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Couples who have been trying to conceive for 12 months or longer without any success meet the official criteria for "infertility". At this point, it makes sense to seek medical help to find out what is going on with you.

Infertility testing looks at both partners in depth. What can you expect from female infertility testing? Which tests are usually carried out?  

An initial consultation with a fertility specialist is the first step for both partners. Depending on where you live, you may require a referral from your family doctor or OBGYN. The first appointment is mainly to discuss your situation. Expect questions about the length of time you have been trying to conceive, your menstrual cycles, and general medical history. The fertility specialist will also ask about your health, lifestyle, and diet as well as your sexual history and if you have ever been pregnant in the past.

Birth control may be another issue to be discussed. During this initial appointment, you will have the chance to provide any information you have regarding your cycles. It's important to tell the specialist if you have been tracking your ovulation, both if you used ovulation tests that have never turned up positive and if you do know for sure you are ovulating regularly. If you have any particular pelvic symptoms or experience bleeding outside of menstrual periods, this is also the time to say so.

You can also expect a physical exam. Things like hair growth, breasts, and weight can sometimes provide valuable pointers that help the specialist form a picture about what could be going on with your fertility. A PAP smear, STD tests, thyroid checks, and ovulation testing can also be part of the fertility testing process in the early stages. Your partner, meanwhile, should be undergoing a sperm analysis.

Ovulation testing

You may have used ovulation tests at home, or perhaps you charted your fertility using your basal body temperature. These activities are definitely valuable and something you need to share with your fertility specialist. The fertility specialist can take ovulation testing to the next level though, by finding out how your many reproductive-related hormones function throughout the menstrual cycle. Ultrasound can show whether or not you ovulated, and how thick your endometrium (uterine lining) is. Monitoring cervical mucus can also provide much needed insights. Hopefully, these tests alone will give your specialist the information they need about your fertility. By this time, it is also possible that your partner's sperm analysis shows that your infertility is due to a sperm count or quality issue. If, however, you and your partner have passed these tests without any sign of the real problem, further tests will be conducted.

A closer look at your uterus, fallopian tubes and ovaries

Blocked fallopian tubes, ovarian cysts, endometriosis, and uterine abnormalities like growths or scarring can all cause infertility. The next stage of female fertility testing is going to examine these parts of your reproductive system in detail, using X-rays, ultrasound, hysteroscopy (looking at the uterus) and laparoscopy (looking at the fallopian tubes).

During a hysteroscopy, a viewing instrument can be inserted through the cervix to take a closer look at the uterus. A laparoscopy is a similar procedure, but since the laparoscope can't be inserted through your vagina, small incisions are made into your abdomen in order to look at the fallopian tubes and ovaries. A laparoscopic viewing operation requires general anesthesia and will cause some discomfort afterwards. It will also provide a lot of information about scarring, adhesions and any other problems you may have.

Sometimes, an endometrial biopsy will also be part of the fertility testing process. This test uses a small sample of the lining of your uterus to assess if there is anything abnormal going on, and to see if your uterine lining is thick enough to sustain a pregnancy. It is important to note that not every woman's fertility testing will be the same. Your fertility specialist is going to form her own suspicions based on your initial consultation and your medical history, and will then figure out how to proceed. You will hopefully walk away from the fertility testing process with a clear diagnosis and a treatment plan. But sometimes, the cause of infertility remains unclear and you will be diagnosed with idiopathic, or unexplained, infertility.

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