Understanding your fertility is all about giving yourself options.
Right now, starting a family and having kids might be a distant thought. But, the sooner you figure out the state of play, the sooner you can make informed decisions about your reproductive health.
The research tells us that 1 in 9 Australian couples will experience trouble conceiving [1]. You might already know this firsthand if you're actively trying to start a family or thinking about trying soon.
The good news is that by speaking to a fertility specialist and taking a fertility test, you can identify any fertility problems early.
Plus, you'll be able to score personalised insights about everything from your ovarian reserve to possible egg-freezing and IVF outcomes.
Ready to find out more about how fertility tests work and what to expect when checking your fertility? Let's dive in.
How can I check my fertility (and why should it be a priority)?
If you think fertility is just about waiting and seeing what happens when you're ready for kids, think again.
Here's the thing about fertility testing: Most of us wait until we're experiencing issues to get checked.
We also know that fertility declines as a person ages.
For women, fertility begins to reduce in their early 30s and steeply declines after 35 [2]. For men over 45, the research tells us that the risk of miscarriage as well as a child's risk of mental health and development disorders increases [2].
To put this into perspective, let's run you through a few important stats about age and fertility:
- A woman in her mid-20s has a 25 to 30 per cent chance of conceiving every month.
- By the age of 40, her chance of falling pregnant each month drops to just 5 per cent.
Unfortunately, the chance of miscarriage also rises dramatically after the age of 35. As for male fertility, we know that conception is 30% less likely for men over 40.
Whether you're interested in learning more about your egg reserves, are concerned you might have a condition (like polycystic ovarian syndrome, a.k.a. PCOS) or haven't had success when trying to conceive naturally, checking your fertility is a smart move.
Depending on what test your GP or fertility specialist recommends, you'll be able to assess everything from your hormone levels to how well you're ovulating during your menstrual cycle. Some tests can even assess the structure of your uterus, fallopian tubes and ovaries.
Plus, you have a range of options as to how you test your fertility (such as going to a GP or specialist or taking an at-home hormone test).
How is fertility tested?
Checking your fertility usually involves things like blood tests, transvaginal ultrasounds and hormone level checks.
It's also important to remember that it's not just the female partner that should be getting tested. The research tells us that 40% of cases where couples are struggling to conceive are due to solely male fertility factors.
Let's cover the main ways fertility is tested and why a combination of tests is often used to find the best possible fertility treatment.
Blood tests
First up, one of the most common types of fertility tests you'll likely encounter is what's called the ovarian reserve (AMH) blood test. This simple blood test is designed to review your fertility and measure the number of eggs left in your ovaries.
To understand how this test works, let's run you through what an ovarian reserve is and why it matters.
When you're born, you have roughly 2 million eggs stored in your ovaries. As you age, the quality and quantity of these eggs decrease progressively until you reach menopause (or even earlier if you're navigating premature menopause).
That's why checking your ovarian reserve is important — it gives you an indication of how many eggs you have remaining in your ovaries at the time of testing.
What is the AMH test?
We're glad you asked. The anti-mullerian hormone (AMH) is produced by the follicles in your ovaries. By testing the level of AMH in your blood, you're able to get a good snapshot of your ovarian reserve.
The blood test reveals how many eggs you're likely to have left and how many fertile years you've still got ahead.
It's important to know the limitations of this hormone test, as it can only reveal the quantity (not the quality) of your eggs.
Plus, by checking your fertility hormones, you'll be able to uncover any underlying conditions (like PCOS) that may impact your chances of conceiving.
What other hormones can a blood test check?
Your GPs or fertility experts may also recommend a range of blood tests to look into a number of hormones related to your fertility [3].
Typically, the hormones they'll be reviewing include:
- Follicle-stimulating hormone (FSH) is responsible for stimulating the growth of the follicle containing the egg.
- Luteinising hormone (LH) helps to stimulate the rapid growth of the follicle that contains the fertile egg just prior to ovulation.
- Prolactin is the hormone that is usually elevated during pregnancy and plays a key role in preparing the body for breastfeeding.
- Thyrotrophin is a hormone that can show if our thyroid gland is underactive (which can lead to thyroid problems and irregular periods).
- Androgens are often elevated for women navigating ovulation problems or conditions such as PCOS.
By running fertility blood tests on these hormones, you'll be able to identify any contributing factors that may be impacting your fertility (or even get to the root of unexplained infertility).
Vaginal ultrasounds
Another way of assessing your fertility is to have an ultrasound scan of your ovaries, womb and fallopian tubes. A transvaginal ultrasound is one way of doing this and uses a small ultrasound probe inside your vagina to help your doctor check the health of your reproductive organs.
By having an ultrasound scan, you can check for conditions like endometriosis as well as blockages in your fallopian tubes that may prevent you from falling and remaining pregnant [4].
