For couples who are hoping to become parents, struggling to conceive can be a frustrating and unexpected experience. But it’s also a common one – according to the Centers for Disease Control and Prevention (CDC), one in every five married women in the U.S. aged 15-49 with no prior births is unable to get pregnant after a year of trying. Many people who experience infertility do end up having children, but sometimes they need medical help.
People in this situation are often unsure when it is appropriate to seek medical guidance, what happens during a fertility evaluation, or what types of fertility testing may be recommended. Understanding what to expect during an initial fertility consultation can help you feel more prepared and informed.
A fertility evaluation may involve reviewing your medical, sexual, and reproductive history, discussing menstrual cycles and previous pregnancies, performing a physical examination, and recommending diagnostic testing when appropriate. Depending on the individual’s or couple’s circumstances, evaluation may consider factors affecting either partner.
Instead of searching online for information about when to see a fertility specialist, what infertility testing for women entails, and what happens during an initial fertility consultation, consider meeting with a TopLine MD Alliance Network physician. These experienced providers support Florida patients through a wide range of reproductive and women’s health needs, including fertility evaluation. Through coordinated care and connections to trusted medical professionals, people struggling to conceive can receive guidance and referrals when they need additional evaluation or specialized care.
Fertility facts for women and men
Pregnancy is the result of a process that has many steps, and both women and men can contribute to infertility. To get pregnant:
• A woman’s body must release an egg from one of her ovaries
• A man’s sperm must reach and fertilize the egg
• The fertilized egg must travel through the woman’s fallopian tube to her uterus
• The embryo must attach (implant) inside the woman’s uterus
A woman needs functioning ovaries, fallopian tubes, and a uterus to get pregnant. Therefore, conditions affecting any of these organs can contribute to female infertility.
At the same time, a man needs to produce sperm that is capable of reaching and fertilizing an egg. Male infertility plays a role in about half of all couple infertility cases, due to conditions like low sperm count, misshaped or poorly moving sperm, or blocked tubes in the male reproductive system.
When to seek a fertility evaluation
The CDC and other major health organizations define infertility as not being able to conceive after one year or more of unprotected sex. Because fertility in women is known to steadily decline with age, most providers evaluate and treat women aged 35 or older after six months of trying to get pregnant. (Women aged 40 or older should consult a fertility specialist after three months of trying to get pregnant.)
Aside from age, certain medical histories and symptoms may be reasons to seek a fertility evaluation sooner. These include:
• Irregular, painful, or absent periods, which often indicate ovulation challenges
• Diagnosed health conditions like polycystic ovary syndrome or PCOS (a hormonal imbalance that stops a woman’s ovaries from releasing eggs), endometriosis (when tissue similar to the lining of the uterus grows outside the uterus, causing inflammation, pain, and scarring), or uterine fibroids (non-cancerous growths that develop inside or outside the uterus)
• A history of pelvic infections or sexually transmitted diseases (STDs), including chlamydia or gonorrhea
• Two or more consecutive miscarriages, which may indicate structural issues in the uterus
• Known or suspected sperm quality issues, such as erectile dysfunction, difficulty ejaculating, or testicular trauma
Despite these potential complications, remember that it only takes one egg and one sperm to make a healthy embryo. For many individuals and couples, seeking a fertility evaluation is the first step toward becoming pregnant.
What happens at a fertility evaluation?
Your initial fertility consultation with a TopLine MD Alliance Network provider typically begins with a detailed review of the medical, sexual, and reproductive history of both partners. This review includes the assessment of menstrual cycle regularity, previous pregnancies or miscarriages, and any known health conditions like PCOS, endometriosis, or uterine fibroids, followed by a complete physical examination.
It’s important to be honest and transparent about prior sexual relationships, STDs, lost pregnancies, lifestyle habits, and other personal medical information that may impact fertility, so you can get the most effective care possible.
In most cases, an obstetrics and gynecology provider (OB/GYN) conducts the initial fertility consultation. If needed, you may be referred to a reproductive endocrinologist or fertility specialist for more advanced assessment.
