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    Fertility Problems: Should I Be Tested?

    Fertility Problems: Should I Be Tested?

    You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

    Fertility Problems: Should I Be Tested?

    Get the facts

    Your options

    • Have tests to try to find out the cause of infertility.
    • Don't have tests. To make family planning decisions, use the information you already have.

    Key points to remember

    • If you are younger than 35 and are trying to get pregnant (conceive), most doctors suggest trying well-timed sex for at least 1 year before thinking about testing. The best time to conceive is just before ovulation . Some couples find that they have been missing their most fertile days when trying to conceive.
    • If you are a woman 35 or older and have tried well-timed sex for 6 months, you might want to think about infertility testing before age-related problems make it too hard to conceive.
    • Infertility tests may find what is causing the problem. Sometimes you can be treated at the same time.
    • Testing and treatment can be stressful, costly, and sometimes painful. You may need only a few tests, or you may need many tests over months and years.
    • If you decide to have infertility testing, talk with your doctor about how much testing you are willing to do and for how long. You may only want to have tests for problems you are willing to treat or that will help you move on to other options, such as adoption.
    • Tests can't always find the cause of infertility. And not all infertility problems can be treated.
    FAQs

    What is infertility?

    You may be infertile if you have not been able to get pregnant after trying for at least 1 year.

    A woman's fertility slowly drops from her mid-30s into her 40s because of the natural aging of the egg supply. A man's fertility is not affected as much by age.

    Defining infertility is a personal issue. It can depend on your age and how much time you choose to spend trying to get pregnant without medical help.

    What kinds of problems lead to infertility?

    In about 35 out of 100 couples, testing finds a male fertility problem, such as with sperm production or ejaculation. 1

    In about 50 out of 100 couples, testing finds a female fertility problem with ovulation, fallopian tube function, or other pelvic problems. 1

    Some couples find that both partners have a fertility problem.

    In 10 out of 100 couples, no cause is found. 1

    It can be stressful for you and your partner to find out the reason for infertility. Knowing where the problem is may create feelings of guilt and blame and may put strain on your relationship. Not being able to find any cause can also create stress. You may want to talk with a counselor or join an infertility support group before you make your decision. Talking with other people can help you feel less alone.

    What types of tests are done?

    Tests for infertility can range from a simple blood test to surgery. If you decide to have testing, your doctor will want to check you and your partner at the same time.

    • Basic tests can show if there are problems with eggs or sperm. Depending on the results, the test may be repeated, or you and your partner will be treated with medicines and hormones. These tests may include:
      • Basal body temperature tests.
      • Blood tests.
      • Semen analysis.
    • Advanced tests check the reproductive organs of both partners. These tests look for diseases or fertility problems that might be treated. These tests may include:
      • Hysterosalpingogram . This checks the fallopian tubes and can clear them if a blockage is found. The test may be done with or without ultrasound .
      • Laparoscopy . This test looks at reproductive organs and checks for problems such as endometriosis .
      • Hysteroscopy . This test looks for growths or defects in the uterus that can't be seen with other tests.
      • Sperm antibody test. This test shows whether sperm have been damaged by antibodies .

    How can you use the test results?

    Based on your test results, your doctor can help you decide about your next testing or treatment option. Take some time to think about what you have learned from each test and what you want to do next.

    For example, if your first test results are normal and no clear reason is found for your fertility problem, you may:

    • Keep trying to conceive on your own, having sex just before ovulation to increase your chances of getting pregnant.
    • Have advanced tests to find out a cause for your fertility problem. These tests will check your fallopian tubes to be sure that eggs can enter the tubes, be fertilized, and start to grow in the uterus. The tests may involve cutting or poking, and they have risks, such as cramping or infection.

    Tests can't always find the cause of infertility. And not all infertility problems can be treated.

    Depending on the results of these tests, your doctor may suggest treatment, such as:

    Before you decide about testing, think about:

    • How important is it to you and your partner to know why you haven't become pregnant?
    • How will test results affect your family planning?
    • How will you deal with the stress of testing?
    • How much will it cost? Talk with your doctor and your health insurer about costs.

    What else do you need to know about testing?

    Testing and treatment can be costly, stressful, and sometimes painful. Before starting, talk about how much testing you are willing to do and for how long.

