone.
FSH levels play a crucial role in sperm production. LH regulates the release of testosterone, which further contributes to sperm production. Any kind of hormonal imbalance in the blood could be a reason behind male infertility.
Your doctor will also prescribe an analysis of the testosterone levels to understand better what’s causing infertility.
4. Anti-Sperm Antibodies Testing
The sperm isn’t free-floating in your body, meaning it doesn’t come in direct contact with the body’s immune system. However, in times that they do due to infections or external trauma, the immune system might produce anti-sperm antibodies in the blood.
This leads to sperm damage and could be a potential reason behind infertility. The test is often kept as a last resort if none of the standard tests aren’t showing any potential signs or complications in the body.
5. Imaging Tests
Besides bloodwork, imaging tests like a scrotal ultrasound or transrectal ultrasound are some other tests involved in the fertility workup. They can identify potential risks of:
- Tumor growth
- Fluid deposition in testicles
- Testicular torsion
- Blockages in the reproductive tracts
Which one of the imaging tests your fertility specialist prescribes will depend on the reports from the blood work and the kind of accessory symptoms you are experiencing.
6. Genetic Testing
Sometimes, there is nothing wrong anatomically or even physiologically, but genetic disorders could be a reason why you aren’t able to conceive with your partner.
Around 10-20% of men worldwide have genetic abnormalities contributing to fertility issues. Comprehensive genetic testing helps identify chromosomal abnormalities and even determine a potential cause behind infertility if none of the other tests show any reason.
Test for Women in Fertility Workup
As a female, if you aren’t able to conceive a baby naturally, there could be multiple reasons behind it. A complete fertility workup investigates all these potential risks to narrow down a diagnosis and get the patient on the right treatment route.
Some of the most crucial tests include:
1. Ovulation Testing
In females, active ovulation is crucial for a natural conception. If you aren’t ovulating as per normal, it could be a sign of poor ovarian reserve or even hormonal complications.
Ideally, testing for ovulation is crucial to understanding the blood hormone balance and how they interact to support reproductive functions. High progesterone levels in the blood typically indicate that a woman is ovulating. Your doctor might prescribe tests for measuring the levels of LH and prolactin.
2. Ovarian Reserve Testing
Females are born with a set number of ovarian follicles, which last them through the reproductive years until one hits menopause.
Ovarian reserve testing analyzes the quality and availability of eggs in the ovaries. Most women, after age 35, have a depleted ovarian reserve, which could be a reason for infertility in the patient.
Ovarian reserve testing is done by monitoring the levels of FSH, Anti Mullerian Hormone (AMH), and Antral Follicle Count (AFC), or via ultrasound.
This fertility test is a type of X-ray that analyzes the uterine health of the patient. It also monitors for potential signs of fluid accumulation inside the fallopian tubes that could pose as an obstruction or lead to active infection in the female reproductive tract.
If the reports are abnormal in the test, your fertility specialist will prescribe further blood work or imaging tests to determine what’s wrong.
4. Hormonal Testing
Besides ovulatory hormones like LH, FSH, progesterone, and prolactin, the fertility workup also involves monitoring the levels of other reproductive hormones.
This includes thyroid and pituitary hormones in the blood, which have regulatory properties in the female reproductive function.
5. Imaging Tests
Pelvic ultrasound is the most common imaging test for a female fertility workup. It checks the uterus, ovaries, fallopian tubes, and the adjoining parts in the female patient.
This test can diagnose any obstruction, tumor growth, or even cysts in the ovaries. It is a crucial test in determining what’s causing the signs of infertility in the female patient.
6. Genetic Testing
Like in men, genetic testing is equally important in females to determine if any chromosomal abnormalities are actively contributing to the complaints of infertility in the patient.
In rare cases, despite all these comprehensive testing and fertility workups, the reports might not showcase any potential complications. If that’s the case, it is a condition called “unexplained fertility.”
Where Should you Get the Fertility Workup?
A basic fertility workup is the first step to determining what’s wrong or preventing you from conceiving a baby naturally.
Remember that infertility can be a direct consequence of male or female infertility. It could be both or either. And the only way to determine that is with a comprehensive fertility workup. Since the process is quite sensitive, consulting reputed and reliable fertility specialists is crucial.
You want to consult a specialist with years of experience in diagnosing and treating patients with similar complications. You also want to cross-verify the patient testimonials to ensure that the specialist and the clinic have a good record in the market.
That said, a fertility workup typically starts with the first consultation. That’s when you can assess how comfortable you are working with the doctor to determine what’s wrong. If the doctor is judging or making you uncomfortable, it’s ideal to seek another specialist.
Some of the factors worth considering when getting a fertility workup include the following:
- Choose a clinic and a specialist with at least 10+ experience in diagnosing and treating infertility.
- Choose a well-equipped clinic wherein you can get all the tests and relevant monitoring without stepping out.
- Choose a place where you feel safe and comfortable discussing something as vulnerable as infertility.
Having an affirmative answer to all the above factors is when you can proceed with the fertility clinic and get the relevant testing done to determine what’s wrong.
Things to Keep in Mind before a Fertility Workup
Reaching out to a fertility specialist takes a lot of courage for some individuals. Since discussions surrounding infertility are still taboo (especially in India), it isn’t surprising that most men and women prefer not to seek the medical help they need.
Kindly remember that infertility is a lot more common than you think. Not getting a fertility workup can further slim your chances of becoming a parent. So, it’s always better to get the help you need instead of worrying about “what society will think.”
Some of the factors worth considering before getting a fertility workup are:
- Find an experienced and reputable fertility specialist and clinic in your area.
- Be mentally prepared to go through multiple tests and procedures to determine what’s wrong.
- Prepare a file listing your and your partner’s medical history before consulting the specialist. These medical records are crucial for a further diagnosis.
A fertility workup doesn’t 100% guarantee a diagnosis. Sometimes, despite comprehensive testing, the doctors might not be able to conclude what’s causing infertility. Ideally, you should have practical and realistic expectations from the medical procedure.
When should I get a fertility workup?
Most experts suggest getting a complete fertility workup if you haven’t conceived naturally after engaging in unprotected sexual intercourse for 12+ months.
Can a doctor check if im fertile or not?
Depending on your symptoms and past medical history, your doctor will prescribe you a series of blood tests and imaging tests to determine whether or not you are infertile.
What are the symptoms of poor egg quality?
Some of the most common signs of poor egg quality in women are absent or delayed periods, irregular periods with extremely low or heavy flow, a history of miscarriage, shorter menstrual cycles, etc.
Who should go for a fertility workup?
Couples who haven’t been able to get pregnant after engaging in unprotected sexual intercourse for 12+ months should consider a fertility workup. Besides that, if you have been pregnant but are facing issues conceiving again, it warrants a work up too.
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