Before Pregnancy: Fertility Testing

Parenting partners have unique considerations to take into account when planning for pregnancy. Given that many women may be well into their 30s (or 40s) by the time they decide to have a child with a parenting partner, there may be additional fertility challenges associated with later conception attempts.  Additionally, given the lack of a shared medical history between parenting partners, it is prudent to spend some time discussing and planning a medical “plan of action” for conceiving.

Most parenting partners should be able to conceive relatively easily, with little or no medical assistance.  However, pre-conception testing may still be advisable, particularly for women over 35,to ensure that if fertility challenges do exist, they can be identified and overcome before significant time, effort or resources are wasted.

Blood testing

Blood tests are available to help assess a woman’s “ovarian reserve” (the number and quality of your remaining eggs), and to screen for hormonal imbalances (of the thyroid, adrenal and/or pituitary glands), and other conditions like insulin resistance that can interfere with ovulation. If your periods are irregular, or if you are over 35, these tests could be particularly helpful.  Assessment of these hormone levels can be very important in helping to decide whether to consider doing insemination in conjunction with a fertility drug, or perhaps considering IVF at an early stage.

The most predictive reproductive hormone is the FSH level, which predicts a woman’s ovarian reserve and is therefore a general indicator of how many good quality eggs likely remain in the ovaries. TSH controls how the thyroid gland functions, and many women with undiagnosed thyroid disorders may have menstrual cycle irregularities or infertility as an initial symptom. Other signs of thyroid disturbances include weight gain, fatigue, or depression. Prolactin is a hormone that may be overproduced within the brain, contributing to irregular egg release or early miscarriage. If significantly elevated, prolactin can lead to a milky discharge from the breasts. Both DHEA and testosterone may also be elevated in women with polycystic ovarian syndrome or adrenal disorders. This may lead to irregular ovulation as well as excessive and unwanted hair growth, especially in a male pattern (face, abdomen, buttocks).

X-rays

Another helpful type of pre-conception testing involves having X-rays taken. A hysterosalpingogram (HSG) tests for blockage anywhere along the reproductive tract. For example, obstruction of the fallopian tubes (from conditions such as scar tissue, endometriosis, or fibroids) may be detected with HSG. Defects in the lining of the uterus (from adhesions, fibroids, malformations, or polyps) which can prevent implantation and cause miscarriage may also be detected using this procedure.

Another type of X-ray, a sonohysterogram (SHSG) tests for defects in the lining of the uterus (including adhesions, fibroids, malformations, or polyps) which could prevent implantation or cause miscarriage.

Ultrasounds and ovulation testing

Ultrasounds can measure the size, shape and rate of growth of the developing follicle (which contains the maturing egg) and are often performed in conjunction with measurements of hormones that must reach certain levels around ovulation. Such monitoring tells us whether you are ovulating, when, and how well. Suboptimal findings generally support the use of fertility drugs to enhance ovulation.