Episode 178: Fertility 101: Common Fertility Tests

Dr. Dudley: For the semen analysis, most men abstain from ejaculation for about two to five days, meaning no ejaculation anytime of any kind prior to collecting that sperm. And then in women, we assess the wombs, ovulation status and ovarian reserve typically within one visit. So, for an individual we would usually have them come in around the tail end of their follicular phase, allowing us the opportunity to assess their ovarian reserve via ultrasound and blood draw. Confirm if they’re ovulating and then we typically would perform some sort of uterine evaluation often using a test called hysterosalpingography (HSG). Which confirms both diagnostic and therapeutic diagnostic in the sense that it tells us that someone’s uterus and tubes are within normal limits. Therapeutically, in the sense that flushing out one’s tubes is a good low-tech fertility treatment. There are a couple of different alternatives that we employ at times, for individuals, kind of depending on their medical history and surgical history, and those could include things like a histogram where you fill the uterine cavity with a little bit of fluid and get a better view of the wall of the uterus at the time of the procedure.

All of these assessments are consolidated into a single visit. With luck, we obtain both semen analysis results and ovarian reserve testing within this cycle, so even 7-10 days later, you’re following up with the patient, breaking the whole thing down. You’re saying here’s what we did. Here’s what we found. Here’s what the plan is.

Dr. Dudley: Ovarian reserve really has two components: quality and quantity. Quality tends to trend with age, while quantity refers to the number of eggs. Women are born with, in some cases, millions of eggs, which gradually decline over the course of their lives. There are women who are born with a high reserve, destined to go through menopause around 58, while others may have a low reserve and experience menopause in their 20s, and everything in between. In a perfect world, we would be able to hook up women to some sort of meter and say you have you know, 24,832 eggs left, but that’s not possible. However, we can assess this through what is called the antral follicle or follicle count. This assessment provides an idea of a typical distribution, resembling a bell curve, with many women falling within the average range, while some have a high count and others a low count.

So as time goes on, the number of eggs a woman has in her ovaries goes down. And while a quantity does impact fertility, the perhaps bigger and trickier measure is quality. When women are younger, the prevalence of genetic abnormalities in the eggs is lower and the prevalence of normal eggs is higher. And as they get older, the prevalence of abnormal eggs increases.

Dan Bulger: Okay, so the main tests are what we just listed, a blood test that looks at your Anti-Mullerian hormone or AMH, which can provide some information about ovarian reserve. Your age is used as a guide for egg quality, an ultrasound to look at the ovaries and the uterus. An HSG to see if the fallopian tubes are open. And for men a sperm test, if any issues are found more tests might be needed. Like for men, if there’s no sperm, perhaps they’ll need to be referred to a reproductive endocrinologist for further testing. But now, you might be wondering, well, it’s 2024. Certainly, some of this can be done at home. Right?

Dr. Dudley: There are two different classes of at-home tests: kits that are sent to reference labs, which are reliable, yes and the sort of kits that you can order through Amazon to evaluate your semen analysis. I wouldn’t describe those as being helpful. Some at-home diagnostics can give folks a false sense of security or anxiety. For the purpose of checking your anti-mullerian hormone (AMH) with an at-home diagnostic kit in lieu of getting an AMH performed at your annual exam, if you’re a woman, I think is probably fine. If on the other hand, someone is experiencing trouble conceiving, if you’re to the point where you’re ordering one of these things or are contemplating it. In general, I would say that’s the best time to talk to your OB, or talk to your reproductive endocrinologist.