Should You Consider Fertility Testing?

Fertility testing for all genders usually involves getting tested in a healthcare provider's office but is available in other forms. For example, you can order an at-home test to measure your hormone levels. One company, Kindbody, even offered pop-up clinics on the streets of Manhattan.

Anyone could need testing, but that doesn't mean it's a good idea for everyone to have fertility testing. It comes down to factors like your age, health or lifestyle factors, and the length of time you've been trying to conceive. Here's what to know about fertility testing, including more about the types, costs, and more.

How Common Is Infertility?

Fertility problems affect 15% of couples and become more common as individuals age. For people of reproductive age, around 11% of women and around 9% of men experience infertility.

When Should I Get Fertility Testing?

The timing to get fertility testing depends on your age. If you are under 35 and have been trying to conceive for a year without birth control, you should consider having fertility testing completed. People over 35 should consider fertility testing if they've been trying to conceive without success within six months.

Who Might Want To Get Tested

If you don't fall under the situations above, you might also want to get tested if you have symptoms of health conditions that could increase infertility risk.

What Can Affect Fertility?

There are various causes of infertility. Some causes might be physical, while others may be related to lifestyle factors.

Physical Factors

The causes of infertility in people assigned female at birth can be:

• Autoimmune disorders
• Cancer or tumors
• Diabetes
• Functional problems with the ovaries—for example, a lack of ovulation, the release of an egg, due to menopause or polycystic ovary syndrome (PCOS)
• Obstructed Fallopian tubes, when they are blocked, open, or swollen
• Scarring due to abdominal surgery, endometriosis, or sexually transmitted infections (STIs)
• Thyroid disease
• Uterus characteristics, such as the presence of polyps

Infertility causes for people assigned male at birth might include:

• Environmental toxins
• Functional problems with the testicles or ejaculation
• Genetic disorders, like ones that result in low sperm or no sperm production
• Hormone-based disorders, such as ones that cause increased exposure to estrogen or testosterone
• Infection
• Long-term exposure to high heat
• Uncontrolled diabetes

Lifestyle Factors

Even if a couple's fertility tests all come back normal, other factors could get in the way of a healthy conception and pregnancy. Those lifestyle factors that could affect fertility include:

• Extreme weight changes
• High physical activity
• Increased emotional stress
• Not getting enough nutrients
  
• Smoking
  
• Use of drugs or excessive alcohol

Types of Fertility Tests

A healthcare provider may use one or more of many tests to help evaluate your fertility. These tests include blood tests, at-home tests, and more.

Blood Tests

When a person has questions about fertility, healthcare providers usually start with a blood test to determine levels of anti-Mullerian hormone (AMH). The eggs release this hormone, which declines with age as the number of eggs shrinks.

An AMH test can provide a good idea of how many eggs someone has left, Jennifer Eaton, MD, a fertility specialist and director of the Women & Infants Fertility Center in Providence, Rhode Island, told Health. You can get your AMH levels tested in a healthcare provider's office or at a lab facility.

Blood tests for fertility can also measure levels of follicle-stimulating hormone (FSH). This number goes up as a person's egg count goes down, so it can be another indication of whether their "ovarian reserve," or the number of eggs they have left, is typical for their age.

Home Fertility Tests

You can also order an at-home kit from a company like Modern Fertility, Let's Get Checked, or Everlywell to determine your AMH levels. At-home fertility tests geared toward semen analyses are also available. A semen analysis assesses the count, movement, and shape of sperm. With any home test, the results take a few days to be analyzed.

Hysterosalpingographies

A healthcare provider may recommend other blood and urine tests and hysterosalpingography (HSG) for couples trying to get pregnant who haven't succeeded. HSG is an X-ray of the uterus and fallopian tubes to check for abnormalities or blockages.

A healthcare provider can perform the procedure in an OB-GYN office, a clinic, or a hospital. HSG should preferably be done in the first 14 days of a person's menstrual cycle to reduce any possibility that a person might be pregnant.

Other Fertility Tests

To further evaluate fertility, a healthcare provider might also consider additional tests such as:

• Genetic testing
• Hormone measurements
• Hysteroscopies
• Laparoscopies
  
• Saline sonohysterograms
• Testicle biopsies
• Transvaginal ultrasounds

How Reliable Is Fertility Testing?

AMH tests tend to be a go-to for providers. However, a 2017 study found that ovarian reserve numbers do not necessarily indicate fertility.

Researchers gave blood and urine tests to 750 people who had been trying to get pregnant for three months or fewer, ages 30 to 44, and then followed them for six to 12 months. Almost 500 of those participants conceived naturally during that time, and their levels of AMH and FSH had no significant association with those who got pregnant and those who didn't.

Lead study author Anne Z. Steiner, MD, professor of obstetrics and gynecology at the University of North Carolina, told Health she was surprised by the results. However, Dr. Steiner said these findings should discourage people in their 30s and 40s from reading too much into these tests. That should be the case—especially if they haven't already been trying to get pregnant for several months.

Dr. Eaton agreed and said she doesn't recommend these tests to people just curious about their numbers. The test may be helpful, though, for people who are considering freezing their eggs or undergoing IVF.

"These tests are really to test the quantity of the eggs, but the more important thing is the quality of eggs," said Dr. Eaton. "We don't have any good tests for egg quality, so we don't have any good test for somebody to know if they're truly fertile or not."

Another reason AMH may not be a good indicator of fertility is the lack of standards for the test. One study reported that while AMH is the preferred method for determining ovarian reserve (the number of eggs someone has), there are no international standards.

The lack of standards makes it difficult to compare tests taken from different sites or with different brands. The study authors also stated that very little is known about what affects AMH levels, limiting the proper interpretation of the results.

How Much Does Fertility Testing Cost?

Many insurance companies won't cover fertility testing for people under 35 unless they've been trying to conceive for a full year. For those 35 and over, tests are generally covered after couples have been trying for six months.

To be sure about coverage, you may want to contact an insurance company to determine if they will cover fertility testing costs before completing it.

Additionally, if you want to find out your AMH levels, you can ask a healthcare provider or insurance company whether this test would be covered. At-home kits fall in the $100 to $200 range, while costs in a healthcare provider's office or at a fertility clinic can vary.

How Infertility Is Treated

The causes of infertility guide which treatments a healthcare provider will use or recommend. Treatment options could include:

• Intrauterine insemination (IUI): IUI consists of giving a woman an injection of prepared sperm to help with fertility. You may also need to take ovulation-inducing medications along with this treatment.
• In vitro fertilization (IVF): IVF is a fertility treatment where an egg and sperm are joined outside the body on a lab dish. Fertilized eggs that become embryos are then placed in the womb.
• Medications: Several medications may be used to help with fertility. Some medications may, for example, assist in egg development and ovulation or increase blood hormone levels for sperm production.
• Surgery: Surgery may be necessary and helpful for physical problems affecting fertility in all genders.
• Therapy: You may be recommended counseling about a condition causing or contributing to infertility. Behavioral therapy may also be considered if sexual problems are associated with fertility problems.

A Quick Review

To find out how fertile you are, you can have fertility tests completed either in a medical office or from home. However, there are a few things to consider about fertility testing, from the types of tests you may need to testing expenses to the reliability of certain tests.

Overall, fertility testing results shouldn't be the only thing that guides your decisions about pregnancy. Try to consider the whole picture of everything affecting your fertility level, including lifestyle factors such as nutrition and stress.