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Houston Fertility Journal

    Should You Undergo Fertility Testing Before Trying to Get Pregnant?

    [fa icon="calendar"] May 7, 2019 12:47:49 PM / by Center of Reproductive Medicine   

    Center of Reproductive Medicine

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    After a year of trying to conceive, 12-15% of couples are still unable to get pregnant. That’s a scary figure for anyone who hopes to become a parent soon. Even scarier is the fact that there are rarely symptoms if any at all when it comes to infertility. So you might not know if you’re among the unlucky few until you’ve spent months staring at negative pregnancy tests. What if you could reduce the uncertainty and shorten the timeline to pregnancy? Fertility testing before you begin trying to get pregnant can do exactly that. So is it a good idea? Here’s what you need to know.

    What Can My Doctor Test for Before I Start Trying?

    Most people have heard that if you try for several months without getting pregnant, you should probably consider fertility testing. What many don’t realize is that a doctor can do all of the same tests before you even begin trying. For individuals and couples who are eager to conceive, anxious about fertility issues, or who simply want to ensure the odds are in their favor, fertility testing before trying to get pregnant is a great place to start.

    So what will your doctor test for? The most common tests assess:

    • Whether the woman is regularly ovulating.
    • The man’s sperm quality, including his sperm motility (ability to move), morphology (overall health and form), and count (the number of sperm).

    These tests are minimally invasive, and typically only require a blood sample from the woman and a semen sample from the man.

    Additionally, a doctor may recommend other tests based on various personal risk factors. For example, if the woman has irregular periods or a history of miscarriages, a doctor may want to test for a luteal phase defect or look for signs of pelvic inflammatory disorder.

    Depending upon your medical history, a doctor may recommend additional tests, including:

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    With the right testing, a doctor can determine:

    • How fertile a man’s sperm is.
    • If the woman has issues with ovulation.
    • How frequently the woman ovulates.
    • Whether the woman’s uterus will allow an egg to implant.
    • Whether the woman has a chronic medical condition that might make pregnancy dangerous.
    • Whether either partner is at risk for genetic anomalies that can increase the risk of miscarriage or birth defects.
    • Whether the woman has a diminished ovarian reserve, which is a major cause of infertility, especially in women over the age of 40.

    No two couples are exactly alike, so it’s important to talk to your doctor about your specific health history, concerns, and fertility risk factors. This allows your provider to make personalized recommendations for testing.

    Most couples begin with anti-Mullerian hormone (AMH) testing. AMH testing ensures that the woman has a reasonable likelihood of continuing to produce eggs as she tries to get pregnant. If AMH testing suggests that a woman has diminished ovarian reserve, the couple may need to quickly move to IVF to improve the chances of pregnancy. In some cases, the only option might be donor eggs or a surrogate.

    Will Insurance Cover Fertility Testing?

    For many couples, a major barrier to fertility testing is cost. Insurance is not required to cover fertility testing, and laws can vary from state to state. However, some insurance plans cover certain tests and portions of infertility testing. Therefore, it is important to review the terms of your plan and to work with a fertility specialist who has experience billing and filing with various insurances.

    Some fertility tests are more likely to be covered than others. For example, a number of chronic medical conditions may affect fertility. Testing for these conditions may be medically necessary for your overall health, and so insurance is more likely to cover them.

    Even when insurance offers no coverage for fertility testing, early testing can save you time, money, and heartache. Identifying infertility issues early enables prompt treatment. Fertility declines with age, so every month you spend trying to get pregnant is a month of lost fertility. It’s better to know if you are infertile as early as possible, so you can cultivate an effective plan for treating the problem. In some cases, you may even be able to improve fertility with simple lifestyle changes, such as quitting smoking or losing weight.

    What Type of Provider Should I See for Fertility Testing?

    If you already have a good relationship with a gynecologist or primary care provider, you might be tempted to see them for preliminary fertility testing. Most fertility experts recommend against doing this. And the reason is simple:

    Your regular doctor is not a fertility expert.

    Fertility medicine is a challenging field, and the research is constantly being updated and improved. What your doctor learned in medical school might no longer be pertinent. And if you’re going to spend money on fertility testing, you should ensure you’re getting cutting edge care and tests from an expert in their field -- not incomplete or dated testing from a provider who specializes in something else.

    There’s another reason to see a fertility specialist. When you rely on your family physician or gynecologist, you might end up testing only one partner. Yet fertility issues are equally prevalent in men and woman, in fact, in about a third of cases there’s an issue with both the man and the woman. It’s important to test both partners for fertility issues to get the right diagnosis and develop the right treatment plan.

    Your gynecologist or family physician can offer a referral to a fertility specialist. In most cases, however, you don’t need a referral. You can simply research your options and schedule an appointment.

    Signs of Infertility: Who Should Consider Testing Before Trying?

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    Most infertile couples do not know they are infertile until they’ve tried for months, or even years, to have a child. Infertility is often invisible, and it’s impossible to diagnose infertility based on symptoms alone.

