Infertility is the inability of a couple to reach pregnancy after one year of unprotected sex (using no birth control). Between 10% and 25% of couples have infertility problems sometime during their lives. Infertility problems are more common in people over the age of 35.

Infertility testing consists of a variety of tests done to help determine why a couple cannot get pregnant. The tests can help find out whether the problem lies with the man's reproductive system, the woman's, or both. 

Infertility testing usually starts with simple tests. If the cause of infertility cannot be identified by means of these simple tests, more complicated testing can be done. The initial tests include:

• Physical exam and medical history. Physical exams of both the man and woman are done to determine their overall health and to reveal any obvious reasons for their infertility. The doctor will also ask questions about their sexual practices (including birth control), history of sexually transmitted diseases (STDs), need for medications, and the use of caffeine, tobacco, alcohol, and recreational drugs (such as marijuana).
• Semen analysis. A semen analysis measures the volume of the semen, the number of sperm (sperm count), the percentage of sperm that appear normal, the percentage of sperm that can move forward normally, and the number of white blood cells in the semen. See Semen Analysis test.
• Basal body temperature (BBT). Basal body temperature (BBT) is the lowest body temperature a healthy person achieves during a day. The natural changes that occur to a woman's hormone levels during her menstrual cycle cause her BBT to drop 1 to 2 days before ovulation and to rise 1 to 2 days after ovulation. A regular change in a woman's BBT indicates that ovulation is occurring. See Fertility Awareness test.
• Blood tests for luteinizing hormone (LH), progesterone, or follicle-stimulating hormone (FSH). The levels of luteinizing hormone and progesterone in the blood vary throughout a woman's menstrual cycle. Monitoring the levels of these two hormones throughout the menstrual cycle can help determine whether the woman is ovulating. Occasionally, follicle-stimulating hormone may be used to evaluate the woman's egg supply (called ovarian reserve). However, many doctors question the value of the FSH test. 
• Postcoital test. The postcoital test analyzes a woman's cervical mucus after sexual intercourse to determine if sperm are alive and able to move normally through the mucus. This test must be done the day before or the day of ovulation. Doctors disagree about the value of the postcoital test. It is not a good predictor of fertility and often is not done.

If the first tests do not reveal a cause for infertility, additional tests usually include:

• Hysterosalpingography. Hysterosalpingography is an X-ray test that examines the inside of the uterus, the fallopian tubes, and the surrounding area. A special dye (contrast material) that shows up on X-ray pictures is injected through a thin tube that enters the vagina and goes into the uterus. Because the uterus and the fallopian tubes are connected, the contrast material should normally flow into the fallopian tubes. As the contrast material passes through the uterus and fallopian tubes, X-ray pictures are taken continuously. The pictures can reveal blockage of the fallopian tubes that would prevent an egg from reaching the uterus or prevent sperm from traveling into a fallopian tube and fertilizing an egg. Hysterosalpingography may also detect abnormalities on the inside of the uterus that might prevent a fertilized egg from attaching (implanting) to it. 
• Endometrial biopsy. During an endometrial biopsy, a small piece of the uterine lining (endometrium) is removed for examination. Normally the endometrium changes throughout a woman's menstrual cycle. Early in the cycle, the endometrium grows thicker until an egg is released from an ovary (ovulation). If the egg is not fertilized by a sperm, the endometrium is shed (menstrual bleeding). An endometrial biopsy determines if the endometrium is going through the normal stages of change that occur during the menstrual cycle. 

If these tests do not reveal a reason for infertility, additional tests may include:

• Laparoscopy. Laparoscopy is an examination of the woman's pelvic organs (uterus, fallopian tubes, and ovaries) using a thin, lighted scope that is inserted through a small cut in the abdomen. This exam is used to diagnose conditions such as cysts, fibrous bands of scar tissue (adhesions), fibroids, and infection that can affect fertility. Laparoscopy can also be used to remove growths or treat other conditions, such as endometriosis. See Laparoscopy test.
• Ultrasound. Ultrasound uses sound waves to form a picture of structures inside the body. For a woman, it may be done to determine whether eggs are developing normally in her ovaries. For a man, it may be done to determine whether a problem in his testicles is preventing the normal formation and release of sperm. 
• Antibody tests. Antibodies are substances produced by the body's immune system to detect and destroy foreign substances (such as bacteria and viruses). Sometimes the body makes antibodies against normal cells, such as sperm cells (anti-sperm antibodies). Antibody tests may be done to determine if antibodies against the man's sperm are present in his or the woman's reproductive tract. Doctors disagree about the value of antibody tests for determining the cause of infertility.
• Hysteroscopy. Hysteroscopy is an examination of the lining of the uterus using a thin, lighted scope that is inserted through the vagina and cervix into the uterus (endometrium). Hysteroscopy is used to diagnose problems of the endometrium. It can also be used to remove abnormal growths or samples of tissue.
• Karyotyping (chromosome analysis). Karyotyping is a test that examines the genetic material (chromosomes) in a person's cells for abnormalities. Some genetic abnormalities interfere with the processes necessary to achieve pregnancy. See Karyotyping test.

Doctors disagree about the value of the postcoital test and the anti-sperm antibody test.

Infertility Testing
Results

The most common causes of infertility are:

• Problems with the man's reproductive system (including low sperm count).
• Problems with the woman's fallopian tubes (such as blockage).
• Problems with the woman's ability to produce an egg (ovulate).
• Structural problems with the woman's uterus or cervix.

Infertility testing does not always reveal a treatable cause.

Treatment for some problems can also occur during some tests, such as hysteroscopy and laparoscopy (see Laparoscopy test). Occasionally, hysterosalpingography may open a blocked fallopian tube.