This is Infertility is a bi-weekly podcast where we fuse narrative storytelling with experience and science to give you a new perspective on what it’s really like to go through a family building journey. Each episode dives into the emotional, physical, and financial burdens carried by those who experience infertility on their path to parenthood. Be it IVF, IUI, egg freezing, surrogacy, adoption, etc., the path is never the same and it can be long, painful, and lonely. It’s our mission to give those struggling a platform to be heard, a community connection, and an opportunity to raise awareness of the 1 in 8 who, for many reasons, struggle with infertility.
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This is Infertility

Episode 178: Fertility 101: Common Fertility Tests

The Fertility 101 Series, because there’s no shortage of daunting terms to keep your mind running, is a quick and dirty breakdown on a specific topic with insights from a fertility expert.

This week’s guest, Dr. Paul Dudley, Medical Director of Pinnacle Fertility Atlanta, dives into what tests are expected during an initial consultation, including the need for a blood test, semen analysis (if a partner is involved), and comprehensive assessments like an ovarian reserve evaluation. He also shares his perspective on at-home fertility testing kits and when to seek guidance from your doctor when trying to conceive.

Guest: Dr. Paul Dudley, Medical Director, Pinnacle Fertility Atlanta

Host: Dan Bulger, Progyny

For more information, visit Progyny’s Podcast page and Progyny’s Education page for more resources. Be sure to follow us on Instagram, @ThisisInfertilityPodcast and use the #ThisisInfertility. Have a question, comment, or want to share your story? Email us at thisisinfertility@progyny.com.

You can also watch the podcast on YouTube:

Here are some highlights from this episode:

Initial testing

02:33 – 04:57

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.

Ovarian reserve

05:19 – 10:11

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.

Test run down + at home kits

10:56 – 12:29

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.

Dan Bulger

Host

Dan Bulger
Producer at Progyny

Dan has been in the healthcare industry for the past ten plus years as a multimedia content producer. Better known as ‘Video Dan’ he has interviewed numerous doctors, patients and other experts in the world of fertility. He’s also the producer for this podcast, This is Infertility and the producer behind the Progyny YouTube Channel which features interviews with dozens of the nation’s leading fertility specialists. On a personal note Dan’s parents started fostering kids when he was four years old, and he considers himself a proud older brother to over 100 foster children.

Dr. Paul Dudley

Guest

Dr. Paul Dudley
Medical Director at Pinnacle Fertility Atlanta, a provider in Progyny’s network

Dr. Paul Dudley is a Board-Certified Fertility Specialist with nearly two decades of experience in the field.

Dr. Dudley’s distinguished career began at Seattle Reproductive Medicine, one of the nation’s largest fertility practices completing over 5000 ART cycles per year.

Dr. Dudley became a Partner Physician at SRM in 2010, then advanced to become SRM’s Co-Managing Partner from 2019 to 2023.

A thought leader recognized by his peers, Dr. Dudley served on the Pinnacle Fertility Board of Directors, the Fertility Pharmacy of America Advisory Board, and was elected to the Pacific Coast Reproductive Society Board of Directors where he served in varying capacities from 2015 onward including Society President. Dr. Dudley has been named a ‘Top Doctor’ in Seattle many years running, thrives on complex cases, and is dedicated to his patients.

Dr. Dudley is a native of Douglas, GA. He graduated with Highest Honors from Georgia Institute of Technology followed by a Medical Degree at Emory University School of Medicine. Dr. Dudley’s Residency and Fellowship were both completed at the primary academic program in the nation’s largest medical center – Baylor College of Medicine, part of the prestigious Texas Medical Center.

Dr. Dudley is married with two adult daughters.