Investigating Infertility: The Most Accurate Tests for Women and Men

Investigating Infertility: A Journey Toward Answers

They came to my office with tired eyes but hopeful hearts. A couple in their early thirties—Daniela and Marcos—had been trying to conceive for over a year. “We just want to know what’s wrong,” Daniela said. It was the most common sentence I hear from patients like them. And it’s where every story like this begins: with a search for clarity. With investigating infertility.

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When Should You Start Investigating Infertility?

Timing is everything in fertility. Investigating infertility doesn’t mean rushing into panic; it means knowing when it’s time to look deeper:

• If a woman under 35 has been trying for 12 months without success.
• If a woman over 35 has tried for 6 months with no pregnancy.
• If the menstrual cycle is irregular, painful, or absent.
• If a man has had previous testicular issues, low libido, erectile dysfunction, or hormonal disorders.
• If a couple has experienced multiple miscarriages.

The goal of investigating infertility is to identify problems early enough to act, because fertility is time-sensitive. Each month matters.

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Investigating Infertility: Female Fertility Testing

For women, the process of investigating infertility involves multiple steps to evaluate hormone levels, ovulation, egg reserve, and reproductive anatomy.

1. Hormonal Blood Tests

These are timed with specific days of the menstrual cycle, especially Day 3 and the luteal phase (about a week after ovulation):

Test	What It Measures	Ideal Fertile Range
Anti-Müllerian Hormone (AMH)	Ovarian reserve	1.0–4.0 ng/mL
Follicle-Stimulating Hormone (FSH)	Ovarian stimulation	<10 mIU/mL on Day 3
Estradiol (E2)	Ovary response	25–75 pg/mL on Day 3
Luteinizing Hormone (LH)	Ovulation trigger	5–20 mIU/mL on Day 3
Progesterone	Confirms ovulation	>3 ng/mL in luteal phase
Prolactin	Pituitary function	2–29 ng/mL
TSH / T4	Thyroid health	TSH: 0.4–4.0 mIU/L

The balance of these hormones plays a critical role in egg maturation and release. An imbalance can interfere with conception even if periods appear normal.

2. Ovulation Tracking

Ovulation can be tracked through:

• Basal body temperature (BBT) charting
• Ovulation predictor kits (LH surge detection)
• Mid-luteal progesterone blood levels

In some cases, women ovulate without symptoms, and vice versa. That’s why investigating infertility often includes objective confirmation.

3. Ultrasound Exams

Transvaginal ultrasound provides visual insights into:

• Antral follicle count (AFC): the number of resting follicles in both ovaries
• Ovarian cysts or PCOS signs
• Uterine structure: fibroids, polyps, congenital anomalies

The AFC is particularly relevant when combined with AMH to evaluate ovarian reserve.

4. Fallopian Tube and Uterus Imaging

Open fallopian tubes are essential for natural conception. The tests include:

• Hysterosalpingography (HSG): X-ray with contrast dye to assess tubal patency
• Saline infusion sonography (SIS): ultrasound to evaluate uterine lining
• Hysteroscopy: direct visualization of the uterine cavity

Blocked tubes or intrauterine adhesions may require surgical correction before fertility treatment.

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Investigating Infertility: Male Fertility Testing

It takes two. Investigating infertility means evaluating male factors with equal seriousness.

1. Semen Analysis

A simple test, but often revealing. It analyzes:

• Volume (1.5 mL or more)
• Sperm count (15 million/mL or higher)
• Motility (at least 40% should be moving)
• Morphology (at least 4% normal forms)

Any abnormalities may indicate the need for lifestyle changes or specialized reproductive techniques like ICSI.

2. Hormonal Testing for Men

Key hormones include:

• Testosterone (300–1000 ng/dL)
• FSH & LH (1.5–12.4 mIU/mL)
• Estradiol (10–40 pg/mL)
• Prolactin (2–18 ng/mL)

Low testosterone and elevated FSH can point to impaired spermatogenesis. High prolactin may suggest pituitary issues.

3. Genetic Testing

For severe sperm issues, tests can detect:

• Y-chromosome microdeletions
• Karyotype abnormalities (e.g., Klinefelter syndrome)

This information helps in determining if sperm retrieval or donor sperm is needed.

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What Comes After Investigating Infertility?

Once testing is complete, we develop a plan based on the findings. Options include:

• Lifestyle optimization: weight management, quitting smoking, reducing alcohol, improving sleep.
• Timed intercourse: using ovulation timing to increase chances.
• Ovulation induction: medications like clomiphene or letrozole.
• Intrauterine insemination (IUI): placing prepared sperm directly in the uterus.
• In vitro fertilization (IVF): combining egg and sperm in a lab, then transferring embryos.

Investigating infertility isn’t just about diagnoses. It’s the bridge to action, to healing, to hope. For Daniela and Marcos, it meant uncovering a thyroid imbalance and low AMH. With supplements, stress reduction, and a customized IUI cycle, they conceived within six months.

Their journey wasn’t short. But it started with one step: investigating infertility.