    You may decide to have the basic tests only and to stop when you have enough information. Or instead of advanced testing and treatment, you may decide to keep trying to get pregnant on your own or to adopt a child. Your decision will be based on your health, age, goals, and values.

    Why might your doctor recommend infertility testing?

    Your doctor might advise you to have infertility testing if:

    • You are younger than 35, have regular menstrual periods, and have had sex during your fertile window (the 6 days each month that you can become pregnant) for at least 1 year.
    • You are 35 or older, or you have irregular periods and have had sex during your fertile window for at least 6 months.
    • You are at high risk for fertility problems and have had sex during your fertile window for a few months.
    • You have had several miscarriages .
    • It would be easier for you to make family planning decisions with test results.

    Compare your options

    Compare

    What is usually involved?









    What are the benefits?









    What are the risks and side effects?









    Have infertility testing Have infertility testing
    • You have one or more infertility tests to find out why you and your partner are having problems getting pregnant.
    • You keep track of how often you and your partner have sex, and you talk about this with your doctor.
    • You decide how much testing to do, and you stop when you have enough information. Based on the test results, you may decide to get fertility treatment.
    • You may be able to find out why you are having problems getting pregnant.
    • Some tests can find the problem and treat it at the same time.
    • You may need many tests over many months or years. Tests can't always find the cause of infertility. And not all infertility problems can be treated.
    • Testing is stressful and can be costly.
    • Basic tests, such as semen analysis and blood tests, have no risks or side effects, and they don't cause pain.
    • Advanced tests or surgery may require a cut in the skin and can be painful. They have a higher chance of problems after the test, such as cramping or infection.
    Don't have infertility testing Don't have infertility testing
    • You keep trying to conceive on your own, having sex just before ovulation to increase your chances of getting pregnant. Some couples find that they have been missing their most fertile days when trying to conceive.
    • You consider other options for parenting, such as adoption or raising a foster child.
    • You avoid the cost, stress, and risks of infertility testing.
    • You may have an infertility problem that can be treated, but you may not know it.

    Personal stories

    Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

    Personal stories about infertility testing

    These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

    Most couples we know seemed to get pregnant after just a few months of trying. We've been trying now for about 5 or 6 months and still haven't gotten pregnant. But we aren't sure that we have been having sex at the right time of the month, so we got some information about how to calculate the fertile time. We are going to see if working on our timing for a few months helps us get pregnant. If it doesn't, we'll see our doctor to talk about the next step.

    Lynn, age 33, and James, age 40

    I didn't have any trouble getting pregnant with my first child. But my second husband and I have been trying to have a baby for about a year now, and I still haven't gotten pregnant. Since he doesn't have any children of his own, we can't be sure which one of us may have a problem. We have been having sex at the right times. We agree that it's time to find out whether there may be a problem. We don't want to wait too long, because we'd like the new baby to be able to grow up with his or her big sister.

    Rosa, age 32

    We are getting started on our baby-making a little bit later than a lot of couples: I'm 34 and my husband is 38. It's ironic that we have both been so successful in our careers and yet now seem to be having trouble having a baby! We have been trying for about 8 or 9 months, and it doesn't seem to be happening. My husband is a little on the macho side, so he's not too keen on having a semen analysis. But I'm sure that if I agree to have some tests, he will too.

    Carol, age 34, and Dave, age 38

    We've been trying to conceive for 10 months now. Soon we'll have to start counting in years, I'm afraid. It's been a rude awakening to discover that we can't control our ability to conceive. But since we are both still young, we aren't too worried yet. We are going to try tracking my wife's menstrual cycles and see if that helps before we take the next step. If that doesn't help, I'll consider having my sperm checked.

    James, age 27, and Sabra, age 26

    What matters most to you?

    Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

    Reasons to have infertility testing

    Reasons not to have infertility testing

    Having a biological child is very important to me.

    Having a biological child is not that important to me.

    More important
    Equally important
    More important

    I'm not worried about the cost of infertility testing.

    I'm worried about the cost of testing.

    More important
    Equally important
    More important

    I think I can handle the stress of testing.

    I'm not sure that I can handle the stress of testing.

    More important
    Equally important
    More important

    I accept that testing may not be able to find a problem or treat it if one is found.

    I don't want to have a lot of tests that may not find my problem or treat it.

    More important
    Equally important
    More important

    I know that having these tests means talking with doctors about our sex life.

    I'm not comfortable talking about our sex life.

