Fertility Test for Women

Fertility Tests for Women start with relevant blood tests to assess the hormone levels that cause infertility. These include Follicle-stimulating hormone (or FSH)Luteinizing hormone (or LH)Free and Total TestosteroneProlactin (or PRL) and Sex Hormone-Binding globulin (or SHBG) 


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AMH-MIS may be used in the investigation of ovarian reserve since AMH concentrations in adult women reflect the number of small antral and preantral follicles entering the growth phase of their life cycle. These follicles are proportional to the number of primordial follicles that still remain in the ovary, or the ovarian reserve.
AMH decreases throughout a woman's reproductive life, which reflects the continuous decline of the oocyte/follicle pool with age and, accordingly, ovarian aging.

DHEA is a weakly androgenic steroid that is useful when congenital adrenal hyperplasia is suspected. It is also useful in determining the source of androgens in hyperandrogenic conditions, such as polycystic ovarian syndrome and adrenal tumors.

DHEA-S is the sulfated form of DHEA and is the major androgen produced by the adrenal glands. This test is used in the differential diagnosis of hirsute or virilized female patients and for the diagnosis of isolated premature adrenarche and adrenal tumors. About 10% of hirsute women with Polycystic Ovarian Syndrome (PCOS) have elevated DHEA-S but normal levels of other androgens.

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Measuring the circulating levels of estradiol is important for assessing the ovarian function and monitoring follicular development for assisted reproduction protocols. Estradiol plays an essential role throughout the human menstrual cycle. Elevated estradiol levels in females may also result from primary or secondary ovarian hyperfunction. Very high estradiol levels are found during the induction of ovulation for assisted reproduction therapy or in pregnancy. Decreased estradiol levels in females may result from either lack of ovarian synthesis (primary ovarian hypofunction and menopause) or a lesion in the hypothalamus-pituitary axis (secondary ovarian hypofunction). Elevated estradiol levels in males may be due to increased aromatization of androgens, resulting in gynecomastia.

IMPORTANT - Note this Estradiol test is not for children that have yet to start their menstrual cycle.  If this test is ordered for a child that has yet to begin their menstrual cycle Quest Diagnostics labs will substitute in Estradiol, Ultrasensitive LC/MS/MS - #30289 at an additional charge of $34

Estrogens are secreted by the gonads, adrenal glands, and placenta. Total estrogens provide an overall picture of estrogen status for men and women.

This test is useful in the differential diagnosis of pituitary and gonadal insufficiency and in children with precocious puberty.

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This test is useful in the differential diagnosis of pituitary and gonadal insufficiency and in children with precocious puberty.

Levels increase sharply during the luteal phase of the menstrual cycle. The level increases from 9 to 32 weeks of pregnancy.

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During pregnancy and postpartum lactation, serum prolactin can increase 10- to 20-fold. Exercise, stress, and sleep also cause transient increases in prolactin levels. Consistently elevated serum prolactin levels (>30 ng/mL), in the absence of pregnancy and postpartum lactation, are indicative of hyperprolactinemia. Hypersecretion of prolactin can be caused by pituitary adenomas, hypothalamic disease, breast or chest wall stimulation, renal failure or hypothyroidism. A number of drugs, including many antidepressants, are also common causes of abnormally elevated prolactin levels. Hyperprolactinemia often results in galactorrhea, amenorrhea, and infertility in females, and in impotence and hypogonadism in males. Renal failure, hypothyroidism, and prolactin-secreting pituitary adenomas are also common causes of abnormally elevated prolactin levels.

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For diagnosis of hypothyroidism and hyperthyroidism.

Note: Free T4 Index (T7) will only be calculated and reported if test code code 861 (T3 Uptake) is ordered as well.

This test is useful in the differential diagnosis of male hypogonadism. For males 18 years of age and older only. Pediatric and Female patients will need to order Testosterone, Total, MS #15983.

Please note: If Testosterone, Total, Males (Adult) Only #873 is ordered for a pediatric or female patient, the lab will automatically change the test to and charge for Testosterone, Total, MS #15983.

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The Thyroid-stimulating Hormone (TSH) Blood Test is for differential diagnosis of primary, secondary, and tertiary hypothyroidism. The TSH test is also useful in screening for hyperthyroidism. This assay allows adjustment of exogenous thyroxine dosage in hypothyroid patients and in patients on suppressive thyroxine therapy for thyroid neoplasia.

Infertility refers to being unable to get pregnant. The average diagnosis comes after a period of assessment (1 year or more) with the couple trying to get pregnant. In some cases, a woman may get pregnant but won’t be able to carry the fetus to term (miscarriage), and this is also noted under the same diagnosis of infertility. 

According to modern research, 10-15% of all US couples deal with this concern. Approximately 33% of these cases involve women-related problems concerning fertility. While another 33% includes men-related issues. The remaining 33% consists of a combination of men and women-related problems. 

Timing and interaction of many factors come into play when looking at fertility.  Hormones, both men’s and women’s, constitute a big part of this equation.  These hormones include those produced by a man’s testicles, a woman’s ovaries, and glands like the pituitary, hypothalamus, and thyroid. 

