Fertility tests and treatments

For heterosexual couples, fertility difficulty is when pregnancy does not happen after one year of regular attempts to conceive (fall pregnant). Your doctor may recommend tests to understand more about the cause of fertility problems — these are called fertility tests. Fertility tests are usually done in a hospital or at a fertility clinic.

Fertility difficulty can be caused by factors affecting males or females. Even after testing, it's not always clear what causes an inability to fall pregnant.

Depending on the results of your fertility tests, there are a number of treatments available. Treatment for fertility difficulty can help many people wanting to have a baby, but it doesn't always work. There are physical, emotional and financial costs with fertility treatment.

To understand more about how your health can impact your fertility, read about preconception health for males or talk to your doctor.

Semen analysis

A semen (sperm) analysis can be used to check the health of your sperm. Sometimes fertility problems are because:

• you do not have enough semen
• your sperm are not moving properly
• the shape of your sperm is not right

You will be asked to give a sperm sample. You will need to take it for testing at your local hospital or a pathology laboratory. The sperm must be collected after 2 to 5 days of no ejaculation (sex or masturbation).

Hormone tests

Your doctor can arrange a blood test to check your hormone levels. Having abnormal levels of male hormones, such as testosterone, may affect your fertility.

Imaging tests

Imaging tests can be used to check for tumours in your testicles, which may affect your fertility.

Images can be taken by:

• ultrasound
• magnetic resonance imaging (MRI)
• x-ray

Testicular biopsy

A testicular biopsy involves removing a small sample (piece) of your testicle tissue for testing. This test is used to check for conditions that can affect your fertility, such as cancer.

Testicular biopsy is rare — most of the time a diagnosis can be made using other tests.

Genetic testing

Your doctor may refer you for a genetic test to see if you have any genetic issues that might be causing fertility problems. These tests will usually involve a blood test to check your genes.

There is no single test that can fully determine a female's fertility. To understand more about how your health can impact your fertility, read about preconception health for females or talk to your doctor.

Ovulation assessment

Ovulation is when your ovaries release an egg into the fallopian tubes (the tubes that connect your ovaries to your uterus). This usually occurs around the middle of your menstrual cycle – about 14 days after the first day of your last period. Your doctor may ask questions about your menstrual cycle, such as:

• how regular your periods are
• whether you notice any signs of ovulation

Ovulation problems can be caused by:

• polycystic ovary syndrome (PCOS)
• significant weight loss
• some thyroid conditions
• ageing
• primary ovarian insufficiency

Going through a phase of not having periods or having irregular periods, can be a sign of ovulation problems.

Ovarian reserve testing

Ovarian reserve testing is a way of assessing how many eggs are left in your ovaries. This is usually done by measuring your anti-Mullerian hormone (AMH) levels with a blood test.

Low AMH levels do not always mean low fertility, especially in younger females who are otherwise healthy. AMH testing also can't tell you anything about the quality of the eggs.

If you are considering assisted reproductive technologies (such as IVF), AMH testing can help your healthcare team decide which option is right for you. Talk to your healthcare team about what your AMH results mean for you and your reproductive health.

For more information read Is the anti-Mullerian hormone (AMH) test a reliable test of my fertility?

Hormone tests

Blood tests can be used to determine if hormone levels are affecting your fertility. Hormones that may be tested include:

• luteinising hormone (LH) — this causes the release of an egg during ovulation. Low levels of LH can stop ovulation from happening normally.
• prolactin — this hormone helps your body make breastmilk. If you have a high level of prolactin you may have irregular periods or no periods.
• thyrotrophin (TSH) — this hormone controls how well your thyroid gland works. Your thyroid gland can affect your menstrual cycle and ovulation.
• androgens — these hormones are involved in reproduction. High androgen levels may cause you to have ovulation problems.

Test for chlamydia

Chlamydia is the most common sexually transmitted infection (STI) in Australia. It can cause pelvic inflammatory disease and fertility problems.

