What Comes First: The Chicken Or The Egg?

Couples sometimes wonder which comes first: fertility testing or trying to get pregnant? In general, fertility testing is only needed after the couple has been trying to get pregnant for 6 months to 1 year. There are rare cases in which doctors will perform fertility testing on men or women prior to either attempting to have children. The result is typically the early freezing of eggs and sperm. For couples trying without success, male and female fertility testing is available.

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Male fertility testing

A majority of male infertility testing can be done with a sperm and semen analysis. Sperm will be checked for quantity, shape, and movement. Low sperm count or abnormally-shaped sperm does not necessarily mean a man is infertile. If the male has a normal sperm count and shape, the doctor will likely perform hormone and genetic testing. Hormone testing measures the amount of testosterone and other hormones in the blood. Hormones are essential in sexual development and processes. Abnormalities could mean problems in the pituitary gland, hypothalamus, or testicles. Hormonal causes of infertility can be difficult to treat. Fortunately, most male infertility is not related to hormonal issues. Genetic testing will look for congenital or inherited conditions.
Retrograde ejaculation testing will look to see if there is sperm in the urine. The presence of sperm in the urine indicates the sperm are traveling backward into the bladder instead of forward and out of the body. Medications or assisted reproductive therapy can be used to correct the problem. Antibody testing will look for antibodies attacking the sperm on the way to the egg.

Female fertility testing

Female fertility testing will start with a pelvic exam and ultrasound. Ultrasounds of the uterus and ovaries will determine if the infertility is caused by a physical blockage. Cervical mucus and basal temperature tracking will determine if ovulation is occurring. Ovarian function testing is critical for female fertility. A Pap smear will test the cervical cells for abnormalities.
Hormone testing will look for the hormone levels in the blood and urine. The most common forms of hormone testing in women are the follicle-stimulating hormone (FSH) test and the luteinizing hormone (LH) test. Both FSH and LH are directly tied to reproduction. FSH and LH are both produced by the pituitary gland. Abnormalities could be a sign of underlying issues with the hypothalamus. FSH and LH tests are commonly performed if the patient experiences irregular periods, weight issues, or early or late puberty. Low testosterone levels, decreased libido, and low muscle mass can also be a sign that FSH and LH levels are out of balance.

Additional testing

Additional female fertility tests include hysterosalpingogram (HSG) testing. HSG testing involves injecting dye into the cervix and vagina. X-rays are then taken to locate blockages in the fallopian tubes or cervix. During a hysteroscopy, a small camera is inserted into the uterus to look for physical abnormalities. An endometrial biopsy will determine if the uterine lining is thick enough for implantation.

When to seek help for getting pregnant

Infertility is often complex and involves many factors. There are several tests that can be performed to determine the cause of infertility. Doctors recommend couples try for 6 months to 1 year before coming in for fertility testing. Couples should speak with a fertility specialist to learn more about testing options.

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