When it comes to pregnancies, a woman has to develop an egg in one of the ovaries and then release it. Women are born with a set number of eggs (or oocytes), and each one has its own spot in the ovaries, nesting in a cavity filled with fluid, called a follicle. When a healthy female is born, she will have approximately 1-2 million follicles, but most of these degenerate once puberty hits. As a result, there are about 200,000-400,000 viable follicles left. When a woman starts entering the all-important reproductive years, the numbers dwindle further so much that only about 400 mature eggs are ever released. Most women release about one mature egg per month. 

A woman’s menstrual cycle kickstarts the follicle-stimulating hormone (FSH) that causes the follicles to mature a few at a time. During this stage, typically, only one follicle tends to dominate over the rest. This is when estradiol production begins to rise and hits top gear around day 14 out of the cycle. The estradiol causes the uterine lining to thicken and acts as a catalyst for hormone production of gonadotropin-releasing hormone, FSH, and luteinizing hormone. When these hormones come into effect, the mature egg is released, and that’s what begins the ovulation process. 

The mature egg begins to move through the fallopian tube and, if sperm are present, eventually gets fertilized. If fertilized successfully, the embryo begins to form and move into the uterus before finally settling into the endometrium (or the lining of the uterine). When the embryo starts to develop, the newly formed placenta supplies nourishment and other support during the gestation period. A hitch in any of these processes could spur problems with infertility. In the end, deciphering the things that cause infertility may be complicated, while other times, it may be relatively easy to identify and address the cause. 

Main Causes of Infertility 

It starts with something as simple as age. Couples that are trying to conceive during their 30s or 40s see a rise in these issues. 

The best time for a woman to conceive is during her early 20s before fertility substantially declines by age 35 and even more after 40. When a woman reaches menopause, she doesn’t have many functioning eggs available. 

When it comes to men, their number and motility of sperm decreases, which reduces the likelihood of pregnancy. There are other relevant age-related concerns for men, such as low testosterone levels, erectile issues, ejaculation trouble, and prostate concerns. 

Along with age, other relevant factors to keep in mind for men and women include: 

  • Too Much Exercise 
  • Unhealthy Habits (i.e., Smoking, Alcoholism, Drugs) 
  • Significant Medical Conditions (i.e., Diabetes) 
  • Exposure to Chemicals/Toxins 
  • Exceedingly Overweight/Underweight 

While each of these may play a role in causing infertility, there are times when the root cause is unknown. These conditions may restrict sperm movement, affect ovulation, or affect fertilization or implantation of the egg. 

For women, here are some of the leading conditions that can cause infertility: 

  • Polycystic Ovary Syndrome (or PCOS) – Impedes the Releasing of Mature Eggs 
  • Pelvic Inflammatory Disease (or PID) – Blocks Fallopian Tubes Due to STDs 
  • Primary Ovary Insufficiency (or POI) 
  • Endometriosis 
  • Fibroids in the Uterus 
  • Irregular Hormone Levels (FSH, LH, Estrogens) 
  • Eating Disorders 
  • Autoimmune Disorders (i.e., Antiphospholipid Syndrome) 
  • Hypothyroidism 
  • Gluten Intolerance 

For men, the following conditions can impact their fertility: 

  • Irregular Hormone Levels (Testosterone, FSH, LH) 
  • Erectile Dysfunction 
  • Low Sperm Count, Clumped Sperm, Abnormally-Shaped Sperm, Poor Sperm Movement (Motility) 
  • Obstructions Preventing Ejaculation 
  • Enlarged Veins Near the Testicles (Varicoceles) 
  • Prolonged Fever 
  • Injured Testicle(s) 
  • Mumps Infection (Inflamed Testicles) 
  • Excessive Heat Near the Testicles 
  • Klinefelter Syndrome 

Lab Testing for Women 

It’s best to start with relevant blood tests to assess the hormone levels that cause infertility.

These can include: 

In some cases, changes in thyroid and/or pituitary function can impact the menstrual cycle and ovulation process. Blood tests may help spot irregularities when it comes to thyroid function (Free T4 and/or TSH) along with steroids (DHEA-STestosterone) and while also shedding light on androgen levels. 

Imaging Procedures 

There are specific imaging techniques that can be deployed to spot physical concerns that impede fertilization or healthy pregnancies. These imaging procedures include ultrasound sonograms, x-rays, and fiber-optic endoscopies, all to help locate abnormalities such as abscesses, tumors, fibroids, and/or polyps.   

Lab Testing for Men 

For men, the diagnostic process involves a thorough look through their medical history and a physical exam to spot any abnormalities. Depending on what’s observed, the examination may also involve the use of a trans-rectal ultrasound (TRUS) to find abnormalities that can include blockages affecting the release of sperm during ejaculation. Note: an absence of sperm (azoospermia) may be due to a lack of seminal vesicles or vas deferens.   

Semen Analysis is a foundational test used to aid in diagnosing infertility in men. The semen is collected and evaluated to spot potential defects in the shape, number, or movement (motility) of sperm. 

Blood tests can be used to assess hormone levels. These include: