When should you check?

One definition of infertility is the inability to get pregnant after a year of sex without birth control. Check to see if your fertility is normal by checking your basal body temperature, maintaining a calendar, checking cervical mucus, and testing hormone levels.
One definition of infertility is the inability to get pregnant after a year of sex without birth control. Check to see if your fertility is normal by checking your basal body temperature, maintaining a calendar, checking cervical mucus, and testing hormone levels.

Fertility is the ability of a man or woman to contribute to a pregnancy. Most people can do this without any special effort. About 80% of couples will have a pregnancy in a year if they have frequent (every 2 or 3 days) sex without birth control. But one couple in seven has difficulty conceiving and needs testing and treatment.

One definition of infertility is the inability to get pregnant after a year of sex without birth control. Pregnancy requires the release of an egg from an ovary, a sperm to fertilize it, and the fertilized egg (zygote) to reach the uterus and settle there. A problem with any of these steps can cause infertility. Infertility can result from disorders in both men and women.

Not getting pregnant can be worrying. But you shouldn't jump into fertility testing too quickly. Sometimes, it just takes a few more months of trying. You should consider testing:

  • If you and your partner have been having frequent sex without any contraceptives for a year
  • If you're a woman over 35, you should consider testing after six months. Fertility declines after this age: if you're a woman over 40, you could think of testing earlier
  • If you're a same-sex couple and fail to have a pregnancy after six cycles of artificial insemination

Checking for fertility

Maintain a calendar. If your periods are regular, you probably produce an egg (ovum) every month. If your periods are irregular or your cycle is very long, you should talk to your doctor about early testing.

Basal body temperature recording. Your body temperature rises a little during ovulation (when one of your ovaries releases an egg). You should record your temperature before getting out of bed every morning. A record kept for two or three menstrual cycles may tell you if you are ovulating every month.

Cervical mucus. The cervix is the opening of the uterus inside your vagina. Normally the mucus of the cervix is thick. It becomes thin and slippery around ovulation to allow sperm to get through. Feeling your cervical mucus can tell you if this change is happening. It can also tell you about your fertile days.

Hormone tests for fertility

Hormone test kits are available for use at home. You must prick a finger and send a blood sample to the laboratory. Urine tests are supplied with reagent strips, sometimes with a device to read the results. Some kits test only one hormone, while others test several hormones related to reproductive function.

Progesterone

This hormone shows ovulation. Progesterone levels rise with ovulation and reach their highest level a week later. The timing of this test is crucial and is difficult if your periods are irregular.

Gonadotropins

These two hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), regulate the ovaries and uterus. FSH stimulates the ovaries to produce and release a mature ovum. These hormones' blood levels vary with the menstrual cycle and need expert interpretation. Low levels of FSH may be associated with failure of ovulation.

LH is tested in the urine and increases before ovulation. Home testing kits offer this test to help you predict ovulation and your fertile window.

Estradiol

This is an estrogen produced by the follicles in the ovaries. Its levels can indicate the activity of the ovaries. Measuring estradiol on day two or three of the menstrual cycle helps establish the ovarian reserve. Ovarian reserve is the number of eggs available in the ovaries.

Anti-Mullerian hormone

This hormone is also released by follicles in the ovaries. Anti-Mullerian hormone is another test for ovarian reserve. The blood levels of this hormone indicate how well the ovaries will respond during infertility treatment.

High levels indicate good ovarian reserve. Low levels indicate menopause. The hormone is absent in the blood after oophorectomy (surgical removal of the ovaries).

Prolactin

The pituitary produces this hormone. High prolactin levels can disturb ovulation.

Thyroid hormones

Low levels of thyroid hormones (hypothyroidism) reduce fertility.

QUESTION

The first sign of pregnancy is most often: See Answer

Testing for fertility

Home tests are private and convenient. But if you're unable to get pregnant, you need specialized assessment and treatment. Your doctor will advise you to consult an infertility specialist to assess both partners to find the reasons for infertility. Apart from the hormone tests, they may also recommend other tests.

Semen test. The semen is analyzed for sperm count and sperm motility. Sperms are also studied for abnormal structure. Though semen testing is also available as a home test, it's not complete.

Tests for sexually transmitted infections. Tests for chlamydia, syphilis, and other infections that can reduce fertility.

Your doctor will plan other specialized tests depending on your situation. These tests may include ultrasound, hysterosalpingography, and laparoscopy.

Factors reducing fertility

Fertility depends on the optimum function of the reproductive system of both partners. Some health and lifestyle factors reduce fertility:

Age. As you grow older, fertility diminishes.

Weight. Being overweight and obese affects ovulation in women and sperm function in men.

Smoking. Even passive smoking can reduce fertility.

Alcohol. Excessive alcohol reduces fertility. Women should not drink when trying to conceive to reduce the risk of alcohol exposure to their babies.

Sexually transmitted infections (STIs). Conditions such as chlamydia reduce your fertility.

Stress. This can reduce your libido and frequency of intercourse. Severe stress can reduce ovulation and sperm production.

Medical disorders. Endometriosis, polycystic ovarian syndrome (PCOS), cancer and its therapy, varicocele, cystic fibrosis, genetic disorders, and other disorders can reduce fertility.

Increasing fertility

Some advice about increasing your likelihood of pregnancy:

  • It's not necessary to time sexual intercourse with ovulation. Having unprotected vaginal sex every two or three days gives you the best chance of pregnancy.
  • Avoid worrying about conception and keep sex enjoyable by developing your relationship. Reducing stress helps.
  • Frequent intercourse is essential. Ideally, sperm should be in the pelvic area when the ovum is released from the ovary. Also, when men have sex after several days, their sperm motility is reduced.
  • Avoid smoking. It ages the ovaries and eggs and reduces your fertility. 
  • Limit alcohol. Women should have no more than two units a week and men four units a week when trying to have a baby.
  • Reduce caffeine. You shouldn't have more than one or two drinks with caffeine.
  • Avoid illegal drugs.
  • Be physically active. It helps enhance fertility.
  • Maintain a healthy weight.
  • Avoid warmth to the scrotum (hot baths, saunas, seat warmers, tight underwear, etc.). The testes produce the best quality sperm when kept cool.

Seeking expert help is best

If you've been trying to get pregnant for three years, your chances of success naturally are less than one in four. You can try to test your and your partner's fertility at home, but it is a complex subject and needs expertise. You should talk to your health care provider, who will refer you to a fertility specialist for testing and treatment. 

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Medically Reviewed on 10/5/2022
References
SOURCES:

American Association for Clinical Chemistry: "Fertility Testing."

American College of Obstetricians and Gynecologists: "Evaluating Infertility."

Centers for Disease Control and Prevention: "Infertility FAQs."

National Health Service: "Fertility," "Fertility and Infertility." "Infertility Diagnosis," "Infertility Overview," "Patient's Journey — What to Expect."