Diagnostic laparoscopy
Also known as keyhole investigation, diagnostic laparoscopy can be used if you're suspected of having a pelvic problem [3].
If you've been navigating period pain, significant discomfort during sex or have a history of recurring pelvic infection, this test can be used to examine your womb, fallopian tubes and ovaries.
Sperm test and semen analysis
Did you know up to 2 in every 5 cases of fertility problems are caused by the male partner [4]? That means it's important to ensure your partner's sperm and semen are checked to assess both quality and quantity.
To run a semen analysis, your partner will need to speak with a doctor or urologist (a male reproductive specialist) to organise a check-up. He'll need to avoid sex for up to 5 days (to let his semen build up) and ensure there's enough to analyse.
Typically, this sperm test and semen analysis will look at a few things, including semen volume, sperm concentration, sperm mobility and sperm morphology (a.k.a. are they the right shape to penetrate an egg properly?).
Plus, a blood test might be used to check for hormonal imbalance as well as a scrotal or transrectal ultrasound scan (to check for abnormalities in the testes).
Testing for chlamydia
We know that chlamydia is the most common sexually transmitted infection (STI) [5]. This STI can also cause pelvic inflammatory disease and even lead to fertility problems.
That's why your doctor might book you in for chlamydia. Usually, this involves a urine test or a simple swab of your urethra (the tube where your urine passes).
X-ray of fallopian tubes
Also known as a hysterosalpingogram (or HSG, for short), this X-ray is used to check for any blockages in your fallopian tubes.
In most cases, opaque dye is injected through the cervix while you're having your scan, which can show if any blockages might be preventing eggs from passing through your tubes properly.
Genetic testing
If you know you're a carrier of a single gene mutation, have experienced recurring miscarriages or have previously had a pregnancy impacted by chromosomal variation, you might consider getting genetic testing done.
Often used by women going through an IVF cycle, a pre-implantation genetic test (PGT) can test your embryos for gene conditions or chromosome variation [7].
If you've been navigating infertility problems or want to avoid passing on serious genetic diseases, this type of testing can be helpful (particularly if you're considering a fertility treatment like IVF).
Your fertility specialist will be able to recommend one or more tests to help you get to the bottom of any challenges or conditions impacting your ability to conceive.
How to check for infertility
Female and male infertility (or fertility problems more broadly) are more common than you might think. The stats tell us that 1 in 9 Australian couples struggle to conceive (even after a year of trying).
It's important to point out that infertility doesn't mean you're infertile.
Instead, the medical world uses the term 'infertility' to explain when a couple hasn't been able to conceive after 12 months of regular unprotected sex.
For women, there are a number of factors that are used when evaluating infertility, including:
- The number and equality of eggs in her ovaries.
- How often (and how regularly) ovulation happens and timing sex around a woman's fertile window (usually 5 days before ovulation).
- Blocked or damaged fallopian tubes that can make it difficult for sperm to reach the egg.
- A hostile uterus (a.k.a not having enough cervical mucus or the right acidity for sperm to swim through it).
Plus, common reproductive conditions such as PCOS, endometriosis and fibroids can make it difficult to fall pregnant, too.
For men, male infertility can include things like sperm delivery, semen volume, sperm count and sperm quality.
The best place to start is by taking a fertility test or booking a chat with your GP. They'll be able to arrange any infertility testing that might be helpful and can even make referrals to reproductive specialists who can run other tests for infertile couples.
What's the difference between a fertility health check and a fertility assessment?
In a nutshell, a fertility health check involves 3 key steps — an AMH blood test, semen analysis and a review appointment with your fertility specialist.
On the flip side, a fertility assessment includes all the same tests as a fertility health check but goes one step further.
This fertility assessment also uses pelvic ultrasounds to look for any abnormalities in the uterus that may be impacting your fertility success or causing a pregnancy delay.
When to seek help from doctors or fertility experts
So, when should you consider chatting with a doctor or fertility specialist about your reproductive help? Obviously, we're big advocates for being proactive and conducting things like ovarian reserve testing early.
But, if you're actively trying to conceive, here are a few signs that might indicate it's time to book an appointment [6]:
- If you're over 36 years old and have been trying to conceive naturally for over a year without success.
- If you are concerned about your fertility (for example, if you've received treatment for cancer or think you might have an STI).
Seeking fertility treatments and testing can be a daunting and stressful prospect. But the sooner you learn more about your body, the sooner you can make informed decisions about your fertility timeline.
In the meantime, it may also be worth changing your lifestyle to make it more fertility-friendly. Habits like exercising regularly, taking a prenatal vitamin, limiting coffee and alcohol consumption, and eating a healthy diet are great first steps.
Image credit: Kin / Pexels + Karolina Grabowska
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