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Diagnosing Infertility

At your first consultation at Fertility PLUS, one of our doctors will review your medical and fertility history. Your GP will have already arranged for you, as a couple, to have basic tests to check for any likely fertility problems.

At this consultation we will identify and arrange any further tests that are needed. We can usually give you a clear evaluation of your treatment options within a couple of clinic visits. Tests we might request are:

Pre-treatment screening blood tests
Tests for male infertility
Tests for female infertility

Pre-treatment screening blood tests

Screening for hepatitis B, hepatitis C and human immuno-deficiency virus (HIV) in both partners is required before treatment commences. A positive result does not exclude you from receiving treatment. Females will also be screened to confirm whether they are immune to rubella (German measles).

Tests for male infertility

In approximately one third of the couples that we see, male infertility is identified as the primary issue.

The most important test for male infertility is a semen analysis. A fresh sample is checked for:
  • Volume - the volume of fluid produced
  • Concentration - the number of sperm per millilitre of semen
  • Motility - the percentage of sperm that are moving
  • Morphology – the percentage of normally shaped sperm
  • Anti-sperm antibodies which may impair sperm function
It is important to understand that sperm quality can vary from sample to sample, so we may ask for a second sample if some sperm parameters are borderline. If treatments such as intrauterine insemination or IVF are being considered, we may ask you to provide another sample for the laboratory at Fertility PLUS to assess. We have a private room in the clinic where men can produce a sample if there is a likely to be a delay bringing a sample from home.

Other tests we may request are a hormone profile and chromosome testing. This is sometimes requested in men with greatly reduced sperm counts or quality.

Tests for female infertility

Tests for possible female problems look for:
  • Problems with ovulation (not releasing an egg each menstrual cycle)
  • Damage to the fallopian tubes that may prevent sperm reaching the egg
  • Problems within the pelvis or uterus that reduce fertility, such as endometriosis and fibroids
  • A lower than expected number of eggs in your ovaries for your age (also called ‘low ovarian reserve’). This is tested by a blood test

These tests include:

Trans-vaginal ultrasound

An ultrasound scan will usually be done at some time during your investigation. An ultrasound probe is placed in the vagina so that the shape, size and position of the uterus and ovaries can be assessed. Abnormalities such as fibroids, ovarian cysts, and polyps within the uterus can be seen.


This is an x-ray to check whether your fallopian tubes are blocked. A small tube is inserted into the opening of the cervix and fluid visible on x-rays is injected through your cervix into the uterus and fallopian tubes. This test can be used to show if the fallopian tubes are open or blocked. However, it can’t pick up pelvic scarring outside the fallopian tubes or endometriosis, which is better detected by laparoscopy. The advantage of a Hysterosalpingogram is there is no recovery time and general anaesthetic is not required.


This operation is performed under a general anaesthetic. A small incision is made at your belly button (navel) and a tube like instrument with a camera attached is inserted to view your pelvic organs. The aim is to check if there is any blockage of the fallopian tubes. Laparoscopy also allows your doctor to check for endometriosis or damage to the outside of the fallopian tubes from past infection. There is a small risk of complications such as damage to other organs (e.g. bowel or blood vessels) and requiring further surgery to repair the damage.

Testing ovarian reserve

Two types of hormone tests are done to assess whether a women’s ovaries have fewer eggs than expected. In all women, the number of eggs declines with age and the decline occurs more quickly during your late thirties.

Follicle stimulating hormone (FSH) is checked on day two or three of a menstrual cycle. This hormone, which is produced by the pituitary gland, stimulates follicular growth and the development of a mature egg prior to ovulation. In women with a reduced number of eggs, higher levels of FSH are needed to promote follicular growth and hence the FSH levels are elevated.

Anti-mullerian hormone (AMH) is produced by the ovary and reflects how many immature eggs are ready to respond to the stimulating effects of FSH hormone. It can be checked at any time in a woman’s menstrual cycle. AMH levels decline with age and are lower in women with fewer eggs. AMH levels give an indication of how a woman is likely to respond to the hormone stimulation of IVF treatment, but it is not necessarily a prediction of the likelihood of pregnancy. Women with reduced egg numbers will have very decreased levels of AMH. This test is not funded and patients are charged a fee.

Women can still conceive naturally with a significantly reduced ovarian reserve. However, conceiving through the IVF process is less likely in women with a reduced ovarian reserve because it is more difficult for their ovaries to produce optimum numbers of eggs when stimulated with drugs. This is reflected in the eligibility criteria for publicly funded IVF – women are not eligible for publicly funded IVF using their own eggs if their FSH is significantly elevated (above an FSH level of 14 iu/ml). AMH level is not used to decide on eligibility for public funding. Women who are not eligible for IVF with their own eggs may qualify for donor egg IVF treatment.
National Women's Health
Phone: 09 307 4949
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