Essential Fertility Tests for Women Trying to Conceive Again

Want to conceive quickly?

Hello doctor, my eldest is one year and seven months old.
We have been trying to conceive a second child for almost a year.
I would like to ask what kind of tests we should undergo at this stage.

Li's, 30~39 year old female. Ask Date: 2016/03/24

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, the general definition of infertility is the inability to conceive after one year of regular sexual intercourse.
In cases of infertility, both partners should undergo examinations at a gynecologist, which may include semen analysis, hysterosalpingography, ovulation testing, and hormone blood tests, among others.
If there are still concerns, it is advisable to consult your regular gynecologist.
Wishing you good health.

Reply Date: 2016/03/24

More Info

When trying to conceive again after having a child, it’s essential to undergo certain fertility tests to identify any potential issues that may be affecting your ability to conceive. Given that you have been trying for nearly a year without success, it would be prudent to consult with a fertility specialist or your gynecologist to discuss the following essential fertility tests:
1. Hormonal Testing: This includes checking levels of hormones such as Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), Estradiol, and Progesterone. These hormones play crucial roles in regulating the menstrual cycle and ovulation. Abnormal levels can indicate issues with ovarian function.

2. Thyroid Function Tests: Thyroid hormones are vital for regulating metabolism and can significantly impact fertility. Tests typically include Thyroid Stimulating Hormone (TSH) and Free T4 levels. An underactive or overactive thyroid can lead to irregular menstrual cycles and difficulties in conceiving.

3. Prolactin Levels: Elevated prolactin levels can interfere with ovulation. A simple blood test can determine if your prolactin levels are within the normal range.

4. Ovarian Reserve Testing: This can be assessed through tests such as an ultrasound to measure the antral follicle count (AFC) or a blood test for Anti-Müllerian Hormone (AMH). These tests help evaluate the number of viable eggs left in the ovaries.

5. Pelvic Ultrasound: A transvaginal ultrasound can help visualize the ovaries and uterus, checking for any abnormalities such as cysts, fibroids, or polyps that could affect fertility.

6. Hysterosalpingography (HSG): This is an X-ray procedure where a dye is injected into the uterus and fallopian tubes to check for blockages. It can help determine if the fallopian tubes are open and if the uterine cavity is normal.

7. Laparoscopy: In some cases, a minimally invasive surgical procedure may be recommended to look for conditions such as endometriosis or pelvic adhesions that could be affecting fertility.

8. Genetic Testing: If there are concerns about genetic issues, especially if there is a family history of genetic disorders, testing may be recommended.

9. Semen Analysis for Partner: If applicable, it’s also crucial to have your partner undergo a semen analysis to rule out male factor infertility, which accounts for a significant percentage of infertility cases.

In terms of timing for these tests, it is generally recommended to perform hormonal tests during specific phases of your menstrual cycle. For example, FSH and Estradiol are typically tested on cycle day 3, while progesterone is tested about a week after ovulation (around day 21 of a 28-day cycle). However, your gynecologist can provide specific guidance based on your cycle and individual circumstances.

Additionally, maintaining a healthy lifestyle can also improve your chances of conception. This includes a balanced diet, regular exercise, managing stress, and avoiding smoking and excessive alcohol consumption. If you have any underlying health conditions (like PCOS or thyroid disorders), managing these effectively can also enhance fertility.

Finally, if you have been trying to conceive for over a year (or six months if you are over 35), it is advisable to seek help sooner rather than later. Early intervention can often lead to better outcomes and may help identify any issues that could be addressed to improve your chances of conceiving.

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