    For this reason, we recommend that anyone who is planning to have a baby consider testing before trying to conceive. If you prefer a more conservative approach, consider testing if you or your partner have one or more risk factors for infertility.

    These factors include:

    • Trying for a baby when the woman is over 35 or the man is over 40.
    • Trying for a baby after a previous history of infertility, even if the infertility was with a different partner.
    • A history of serious chronic illnesses such as diabetes, kidney failure, or cancer.
    • Taking any form of hormone treatment.
    • A history of sexually transmitted diseases or infections.
    • Irregular periods in the woman, especially if the periods are spaced very far apart.
    • A man who has trouble or unable to get an erection.
    • No or very little semen when the man ejaculates.
    • Painful ejaculation or urination.
    • Endometriosis in the women.
    • A history of pelvic inflammatory disease.
    • Swelling on or near the man’s penis or testicles.
    • A history of smoking or heavy drug use in either partner.
    • Obesity in either partner.
    • Women who use hormonal birth control that stops menstruation, or has experienced an absence of periods for three months after stopping birth control.
    • Women who have previously been pregnant and experienced serious trauma or injuries -- such as a uterine rupture, hemorrhage, or infection -- during or shortly after giving birth.

    What if My Doctor Finds a Problem?

    Being diagnosed with a fertility issue can be scary. Perhaps that’s why so many couples avoid testing for months or even years. But the overwhelming majority of fertility problems are treatable. Sometimes it’s as simple as giving the woman a medication to trigger ovulation. Or possibly a minor medical procedure, such as removing a varicocele, which can also have seemingly miraculous effects on fertility.

    Even when treatment is not simple or the problem is serious, all hope is not lost. Intrauterine insemination (IUI), in vitro fertilization (IVF), and other forms of artificial reproductive technologies can help couples get pregnant against the odds. Fertility diminishes with age, especially in people who already have serious fertility concerns. That means now is the best time to get pregnant, and now is the best time to begin treating fertility issues.

    What if I Don’t Do Fertility Testing?

    It’s easy to find alarming statistics online. Some fertility clinics will even try to scare you into testing. Here’s the truth: most couples will get pregnant on their own within a year. Even many older couples, or couples with risk factors for infertility, are able to get pregnant without intervention.

    The odds are in your favor. That doesn’t mean pregnancy is guaranteed. Fertility testing eliminates much of the uncertainty of trying for a baby. Eliminating that angst can improve your mental health, your relationship, and your experience of trying to conceive. It doesn’t mean you have to proceed with testing, but doing so can certainly make the journey to parenthood easier.

    If you’re on the fence about testing, consider talking to a fertility specialist about a conservative approach. A quick semen analysis and a blood test can give you a lot of information. It won’t tell you everything, and won’t guarantee fertility, but can quickly identify a number of issues. Testing can offer peace of mind, particularly to older couples or those who feel very anxious about trying to conceive.

    Will Testing Tell Me Everything?

    Fertility testing before you begin trying to conceive can’t test for every problem. For example, it’s impossible to predict who will have miscarriages. Additionally, early fertility testing is conservative in nature. If a doctor does not find any obvious signs of infertility, there is no reason to keep testing.

    So couples who have previously undergone testing should consider returning to the doctor if they continue to have trouble getting pregnant. Armed with new information about the couple’s history of trying to conceive, the doctor may be able to recommend more targeted tests.

    We recommend that couples see a fertility specialist if:

    • The woman is over 35 or the man is over 40, and the couple has tried longer than six months without getting pregnant.
    • The woman is under 35 and the man is under 40, and the couple has tried longer than 12 months without getting pregnant.
    • The couple has had more than two consecutive miscarriages.

    How Fertility Testing Offers Peace of Mind

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    Infertility is common. Despite this, most couples are not infertile. The overwhelming majority of people who undergo advanced fertility testing prior to trying for a baby will not uncover a problem. In fact, the absence of a problem is a great reason to undergo testing.

    When a fertility specialist gives you a clean bill of health, it offers immense peace of mind. Trying to conceive can be stressful, especially in the first few months. Many couples find the two-week wait unbearable and spend endless hours scouring the Internet for pregnancy symptoms, warning signs of infertility, and advice on how to interpret every twinge, ache, and pain. When you know that both you and your partner are healthy, you don’t have to worry. You know it’s only a matter of time before you’ll be expecting a baby.

    But what if fertility testing uncovers a problem? This can be a devastating blow, but there’s a huge upside: the sooner you identify fertility issues, the sooner you can treat them. Don’t waste months on an exercise in futility. Don’t agonize over negative pregnancy tests and missed opportunities. Start the journey to parenthood in the strongest, healthiest possible position. Choose fertility testing. A few easy appointments offer a wealth of information that can help you become a parent faster and with less stress.

    We’re here for you, whether you’re about to start trying or have tried for years. Parenthood is exciting, scary, and deeply meaningful. We can help you get there faster. Give us a call today!

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