    More important
    Equally important
    More important

    My other important reasons:

    My other important reasons:

    More important
    Equally important
    More important

    Where are you leaning now?

    Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

    Having infertility testing

    NOT having infertility testing

    Leaning toward
    Undecided
    Leaning toward

    What else do you need to make your decision?

    Check the facts

    1.

    If you are younger than 35 and have been trying to get pregnant for 4 months, is it time to think about an infertility test?

    • Yes Sorry, that's not right. If you're younger than 35 and trying to get pregnant, doctors suggest trying well-timed sex for at least 1 year before thinking about testing.
    • No You're right. If you're younger than 35 and trying to get pregnant, doctors suggest trying well-timed sex for at least 1 year before thinking about testing.
    • I'm not sure It may help to go back and read "Key points to remember." If you're younger than 35 and trying to get pregnant, doctors suggest trying well-timed sex for at least 1 year before thinking about testing.
    2.

    Can testing always help you find out the cause of any infertility problem?

    • Yes Sorry, that's not right. Tests can't always find the cause of infertility. And not all infertility problems can be treated.
    • No You're right. Tests can't always find the cause of infertility. And not all infertility problems can be treated.
    • I'm not sure It may help to go back and read "How can you use the test results?" Tests can't always find the cause of infertility. And not all infertility problems can be treated.
    3.

    Can some tests find and treat an infertility problem?

    • Yes You're right. Infertility tests may find what is causing the problem. Sometimes you can be treated during the test.
    • No Sorry, that's not right. Infertility tests may find what is causing the problem. Sometimes you can be treated during the test.
    • I'm not sure It may help to go back and read "Key points to remember." Infertility tests may find what is causing the problem. Sometimes you can be treated during the test.

    Decide what's next

    1.

    Do you understand the options available to you?

    2.

    Are you clear about which benefits and side effects matter most to you?

    3.

    Do you have enough support and advice from others to make a choice?

    Certainty

    1.

    How sure do you feel right now about your decision?

    Not sure at all
    Somewhat sure
    Very sure
    3.

    Use the following space to list questions, concerns, and next steps.

    Your Summary

    Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

    Your decision

    Next steps

    Which way you're leaning

    How sure you are

    Your comments

    Your knowledge of the facts

    Key concepts that you understood

    Key concepts that may need review

    Getting ready to act

    Patient choices

    Credits and References

    Credits
    Credits Healthwise Staff
    Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
    Specialist Medical Reviewer Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology

    References
    Citations
    1. Fritz MA, Speroff L (2011). Female infertility. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 1137?1190. Philadelphia: Lippincott Williams and Wilkins.
    You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

    Fertility Problems: Should I Be Tested?

    Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
    1. Get the facts
    2. Compare your options
    3. What matters most to you?
    4. Where are you leaning now?
    5. What else do you need to make your decision?

    1. Get the Facts

    Your options

    • Have tests to try to find out the cause of infertility.
    • Don't have tests. To make family planning decisions, use the information you already have.

    Key points to remember

    • If you are younger than 35 and are trying to get pregnant (conceive), most doctors suggest trying well-timed sex for at least 1 year before thinking about testing. The best time to conceive is just before ovulation . Some couples find that they have been missing their most fertile days when trying to conceive.
    • If you are a woman 35 or older and have tried well-timed sex for 6 months, you might want to think about infertility testing before age-related problems make it too hard to conceive.
    • Infertility tests may find what is causing the problem. Sometimes you can be treated at the same time.
    • Testing and treatment can be stressful, costly, and sometimes painful. You may need only a few tests, or you may need many tests over months and years.
    • If you decide to have infertility testing, talk with your doctor about how much testing you are willing to do and for how long. You may only want to have tests for problems you are willing to treat or that will help you move on to other options, such as adoption.
    • Tests can't always find the cause of infertility. And not all infertility problems can be treated.
    FAQs

    What is infertility?

    You may be infertile if you have not been able to get pregnant after trying for at least 1 year.

    A woman's fertility slowly drops from her mid-30s into her 40s because of the natural aging of the egg supply. A man's fertility is not affected as much by age.

    Defining infertility is a personal issue. It can depend on your age and how much time you choose to spend trying to get pregnant without medical help.

    What kinds of problems lead to infertility?