Your doctor can refer you for a chlamydia test. This may involve a:

• urine test
• swab from your cervix (you can often do this yourself)

Ultrasound scan

Your doctor may recommend an ultrasound scan of your:

• ovaries
• uterus (womb)
• fallopian tubes

Usually, a transvaginal ultrasound scan is done, which involves a small ultrasound probe being put in your vagina. This is only done with your consent.

This can help your doctor see if you have:

• a condition affecting your uterus, like endometriosis or fibroids
• any blocks in your fallopian tubes
• a condition affecting your ovaries, such as ovarian cysts

Laparoscopy

Laparoscopy is a type of keyhole surgery that involves making small cuts in your abdomen (tummy). A laparoscope (thin tube with a camera) is used to look at your:

• uterus
• fallopian tubes
• ovaries

A laparoscopy may be done if you have a known pelvic problem, such as pelvic inflammatory disease or endometriosis.

Fertility treatments aim to either:

• correct (fix) your fertility difficulties
• use an assisted reproductive technology to help you fall pregnant

The right fertility treatment option for you will depend on the cause of your fertility difficulties. Fertility treatments options vary in:

• how much they cost
• how long they take
• how well they work

Surgery

In some cases, surgery can help fertility issues by:

• treating blocked or damaged fallopian tubes
• removing growths, such as endometriosis or fibroids

Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is where semen is collected and injected into the uterus by a doctor or nurse. This is often called IUI or artificial insemination.

IUI is suitable when:

• there is an issue with the male's sperm quality or quantity
• the mucus in the female's cervix is too thick to allow sperm to pass through

IUI is easier and cheaper than many other forms of fertility treatment.

Ovulation induction (OI)

Ovulation induction (OI) involves the female taking certain medicines. These medicines help the eggs mature and be released from the ovaries.

OI is suitable when the female has normal fallopian tubes but has issues with ovulation.

After taking the medicines, you will either:

• start having scheduled sexual intercourse at particular times
• attend a fertility clinic for intrauterine insemination, where semen is placed into the uterus by a doctor or nurse

In vitro fertilisation (IVF)

In vitro fertilisation is a well-known form of pregnancy treatment that is used for many types of fertility issues. The steps of IVF are as follows:

1. The female is given medicines that make eggs grow and be released from the ovaries.
2. These eggs are collected during a minor surgery.
3. The eggs are then mixed with sperm to fertilise them.
4. The fertilised eggs are then tracked to see if they develop into embryos.
5. An embryo is then injected into the uterus by a doctor.

IVF may be suitable if you:

• have fertility issues
• are sexually-diverse or gender-diverse (LGBTIQA+)
• do not have a partner and want to have a child
• or your partner have a genetic disorder which you do not want to pass on to your child

IVF is more invasive and expensive than IUI or OI.

Intracytoplasmic sperm injection (ICSI)

Intracytoplasmic sperm injection (ICSI) involves a single sperm being injected into the egg to fertilise it. This is done using a needle.

ICSI is usually used if there are male fertility issues such as low sperm numbers.

How can I access fertility tests and treatments?

Some fertility tests and treatments are covered by Medicare. Medicare support is based on clinical need, which means it's available to:

• people without a partner
• sexually-diverse or gender-diverse couples
• couples experiencing fertility issues

If you live in a rural or remote area, patient assisted travel schemes (PATS) can help you access healthcare that isn't available locally. The scheme might provide subsidies for:

• travel costs
• accommodation near your treatment centre
• support person costs

Donor conception may be another option to get pregnant. This may involve donor:

• sperm
• eggs
• embryos

You may also consider other options, such as surrogacy or adoption.

The Fertility Society of Australia and New Zealand offers information on different fertility treatments, including:

• ovulation induction
• intrauterine insemination
• in vitro fertilisation

Learn more about what Medicare covers to help you fall pregnant on the Services Australia page.

Read more about who is eligible for the patient assisted travel scheme (PATS), on the National Rural Alliance page.