Why Investigating Infertility Early Matters

One of the biggest misconceptions I encounter is the idea that fertility is guaranteed until menopause. In truth, a woman’s reproductive potential starts to decline much earlier—often in her early 30s. That’s why investigating infertility proactively, even before a year of trying, can save time, money, and emotional distress.

Early investigation can uncover hidden issues such as:

• Silent ovulatory disorders
• Mild endometriosis
• Thyroid dysfunction
• Low ovarian reserve
• Male factor infertility that shows no symptoms

In many cases, couples wait too long. They try for years, assuming nothing is wrong, only to discover that a simple intervention could have helped sooner. Investigating infertility is not about fear—it’s about preparation. It’s about owning your timeline before biology makes the decisions for you.

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Lifestyle Factors to Consider When Investigating Infertility

Fertility is more than just biology—it’s deeply affected by how we live. When we start investigating infertility, we also examine the daily habits that might be quietly affecting reproductive health.

1. Nutrition and Weight

• Being significantly underweight or overweight can disrupt ovulation.
• High sugar intake and insulin resistance can affect hormone balance.
• Nutrient deficiencies, such as low vitamin D, iron, or omega-3s, may impair fertility in both men and women.

2. Smoking and Alcohol

• Smoking is toxic to eggs and sperm, accelerating ovarian aging and reducing sperm count and motility.
• Alcohol, especially in large quantities, impacts hormone levels and can delay conception.

3. Stress

• Chronic stress may not cause infertility, but it can exacerbate underlying conditions like PCOS or hypothalamic amenorrhea.
• Couples under prolonged stress may also have reduced libido and intimacy, further reducing chances of conception.

4. Environmental Exposures

• Endocrine disruptors like BPA (in plastics), phthalates (in cosmetics), and pesticides can affect egg and sperm quality.
• Investigating infertility sometimes means reevaluating the products we use every day.

This is why a comprehensive approach matters. When I begin investigating infertility in my clinic, I don’t just look at test results. I ask about lifestyle, habits, routines, and even sleep. Sometimes the answers are found outside the lab.

Fertility Preservation and Long-Term Thinking

When investigating infertility, we also assess long-term reproductive health. For example, Siomara, 30, came to us before trying to conceive. She had no symptoms, no partner pressure—just foresight. She wanted to wait until 36 or 37 to become a mother. After a discussion about age-related decline in egg quality and quantity, we tested her AMH and AFC.

Her ovarian reserve was average, but she chose to freeze her eggs. Investigating infertility helped her make an informed choice and take control of her future.

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Myths and Misunderstandings in Investigating Infertility

Many couples delay investigating infertility due to myths:

• “Infertility is always the woman’s fault.” (False. Male factors are involved in 40% of cases.)
• “If I get my period, I’m fertile.” (Not necessarily. Ovulation might be absent.)
• “We’re young, so we have time.” (Fertility can decline even in your early 30s.)
• “You have to try for years before seeing a doctor.” (Early assessment leads to better outcomes.)

Dispelling these myths is part of educating couples and empowering them to act. Investigating infertility is not giving up; it’s taking charge.

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Emotional and Psychological Impact

Investigating infertility can be emotionally draining. Each test, each waiting period, each result brings its own wave of anxiety. Couples often struggle in silence, ashamed or afraid to share what they’re going through.

But the truth is: 1 in 6 couples face infertility.

Investigating infertility should be seen as a courageous act—an informed and loving step toward building a family. It’s not weakness. It’s strength. It’s advocacy for your future.

That’s why, in my practice, we include mental health support in every step of the process. Talking to a therapist who specializes in reproductive health can be as healing as any medication.

Costs are another factor. Not all tests and treatments are covered by insurance. But delaying investigation can make treatments more complex and expensive later. Knowledge is not just power—it’s financial strategy.

Conclusion: Investigating Infertility Can Change Everything

Investigating infertility is more than a diagnostic protocol. It is a journey of courage, of partnership, of trust in science and hope in the future. Whether it leads to timed intercourse, IUI, IVF, egg freezing, or even adoption, the first step remains the same: seeking answers.

No couple should feel alone or ashamed of seeking help. Investigating infertility gives voice to unspoken pain and light to the unknown. It helps transform tears of confusion into tears of joy.

If you’re wondering when to begin—start now. Investigating infertility might be the most important decision you ever make.

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References

Eekelen, R. van, et al. "Natural Conception: Repeated Predictions Over Time." Human Reproduction, Vol.32, No.2, 2017, pp. 346–353. DOI:10.1093/humrep/dew309. “>2. Eekelen, R. van, et al. “Natural Conception: Repeated Predictions Over Time.” Human Reproduction, Vol.32, No.2, 2017, pp. 346–353. DOI:10.1093/humrep/dew309​.

. Barreto, N.C.N. “Predição do Sucesso de Gestação Utilizando Algoritmos de Machine Learning Após Procedimentos de Fertilização In Vitro.” Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Análises Clínicas e Toxicológicas, 2021​.

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