    In about 35 out of 100 couples, testing finds a male fertility problem, such as with sperm production or ejaculation. 1

    In about 50 out of 100 couples, testing finds a female fertility problem with ovulation, fallopian tube function, or other pelvic problems. 1

    Some couples find that both partners have a fertility problem.

    In 10 out of 100 couples, no cause is found. 1

    It can be stressful for you and your partner to find out the reason for infertility. Knowing where the problem is may create feelings of guilt and blame and may put strain on your relationship. Not being able to find any cause can also create stress. You may want to talk with a counselor or join an infertility support group before you make your decision. Talking with other people can help you feel less alone.

    What types of tests are done?

    Tests for infertility can range from a simple blood test to surgery. If you decide to have testing, your doctor will want to check you and your partner at the same time.

    • Basic tests can show if there are problems with eggs or sperm. Depending on the results, the test may be repeated, or you and your partner will be treated with medicines and hormones. These tests may include:
      • Basal body temperature tests.
      • Blood tests.
      • Semen analysis.
    • Advanced tests check the reproductive organs of both partners. These tests look for diseases or fertility problems that might be treated. These tests may include:
      • Hysterosalpingogram . This checks the fallopian tubes and can clear them if a blockage is found. The test may be done with or without ultrasound .
      • Laparoscopy . This test looks at reproductive organs and checks for problems such as endometriosis .
      • Hysteroscopy . This test looks for growths or defects in the uterus that can't be seen with other tests.
      • Sperm antibody test. This test shows whether sperm have been damaged by antibodies .

    How can you use the test results?

    Based on your test results, your doctor can help you decide about your next testing or treatment option. Take some time to think about what you have learned from each test and what you want to do next.

    For example, if your first test results are normal and no clear reason is found for your fertility problem, you may:

    • Keep trying to conceive on your own, having sex just before ovulation to increase your chances of getting pregnant.
    • Have advanced tests to find out a cause for your fertility problem. These tests will check your fallopian tubes to be sure that eggs can enter the tubes, be fertilized, and start to grow in the uterus. The tests may involve cutting or poking, and they have risks, such as cramping or infection.

    Tests can't always find the cause of infertility. And not all infertility problems can be treated.

    Depending on the results of these tests, your doctor may suggest treatment, such as:

    Before you decide about testing, think about:

    • How important is it to you and your partner to know why you haven't become pregnant?
    • How will test results affect your family planning?
    • How will you deal with the stress of testing?
    • How much will it cost? Talk with your doctor and your health insurer about costs.

    What else do you need to know about testing?

    Testing and treatment can be costly, stressful, and sometimes painful. Before starting, talk about how much testing you are willing to do and for how long.

    You may decide to have the basic tests only and to stop when you have enough information. Or instead of advanced testing and treatment, you may decide to keep trying to get pregnant on your own or to adopt a child. Your decision will be based on your health, age, goals, and values.

    Why might your doctor recommend infertility testing?

    Your doctor might advise you to have infertility testing if:

    • You are younger than 35, have regular menstrual periods, and have had sex during your fertile window (the 6 days each month that you can become pregnant) for at least 1 year.
    • You are 35 or older, or you have irregular periods and have had sex during your fertile window for at least 6 months.
    • You are at high risk for fertility problems and have had sex during your fertile window for a few months.
    • You have had several miscarriages .
    • It would be easier for you to make family planning decisions with test results.

    2. Compare your options

    Have infertility testing Don't have infertility testing
    What is usually involved?
    • You have one or more infertility tests to find out why you and your partner are having problems getting pregnant.
    • You keep track of how often you and your partner have sex, and you talk about this with your doctor.
    • You decide how much testing to do, and you stop when you have enough information. Based on the test results, you may decide to get fertility treatment.
    • You keep trying to conceive on your own, having sex just before ovulation to increase your chances of getting pregnant. Some couples find that they have been missing their most fertile days when trying to conceive.
    • You consider other options for parenting, such as adoption or raising a foster child.
    What are the benefits?
    • You may be able to find out why you are having problems getting pregnant.
    • Some tests can find the problem and treat it at the same time.
    • You avoid the cost, stress, and risks of infertility testing.
    What are the risks and side effects?
    • You may need many tests over many months or years. Tests can't always find the cause of infertility. And not all infertility problems can be treated.
    • Testing is stressful and can be costly.
    • Basic tests, such as semen analysis and blood tests, have no risks or side effects, and they don't cause pain.
    • Advanced tests or surgery may require a cut in the skin and can be painful. They have a higher chance of problems after the test, such as cramping or infection.
    • You may have an infertility problem that can be treated, but you may not know it.

