What fertility testing do I need?
We like to organize fertility testing into “tiers” with the first tier being the absolute “musts” to investigate if there is no clear initial reason (such as advanced age). Also keep in mind that, without doing a single fertility test, by biological definition, once you reach the age of 35 there will be some degree of “egg factor” when statistically compared to peak fertility at a younger age. The first tier diagnostics include investigations into 1) eggs (ovulation and reserve/quality) 2) sperm and 3) anatomic factors (uterine, tubes, endometriosis). The corresponding 1st tier tests are 1) ultrasound and bloodwork for egg factors 2) semen analysis for sperm and 3) ultrasound and endometrial biopsies for anatomic factors. Sometimes nothing is revealed and 2nd tier testing is indicated. Also, more information can reveal itself as the fertility journey evolves, and this can trigger additional testing such as investigations into the uterine microbiome, sperm DNA fragmentation or autoimmune factors.