There are several reasons why you might be considering this. Perhaps you’re someone who simply likes to be informed and prepared for major life events. Or maybe you’re wondering about certain medical conditions that could impact your fertility. There may be special circumstances—such as being an older parent—that could make conceiving more challenging in the future. Here’s what to know about whether it makes sense to get your fertility tested now, and if so, how you should go about doing it, along with what to expect once you start the process.
Why Would a Couple Undergo Early Fertility Testing?
The good news is that most healthy couples don’t have trouble getting pregnant once they start trying, says Kate Byron, MD, an OB/GYN at Ohio State University Wexner Medical Center. “Infertility for most patients is the inability to conceive after one year of trying to get pregnant,” Dr. Byron explains. “Most couples will not need to test ahead of time, as about 85-90% of couples will get pregnant within one year, if they are having regular, unprotected sex.” Although routine fertility testing isn’t usually recommended for otherwise healthy couples who are considering having kids in the future, it might make sense to do some preconception counseling with your healthcare provider in the years leading up to starting a family, explains Suzanne Bovone, M.D., an OB/GYN at Obstetrics and Gynecology of San Jose, part of Pediatrix Medical Group. “Prior to having a family, it is very helpful to have a preconception consult with your physician to review your medical history, medications, environmental exposures, travel plans (for potential infection risk such as Zika), goals for when and how many children you want, and most importantly, how to optimize your health prior to pregnancy,” Dr. Bovone suggests.
Medical Reasons or Special Circumstances
There are some couples for whom fertility testing before having kids would be more strongly advised. “There can be many ‘red flags’ that could make one initiate fertility testing sooner,” Dr. Bovone says. “If you have irregular cycles, spotting in between your periods, heavy and painful periods, bleeding after sex, or you aren’t detecting ovulation via over-the-counter testing kits, reach out early,” she recommends. If you have a male partner with difficulty maintaining erections or issues with ejaculations, you may want them to see a urologist for an evaluation, she adds. Additionally, if you have certain known medical conditions, it might make sense to start fertility testing sooner than later. These may include polycystic ovarian syndrome, a history of pelvic inflammatory disease, endometriosis, a history of pelvic surgery/radiation, or known male infertility, says Dr. Byron. If you have these issues and you are in your later 30s or 40s, you should seek immediate fertility testing, Bryon adds. Really, anyone who expects to try conceiving at an older age—after the age of 35 for people assigned female at birth, and over the age of 40 for people assigned male at birth—should meet with a fertility specialist as soon as possible, Dr. Bovone recommends. This is because fertility can start to decline sharply starting at these ages, and it can be helpful to get an assessment to find out where you are at.
Pros and Cons to Conducting Fertility Testing Ahead of Time
For most couples, there are many pros to getting your fertility tested before you are ready to have kids. “Fertility testing ahead of time can be beneficial as the results may provide reassurance,” says Lauren Weissmann, MD, MSCE, OB/GYN and reproductive endocrinologist at South Jersey Fertility Center. “If something is found early on, it can be addressed to improve chances of a successful pregnancy.” On the other hand, sometimes couples experience “information paralysis,” says Katie Sagaser, MS, LCGC, director of genetic counseling at JunoDx. “For some individuals, information is empowering and allows them to act and prepare,” she says. “In contrast, others find information to potentially be overwhelming and not necessarily helpful to them in the long run.” Sagaser urges couples to carefully consider whether the information they may come away with after fertility testing would be helpful or actionable before they begin the process.
What Type of Fertility Testing Is Involved?
The type of fertility testing your healthcare provider recommends may vary, depending on your age, sex, and any underlying medical conditions. But there are certain standard tests that a general fertility workup involves, says Dr. Weissmann. These may include a transvaginal ultrasound, which allows your healthcare provider to look at the uterus and ovaries, Dr. Weissmann describes. “A quick in-office procedure is also completed to evaluate the fallopian tubes and uterine cavity where a pregnancy would implant and grow,” she says. Your provider will also likely order bloodwork at specific points in your cycle to measure hormone levels, Dr. Weissmann adds. A semen analysis might also be done, says Dr. Weissmann. “This involves dropping off a semen sample for analysis by an andrologist (a specialist in male reproductive health),” she says. “The andrologist will examine the semen under a microscope to look at sperm count, motility (ability for sperm to travel), and morphology (shape of the sperm), and other important sperm parameters.” If you are older (aged 35-40+), your healthcare provider may want to measure your ovarian reserve (the number of eggs remaining in your ovaries). Testing your ovarian reserve involves a combination of blood tests and looking at the ovaries themselves via ultrasound. These blood tests may include testing your anti-mullerian hormone (AMH), and follicle-stimulating hormone (FSH), Sagaser explains. “If AMH levels indicate a low ovarian reserve, a more prompt referral to a fertility specialist may be indicated to pursue treatment such as through intrauterine insemination (IUI) or in vitro fertilization (IVF),” she says.
Will Insurance Cover This?
You may be wondering if insurance will cover fertility testing if you haven’t started trying to get pregnant yet. The answer to this will depend on your particular insurance company and their coverage policies. Dr. Weissmann says that in her experience, insurance usually will cover most of the tests used to evaluate fertility. “Most insurances don’t have requirements of first proving infertility to perform any testing,” she says. “If you’re unsure, you can always contact your insurance carrier before an appointment to confirm.”
What to Do if Fertility Testing Finds Issues
It’s possible that after fertility testing, you will find out that everything is in working order and good to go for when you are ready to start your family. But it’s also possible that certain issues will be revealed. If this is the case, it’s understandable that you may feel distressed. But it’s important to keep things in perspective, says Dr. Weissmann. “Discovering a fertility issue can be difficult news to process,” she says. “I think it’s important for patients to know that in many cases there are still options; don’t give up hope.” It can be helpful to find a healthcare provider with a specialty in reproduction and infertility who can help you understand your results and help you decide the best type of treatment if needed, says Dr. Weissmann. Dr. Byron agrees that if you get distressing results, you should investigate further and perhaps get more than one opinion. This is especially true if you do fertility testing through an online company or an at-home testing company. But it may also be the case if you see a provider who doesn’t specialize in fertility issues. “There is context required for a lot of this stuff, so after confirming a level, a doctor can either reassure you, treat an underlying condition, or order a more extensive workup,” Dr. Bryon adds.
A Word From Verywell
The truth is that most couples do not need to actively pursue fertility testing before trying to conceive. However, there are people who might like to have this information ahead of time, and that’s perfectly valid. Moreover, anyone who has a medical condition that might make getting pregnant more difficult, or someone who is planning on trying to get pregnant later in life, should consider fertility testing. Whether you end up getting fertility tests done or not, it’s always a good idea to share your thoughts and questions about your future pregnancy plans with your healthcare provider.