    Personal stories

    Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

    Personal stories about infertility testing

    These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

    "Most couples we know seemed to get pregnant after just a few months of trying. We've been trying now for about 5 or 6 months and still haven't gotten pregnant. But we aren't sure that we have been having sex at the right time of the month, so we got some information about how to calculate the fertile time. We are going to see if working on our timing for a few months helps us get pregnant. If it doesn't, we'll see our doctor to talk about the next step."

    ? Lynn, age 33, and James, age 40

    "I didn't have any trouble getting pregnant with my first child. But my second husband and I have been trying to have a baby for about a year now, and I still haven't gotten pregnant. Since he doesn't have any children of his own, we can't be sure which one of us may have a problem. We have been having sex at the right times. We agree that it's time to find out whether there may be a problem. We don't want to wait too long, because we'd like the new baby to be able to grow up with his or her big sister."

    ? Rosa, age 32

    "We are getting started on our baby-making a little bit later than a lot of couples: I'm 34 and my husband is 38. It's ironic that we have both been so successful in our careers and yet now seem to be having trouble having a baby! We have been trying for about 8 or 9 months, and it doesn't seem to be happening. My husband is a little on the macho side, so he's not too keen on having a semen analysis. But I'm sure that if I agree to have some tests, he will too."

    ? Carol, age 34, and Dave, age 38

    "We've been trying to conceive for 10 months now. Soon we'll have to start counting in years, I'm afraid. It's been a rude awakening to discover that we can't control our ability to conceive. But since we are both still young, we aren't too worried yet. We are going to try tracking my wife's menstrual cycles and see if that helps before we take the next step. If that doesn't help, I'll consider having my sperm checked."

    ? James, age 27, and Sabra, age 26

    3. What matters most to you?

    Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

    Reasons to have infertility testing

    Reasons not to have infertility testing

    Having a biological child is very important to me.

    Having a biological child is not that important to me.

    More important
    Equally important
    More important

    I'm not worried about the cost of infertility testing.

    I'm worried about the cost of testing.

    More important
    Equally important
    More important

    I think I can handle the stress of testing.

    I'm not sure that I can handle the stress of testing.

    More important
    Equally important
    More important

    I accept that testing may not be able to find a problem or treat it if one is found.

    I don't want to have a lot of tests that may not find my problem or treat it.

    More important
    Equally important
    More important

    I know that having these tests means talking with doctors about our sex life.

    I'm not comfortable talking about our sex life.

    More important
    Equally important
    More important

    My other important reasons:

    My other important reasons:

    More important
    Equally important
    More important

    4. Where are you leaning now?

    Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

    Having infertility testing

    NOT having infertility testing

    Leaning toward
    Undecided
    Leaning toward

    5. What else do you need to make your decision?

    Check the facts

    1. If you are younger than 35 and have been trying to get pregnant for 4 months, is it time to think about an infertility test?

    • Yes
    • No
    • I'm not sure
    You're right. If you're younger than 35 and trying to get pregnant, doctors suggest trying well-timed sex for at least 1 year before thinking about testing.

    2. Can testing always help you find out the cause of any infertility problem?

    • Yes
    • No
    • I'm not sure
    You're right. Tests can't always find the cause of infertility. And not all infertility problems can be treated.

    3. Can some tests find and treat an infertility problem?

    • Yes
    • No
    • I'm not sure
    You're right. Infertility tests may find what is causing the problem. Sometimes you can be treated during the test.

    Decide what's next

    1. Do you understand the options available to you?

    2. Are you clear about which benefits and side effects matter most to you?

    3. Do you have enough support and advice from others to make a choice?

    Certainty

    1. How sure do you feel right now about your decision?

    Not sure at all
    Somewhat sure
    Very sure

    2. Check what you need to do before you make this decision.

    • I'm ready to take action.
    • I want to discuss the options with others.
    • I want to learn more about my options.

    3. Use the following space to list questions, concerns, and next steps.

    Credits
    By Healthwise Staff
    Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
    Specialist Medical Reviewer Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology

    References
    Citations
    1. Fritz MA, Speroff L (2011). Female infertility. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 1137?1190. Philadelphia: Lippincott Williams and Wilkins.

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