Fertility testing options for women
Female fertility testing evaluates a woman’s hormone levels, reproductive organs, and ovarian reserve (the total remaining supply of eggs within the ovaries) to identify potential causes of infertility. Your TopLine MD Alliance Network provider may recommend one or more of the following fertility testing options:
Hormone blood test
Certain hormonal imbalances can interfere with a woman’s egg production. This blood test checks various hormone levels during the menstrual cycle, such as progesterone, estradiol, and thyroid-stimulating hormone (TSH).
Ovarian reserve test
Also known as an anti-mullerian hormone (AMH) test, ovarian reserve testing combines fertility blood tests with a transvaginal ultrasound. An AMH test measures a woman’s antral follicle count (AFC) and the amount of AMH hormone produced by her ovaries, which tells the provider if she has a typical egg count compared to other women of similar age. This test is only necessary for women who need to pursue in vitro fertilization (IVF).
Pelvic ultrasound
A pelvic ultrasound (or sonogram) creates detailed pictures of a woman’s reproductive system that can be used to detect ovarian cysts, uterine fibroids, or other abnormalities.
Sonohysterogram
This imaging test allows the provider to see inside a woman’s uterus to help determine the cause(s) of her infertility.
Hysterosalpingogram
This imaging test uses fluoroscopy to take pictures of a woman’s uterus and fallopian tubes and search for blockages.
Hysteroscopy
During this test, the provider inserts a hysteroscope (a thin, lighted tube) into a woman’s uterus to examine the cervix and the interior lining of the uterus.
Genetic testing
Genetic testing can help determine if changes in a woman’s chromosomes or genes are causing infertility or repeated miscarriages.
Fertility testing options for men
Fertility testing for men focuses primarily on semen analysis, which measures sperm count, morphology (shape), and motility (movement). A urologist or a fertility specialist typically performs these tests. Men should be prepared to answer questions about their sex life, whether they have fathered children in the past, and any injuries or surgeries that could affect their fertility.
Semen analysis requires a man to give a semen sample by masturbating and ejaculating into a container at the provider’s office. However, some men prefer to collect their sample at home – ask your TopLine MD Alliance Network provider if this is an option.
The semen sample is then sent to a lab to measure the number of sperm present and assess their shape and movement. The lab also checks the semen sample for any signs of infection or other issues. Sperm counts often change from one sample to the next, so a man may be required to perform several semen analysis tests over time.
Other fertility testing options for men include:
Scrotal ultrasound
This test creates detailed pictures of a man’s reproductive system, including the scrotum and testicles, to check for fertility issues.
Transrectal ultrasound
A small, lubricated wand is placed into a man’s rectum to check his prostate and look for blockages in the tubes that carry semen.
Post-ejaculation urinalysis
The presence of sperm in a man’s urine can show that sperm are traveling backward into the bladder rather than out of the penis during ejaculation (a condition called retrograde ejaculation).
Hormone blood test
The pituitary gland, hypothalamus, and testicles produce hormones that are vital to a man’s fertility. This blood test measures testosterone and other hormone levels.
Testicular biopsy
This test involves removing tissue samples from a man’s testicles to determine if he is making sperm as expected. If so, a blockage or another issue may be affecting sperm production.
Genetic testing
Genetic testing can be used to detect changes in a man’s Y chromosome or other genes that cause low sperm count.
Schedule a fertility evaluation today
The TopLine MD Alliance is a healthcare alliance of independent physicians and medical practice groups dedicated to enhancing the patient experience. By connecting Florida patients with top-tier providers, diagnostic centers, and imaging facilities across the state, the TopLine MD Alliance aims to deliver high-quality care efficiently and conveniently.
TopLine MD Alliance Network fertility specialists and other physicians are trusted healthcare professionals who are ready to help patients understand their reproductive health and coordinate care when additional evaluation or specialized services are needed. Find a fertility provider near you today, and start getting answers.
The TopLine MD Alliance is an association of independent physicians and medical practice groups who are committed to providing a higher standard of healthcare services. The members of the TopLine MD Alliance have no legal or financial relationship with one another. The TopLine MD Alliance brand has no formal corporate, financial or legal ties to any of the physicians or practice groups in the network
