What you need to know about infertility factors, testing and options

The decision to have a child may be one of the most important and life-changing choices you will ever make. Figuring out if parenthood is the right path for you comes with many questions. Are you ready, emotionally and financially? What about your age? How many children would you like to have? The list goes on and on. But there is usually another big question that many people don’t factor into their equation when deciding if they want to have a child.

That issue is fertility.

What is infertility?

According to the Centers for Disease Control and Prevention (CDC), infertility is when you have not been able to get pregnant through unprotected sex after trying for 1 year. And because fertility declines with age, women 35 and over may be diagnosed with infertility after trying for 6 months without success.1 The definition is similar for men: A man may be considered infertile if he is unable to make a fertile woman pregnant after trying for 1 year.

Steps to achieve pregnancy

“There is a huge education gap among people of child-bearing age about what it takes to get pregnant,” says Tarun Jain, M.D., a reproductive endocrinologist and medical director of the Center for Fertility and Reproductive Medicine at Northwestern Medicine. “And for women, there’s a lack of understanding of the impact of age on fertility – when the decline begins and what the implications are.”

This is important because the mechanics of getting pregnant aren’t quite as simple as they may seem – there are a lot of places where something can go differently than expected. According to the CDC, to achieve pregnancy:1

  • A woman’s body must release an egg from one of her ovaries
  • A man’s sperm must join with the egg along the way (fertilize)
  • The fertilized egg must go through a fallopian tube toward the uterus (womb)
  • The embryo must attach to the inside of the uterus (implantation)

Dr. Jain recommends that by the time you are in your early 30s, you and your partner, should know about any possible risk factors in terms of fertility. Those risks may be the deciding factor in getting fertility testing.

Risk factors that can make it harder to conceive

For men, risk factors may include:2

  • Obesity
  • Testicular infections
  • Overheating of the testicles
  • Trauma to the testicles
  • Ejaculatory/erectile disorders
  • History of sexually transmitted infections (STIs)
  • Exposure to environmental toxins
  • Smoking
  • Heavy alcohol intake
  • Drug use

For women, many factors can influence fertility. They range from a woman’s age to how often she ovulates and everything in between. But some common risk factors include:3

  • Irregular menstrual cycles
  • Recurrent pregnancy loss (defined as 2 or more miscarriages)4
  • Structural problems with reproductive system
  • Endometriosis
  • Uterine fibroids
  • Polycystic Ovary Syndrome (PCOS)
  • Autoimmune disorders
  • History of STIs

How does fertility testing work?

For women

Fertility testing is essentially a blood test that measures certain hormones, Dr. Jain explains. This includes checking the levels of progesterone and prolactin, both of which are hormones related to ovulation.5

If the levels of those hormones are abnormal, it can indicate a low reserve of egg follicles. Follicles are small, fluid-filled sacs in the ovaries that contain immature eggs.6 A good supply of these follicles is needed to conceive, says Dr. Jain.

Next, a specialty X-ray or saline-infusion ultrasound is performed. Those procedures give doctors a clear view of a woman’s uterus and fallopian tubes. One advantage of an ultrasound over an X-ray? It lets the doctor count the number of follicles in the ovaries, says Dr. Jain.

For men

Fertility testing consists of a semen analysis. The test will reveal any problems with motility, the concentration of sperm, or the shape and size of the sperm.5

What if a fertility test reveals issues?

Fortunately, you have options. For men, you will be referred to a urologist. Treatment could range from medication to surgery. It really depends on the issue at hand, says Christine Mullin, M.D., chief at Northwell Health Fertility in Manhasset, New York. Women have options. They include:

Freezing eggs and embryos

“Fertility preservation is no longer experimental,” says Dr. Mullin. Freezing eggs is a good option for women who have physical problems, such as damage to tubes or severe endometriosis. (A man’s semen can also be frozen and stored.)7

With freezing embryos, a health care provider removes the eggs from the ovaries, fertilizes them with sperm from a partner or donor, then freezes them for future use, explains Dr. Jain. “The earlier you do it, the higher number of eggs you will get and the better the quality of those eggs.”

In vitro fertilization

This is when a mature egg is removed from the ovaries and fertilized with sperm outside the body, in a lab. Then the fertilized egg (embryo) is transferred to the uterus.

In vitro fertilization (IVF) can have a high success rate, Dr. Jain explains. “For women under 35 who do IVF, there is a 60% success rate on each try,” he says. “But for women ages 40 to 43, there is a success rate of about 15% per try.”

Oral medication

Clomiphene is a medicine that causes the body to make more of the hormones that causes eggs to mature in the ovaries.8


Certain hormones (gonadotropins) can be injected to stimulate eggs to grow in the ovaries, leading to ovulation. Gonadotropin may be prescribed in low doses if a women does not respond to oral medications, like clomiphene or letrozole.9

The pros and cons of fertility testing

Fertility testing tends to bring up a lot of emotions. The excitement and anxiety can be a lot to manage as you await your results.

The biggest downside is the stress the test can create, explains Dr. Mullin. “There is definitely a psychological component to it,” she says. “If a woman’s levels of a certain hormone are low, it can make her anxious and depressed.”

But a significant upside of testing early is that you’ll have more time to come up with a plan if you discover a problem. “And as long as a person is open to potentially taking action based on the results, early fertility testing can be very beneficial,” Dr. Jain says.

Already a member?

Sign in or register on your plan website to see personalized benefit details and resources to help you manage your plan and health.