Laura Berlinsky-Schine
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If you're having trouble getting pregnant, you probably feel overwhelmed. Your inability to conceive can be upsetting, and not knowing the cause of your fertility problems only adds to your stress and anxiety.

A study conducted by the National Institute of Environmental Health Sciences found that most women under the age of 39 who were unable to become pregnant after their first year of trying were able to the second year. For women between the ages of 27-34, just 6 percent were unable to become pregnant in their second year of trying, while only 9 percent of women between the ages of 34 and 39 were unable to conceive the second year.

Naturally, many couples want answers. Will they be able to conceive? What treatments are available? What can would-be parents do to improve their fertility?

Read on to learn about the general steps involved in a fertility test for women. Keep in mind that the steps to gauge male fertility differ and usually involve analyzing a semen sample to understand sperm count and other issues. (There are some over-the-counter DIY testing methods, such as SpermCheck Fertility Test, though medical practitioner's may be more accurate and can identify other fertility issues.)

Talk to your doctor

If you and your partner have been having sex regularly without using any form of birth control for one year or six months if you're under or over the age of 35 respectively, it's time to see a fertility specialist. She can help you figure out what the cause or combination of causes of your infertility might be.

Your doctor will discuss your medical history with you. She will ask about any hormone imbalance and diseases (including sexually transmitted infections or STIs), medications you take, and chronic illnesses. She'll also ask you about your sexual history and habits, including numbers of partners and how often you have sex, and your caffeine, drug, alcohol, and cigarette use, along with the reproductive histories of your immediate family members, including parents and siblings.

Some of these questions may be uncomfortable, but they are important in helping the fertility specialist understand the potential causes of your underlying fertility issues.

Physical examination and blood tests

Your doctor will conduct some blood tests to measure certain hormone levels. Some of these will need to be scheduled at certain points in your menstrual cycle, such as tests for follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which need to be measured in the second or third day of your cycle. Luteinizing hormone will also need to be tested in the middle of your menstrual cycle, when an LH surge generally occurs, and seven days after you start ovulating as well. She will also need to test you estradiol and progesterone levels on the second or third day of your cycle and again after ovulation occurs.

In addition to blood tests, your doctor will also perform a gynecological exam and test you for STIs.
Ultrasound

In some cases, your doctor may perform an intrauterine ultrasound examination. She will insert a transducer into your vagina, and it will translate sound waves into images on a monitor. Your doctor will be able to better understand information about your ovaries, uterus and egg follicles.

Cervical mucus test

Your doctor may also perform a cervical mucus test. Usually, this involves examining a sample of your cervical mucus a few hours after you and your partner have intercourse. It can show if sperm is able to survive in the woman's body and reach the egg for fertilization. Generally, your doctor will advise you to use an ovulation predictor kit, so the test can be perfomed prior to when you ovulate.

Other tests

Depending on your situation and what your doctor finds, she may perform some other tests, such as:

• Hysterosalpinogram (HSG): Liquid dye is injected through your cervix and vagina into your uterus. X-rayes are taken of the fallopian tubes. This will enable your doctor to understand any blockages of the fallopian tubes or uteran defects.

• Endometrial biopsy: This test helps determine if your uterine lining is normal for embryo implantation. A cathether is inserted through the vagina and cervix into the uterus, and a tissue sample is removed and analyzed.

• Laparoscopy: Through a tiny surgical incision in a woman's abdomen, a fiber optic telescope is inserted, so your doctor can look for signs of conditions that affect your chances of getting pregnant, including endometriosis. Your doctor will examine your uterus, fallopian tubes, and ovaries.

Many of these test cause mild or moderate discomfort, while some are associated with very little pain. Most couples better understand the causes of their fertility problems after undergoing some or all of the tests described, and your doctor may be able to help you with a course of treatment to improve your likelihood of sustaining a pregnancy.

If you're having trouble getting pregnant, talk to your doctor about the possibility of undergoing a fertility test. You should also discuss the cost of these procedures with both your doctor and insurance company.

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