In a world where information is at our fingertips, fertility continues to have so many unknowns, but it doesn’t need to be this way. Getting a fertility assessment is an easy way to gather information for understanding your reproductive health. These assessments are an excellent choice for single individuals who know they want children but are unsure of their timeline for starting a family. It can also be helpful for couples who wish to delay having children or have been struggling to get pregnant. While it can be scary to investigate the unknown, it ultimately enables you to make informed decisions about something that is of central importance to their future for many people.
As a Chinese Medicine practitioner specializing in Reproductive Health and Fertility, I’m often the first person to talk to patients about getting a fertility assessment. In the hopes of removing any fear and misconceptions, I spoke with Reproductive Endocrinologist, Dr. Lilli Zimmerman, to gain a deeper understanding of the benefits and logistics of getting a fertility assessment. Below are the major topics we covered in our conversation, with Dr. Zimmerman’s first-hand insight.
What is being evaluated when a woman gets a fertility assessment, and what tests will be performed?
A fertility assessment takes into account key hormonal and structural components of a woman’s reproductive health to give clarity on her immediate and long-term fertility. A fertility assessment will definitely include bloodwork and likely some imaging of the reproductive organs. Blood work will measure estrogen, progesterone, prolactin, follicle-stimulating hormone (FSH), and Anti-Müllerian hormone (AMH), along with other levels such as thyroid. Many of these hormones fluctuate throughout the month, so it is best to test these levels on the second day of a women’s cycle for the most accurate picture. Doctors will also be able to access antral follicle count by ultrasound. Before and after this information is gathered, patients will have a conversation with an OB/GYN or a Reproductive Endocrinologist (RE) to help explain what information has been learned.
How is a fertility assessment different for couples, and are there different tests if the couple is struggling to conceive?
One clear difference will be the addition of a sperm analysis that would determine the sperm’s health in regards to motility, morphology, and count. If there are any red flags, the male may be referred to a Urologist for further examination to determine the cause of the less than optimal sperm. The woman will have her day two baseline and ultrasound. If the couple is working with an RE, the female will also likely have a Hysterosalpingography, or HSG, on cycle day 7-10 to see if there are any structural barriers to conceptions such as a blocked tube or malformation. An RE may also do a saline sonogram to see if there is any scar tissue or polyps in the uterus that would impair implantation. This is also a great time to do genetic testing, if that is something the couple is interested in, or they know they could be carriers for certain genetic disorders.
When should a couple consider getting a fertility assessment?
The standard recommendation for getting a fertility assessment is failure to achieve pregnancy after six months of unprotected sex if the woman is over 35 and one year if she is under 35. It’s important to note that there is no downside to getting an assessment after only a few months of trying with no success. If the woman is experiencing irregular cycles or painful periods, she may want to consult a doctor earlier. Getting a fertility assessment does not mean you will have to start fertility treatments. Many times couples will get an assessment and the doctor will recommend continuing to try naturally for a few more months.
What are the time and financial investments of getting a fertility assessment?
Most of the process is very fast. You’ll have a short consultation with an OB/GYN or RE to decide what tests to have done. The blood draw and transvaginal sonogram will be a few minutes. If you have an HSG that will likely be another appointment and should take between 10-30 minutes. A semen analysis will only take as long as the sample takes to collect.
Many insurance plans will cover a fertility assessment or at least parts of it. There are “pop-up” clinics that do fertility assessments for as little as $100.
Should I go to an OB/GYN or a Reproductive Endocrinologist?
OB/GYN’s specialize in women’s health, and REs specialize in fertility. An OB/GYN can definitely take a blood sample and write a referral for additional testing, but an RE will be able to provide a more comprehensive testing experience from beginning to end, with clear next steps.
Lilli Dash Zimmerman, MD is deeply committed to helping her patients achieve their ultimate dreams of parenthood. Through a personalized tailored approach to fertility assessment and treatment, she offers a full range of reproductive services including IVF, ovulation induction, oocyte, and sperm donation as well as management of reproductive endocrinopathies. She has a special interest in premature ovarian insufficiency, diminished ovarian reserve, IVF with preimplantation genetic testing and screening (PGT-M/S), fertility preservation, LGBTQ family building, PCOS, endometriosis, and repeated IVF failures
