How Is Infertility Tested?

Infertility testing is a structured and evidence-based process used to understand why pregnancy has not occurred. In Australia, infertility is generally defined as the inability to conceive after:

• 12 months of regular unprotected intercourse if a woman is under 35
• 6 months if a woman is 35 years or older

Testing involves assessing both partners. In fact, male factors contribute to infertility in around 40–50% of couples, female factors in about 40–50%, and combined or unexplained causes account for the remainder.

Infertility testing is not a single test. It is a series of investigations designed to examine ovulation, sperm health, fallopian tubes, uterus, hormones, genetics, and general medical well-being.

Step 1: Detailed Medical History

The first step is always a thorough consultation. This is often the most important part of the assessment.

For Women, Your Doctor Will Ask About:

• Menstrual cycle: Regularity, pain, heavy bleeding
• Ovulation symptoms: Mid-cycle pain or changes in cervical mucus
• Previous pregnancies: Including miscarriages or ectopic pregnancies
• Pelvic pain: Possible endometriosis
• Surgical history: Especially abdominal or pelvic surgery
• Medical conditions: Thyroid disorders, diabetes, autoimmune disease
• Medications: Including supplements
• Lifestyle factors: Weight, smoking, alcohol, stress

For Men, Questions Include:

• Previous children
• Testicular injury or surgery
• Mumps after puberty
• Erectile or ejaculation issues
• Medications or anabolic steroid use
• Occupational exposures

This discussion helps guide which investigations are necessary.

Step 2: Physical Examination

A clinical examination may identify physical signs affecting fertility.

In Women:

• Assessment of body mass index (BMI)
• Signs of hormonal imbalance (acne, excess hair suggesting PCOS)
• Pelvic examination to assess the uterus and ovaries

In Men:

• Testicular size and position
• Presence of varicocele (enlarged scrotal veins)
• Signs of hormonal deficiency

Step 3: Female Fertility Testing

1. Ovulation Testing

Ovulation problems are one of the most common causes of infertility.

Tests may include:

• Mid-luteal progesterone blood test: Confirms ovulation
• LH blood tests: Assesses ovulatory pattern
• Basal body temperature tracking (less commonly used now)
• Ovulation predictor kits

If ovulation is irregular or absent, causes such as Polycystic Ovary Syndrome (PCOS), thyroid dysfunction, or elevated prolactin are investigated.

2. Hormone Blood Tests

Hormone testing helps assess ovarian function and egg supply.

Common tests include:

• FSH (Follicle Stimulating Hormone)
• LH (Luteinising Hormone)
• Estradiol
• AMH (Anti-Müllerian Hormone): Reflects ovarian reserve
• TSH (Thyroid Stimulating Hormone)
• Prolactin

AMH has become particularly useful for predicting ovarian response, particularly in IVF.

3. Pelvic Ultrasound

A transvaginal ultrasound provides detailed imaging of:

• Ovarian follicles
• Ovarian cysts
• Polycystic ovaries
• Uterine fibroids
• Endometrial thickness

It can also assess antral follicle count, which supports ovarian reserve evaluation.

4. Fallopian Tube Testing

Blocked fallopian tubes prevent sperm and egg from meeting.

Common tests include:

• Hysterosalpingogram (HSG): X-ray dye test to assess tubal patency
• Tubal ultrasound: Ultrasound-based alternative
• Laparoscopy: Surgical procedure to directly visualise the tubes and pelvis

Laparoscopy is particularly useful if endometriosis is suspected.

5. Genetic Carrier Screening

This is a Medicare bulk billed test increasingly offered in Australia. Genetic carrier screening identifies whether parents carry recessive genetic conditions such as:

• Cystic fibrosis
• Spinal muscular atrophy
• Fragile X syndrome

Over 400 genetic conditions can be tested for. This testing is especially important before IVF.

6.  Karyotype Screening 

This is a blood test both partners that tests the number of chromosomes they have.  This is commonly done prior to IVF or for those with recurrent miscarriage.

Step 4: Male Fertility Testing

1. Semen Analysis

Semen analysis is the primary test for male fertility. It evaluates:

• Sperm count
• Motility (movement)
• Morphology (shape)
• Volume
• pH and infection markers

Abnormal results may require repeat testing, as sperm quality can fluctuate.

2. Hormone Testing in Men

If sperm count is low, blood tests may assess:

• Testosterone
• FSH
• LH
• Prolactin

This helps determine whether the issue is testicular or hormonal.

3. Genetic Testing in Men

Genetic testing may be recommended in cases of:

• Very low sperm count
• Azoospermia (no sperm)
• Recurrent miscarriage

Chromosome analysis (karyotype) or Y-chromosome microdeletion testing may be performed.

Step 5: Additional Investigations

Depending on findings, further tests may include:

• Endometrial biopsy
• Autoimmune screening
• Thrombophilia screening (in recurrent miscarriage)
• Infectious disease testing
• Metabolic testing (diabetes, insulin resistance)

Unexplained Infertility

In approximately 10–20% of couples, all tests appear normal. This is known as unexplained infertility.

It does not mean that nothing is wrong. Rather, it suggests subtle issues not detected by current testing. Treatment options may still be very successful.

When Should Testing Begin?

Testing should begin earlier if:

• The woman is over 35
• There are irregular periods
• Known endometriosis
• Previous pelvic infection
• Male history of testicular problems
• Recurrent pregnancy loss

Early assessment allows earlier intervention and improves success rates.

How Long Does Testing Take?

Most investigations can be completed within one menstrual cycle, though some tests are cycle-specific. A complete fertility work-up typically takes 4–6 weeks.

Emotional Considerations

Fertility testing can feel overwhelming. It may uncover unexpected diagnoses or require further procedures.

Support may include:

• Fertility counselling
• Psychological support
• Clear communication of results
• Written treatment plans

Emotional well-being plays an important role in the fertility journey.

What Happens After Fertility Testing?

Once results are available, your specialist will outline a personalised management plan. This may include:

• Lifestyle optimisation
• Ovulation induction
• Surgical treatment
• Intrauterine insemination (IUI)
• In vitro fertilisation (IVF)
• Egg or sperm freezing
• Genetic counselling

The right treatment depends entirely on the underlying cause.