Female fertility testing

October 31, 2006 7:43 PM

Female fertility questions. I'm in my mid thirties and married within the last year. I want to know what my chances of having kids are, but everything I find on the web says you can go to a "fertility clinic" after you have tried to have kids for a while and not succeeded. That's not going to help me, because we're not ready to have kids RIGHT NOW. Also, what are fertility tests for women like?

So, is it really hard for a woman to figure out how fertile she is? We need to plan for the future. Maybe it isn't even an option for me at this point. If so, I'd like to know.

Also, I would like to know what fertility tests for women are like. Is it much more painful and/or expensive for women then for men? I understand tests are available for men in the US at, eg., CVS, and that they're not that bad. What exactly do they do with women?

Has anyone else been in this position, and what did you do? Are there any options other than a fertility clinic, and, if a fertility clinic is the only answer, will they test me if we haven't been "trying" yet? And finally, what would any tests be like, and are they expensive?

Thanks very much for your help!

posted by Go, now. Go! to health & fitness (17 comments total)

Your gynecologist can do basic hormone level checks and make sure you don't have some of the major fertility problem causes like PCOS and chlamydia . My understanding is that there is no one "fertility test" for women - you really can't know until you try, because there are so many factors involved, FSH levels are considered important, but there are many many other hormones and processes involved. IANAD, I've just had some concerns and had some basic checks done.
posted by crabintheocean at 8:00 PM on October 31, 2006

I can't speak to your latter issues, but for basics on fertility rates with aging try this from Discovery Health - it was the first hit from a google of "fertility rate age" (no quotes). On average your situation is neither dire nor perfect: there are two considerations, one is how fertility declines with age, the other is how complications in pregnancy increase.

My wife and I conceived in our mid thirties: we didn't worry about fertility, we didn't have any problem conceiving, but we did have relatively severe complications with the pregnancy (it's impossible to say if and how much age might have been a factor, though). I have honest doubts whether it would gain you anything to medically investigate your fertility at this point. I'll make the obvious suggestion to discuss this with your OB/GYN.
posted by nanojath at 8:01 PM on October 31, 2006

The chance of having a child with Down Syndrome increases as the mother ages. The chance is quite low until you're in your early 30's, but after that it begins to rise very steeply.
posted by Steven C. Den Beste at 8:02 PM on October 31, 2006

I'm sure the above comments are all true. But at my child's preschool, I'd estimate that about one third of the kids were born when their moms were over 40 (lots of moms with high-power careers) . So waiting a while might require some additional tests when you do get pregnant, and maybe some additional worries on your part, but it's perfectly likely that you'd have an uneventful pregnancy and a healthy child.
posted by nixxon at 8:19 PM on October 31, 2006

Check out fertilityfriend.com.
posted by brain_drain at 8:22 PM on October 31, 2006

This book is a wonderful primer on how to understand your cycle and your fertility. It's been a few years since I read it, but it answered so many questions for me about my cycle and how to interpret whether or not I was ovulating. Then, you'll know that timing isn't the problem if you have problems conceiving, and can look into medical issues right away.

It would certainly be a good idea to talk to your Gyn now. Read up on things like PCOS, fibroids and endometriosis which are common causes of infertility. If you have them, then look into treatment now before you get to the point of trying to conceive.

Also, make sure you're at a healthy weight, that solves a lot of problems too.
posted by saffry at 8:50 PM on October 31, 2006

I second saffry's book recommendation, and would also recommend getting an ovulation prediction kit, which you can find at any major drugstore.

I'm 32, and I'm one of the youngest moms at our preschool by a longshot. I wouldn't be that worried about the risk of Downs or other birth defects--the real numbers aren't nearly as scary in my opinion when you compare them directly to the statistics for younger women.
posted by padraigin at 9:10 PM on October 31, 2006

What nobody has said yet, so I will, is this:

You can be fine. And he can be fine. But you can still have problems concieving together, due to basic chemistry problems you wouldn't have with other partners. So, the only "fertility test" that matters is the one where your husband knocks you up when you do try, or not. Until then, you may pass all the expensive and invasive tests in the world, and be no better off, if when the time comes, the baby doesn't.

If it doesn't happen within a year of when you start trying, he'll get tested first, because it's easy to see if men are likely to be fertile. If he's judged OK, attention will turn to your systems, in graded levels of invasiveness, until a problem is determined, or you run out of patience or money.

It's no use borrowing trouble from tomorrow. But given that you are already in your mid-thirties, you know that your relative risks are increasing, and your likelihood of conception is falling faster and faster as time passes. If you want children, it would be good if you got on with it.

Nothing you could learn now would be a guarantee of future success, anyway. Your reproductive possibilities do have a sell by date, but no one can know it absolutely. Thinking you can wait until you are 40 or 45, and "ready" ignores the essential fact of children:

No one is ever truly ready for kids. And yet, we muddle on.
posted by paulsc at 9:37 PM on October 31, 2006

The chance of having a child with Down Syndrome increases as the mother ages. The chance is quite low until you're in your early 30's, but after that it begins to rise very steeply.

It seems to me that your graph indicates that the chance increases "steeply" after forty, and very slowly before that.
posted by The God Complex at 10:27 PM on October 31, 2006

Been there, done that, lived it. Lot's of misinformation given out on this subject. Basically, when you're ready to have children and assuming you're healthy now, go see your GYN and get checked out (pretty much the normal stuff) and find out what you need to do to be your healthy best.

If, after 6 months (because you're in your 30's, not in your 20's when you can afford to wait around one whole year) of trying 'naturally' you don't get pregnant, then return to your GYN - the basic testing will begin.

In my case basic testing was skipped and my GYN simply prescribed Clomid (pretty much just a boost for ovulation) which worked for my first pregnancy. If it hadn't (and it didn't for my other pregnancies) then hormone & sperm testing would have begun, etc., etc. Fertility clinics and all the hassle that goes with them are usually a last resort - there's lots of stuff to try before going that route, nothing you need to worry about at this point.

Planning is great, and if you need to do that then I say give yourself a 2 year window to achieve pregnancy (it just takes longer when you're older, average wise)- this would assume you need no help or only minor help, such as Clomid. And you run the risk of never becoming pregnant no matter what you try. So try from say, age 38 to 40 - then allow to age 45 for serious fertility help.

Btw, no, testing isn't all that bad. But fertility treatments can be painful. And the worst is getting your hopes up every month only to be disappointed, and the mental and relationship risk of allowing yourself to become consumed by 'getting pregnant' (strictly scheduled sex is rarely fun).
posted by LadyBonita at 10:46 PM on October 31, 2006

Go buy Taking Charge of Your Fertility, read it, and start charting (on paper, with the ovusoft software, with Fertility Friend as linked above, there are many ways to do it). Chart for several months, and take your charts to your GYN for a checkup, bloodwork, and review of your charts and family history. Unless you've got crazy charts, you'll know real quick if you are ovulating, which is pretty much phase one of fertility. You go from there depending on what you want to know or what your examinations reveal.
posted by Lyn Never at 6:31 AM on November 1, 2006

I'm 40+ and when we decided to try to get pregnant a year ago, the first test my doctor did was a blood test, five days after the start of my period, which measures (this is oversimplified) how hard your body has to work to produce an egg. They hope to see a number under 12. Mine was 5 and 4 months later we were pregnant. Our son is 3 months old now and we feel very fortunate and very happy.

It sounds like this is the kind of test you are looking for - something that will give an indication of how easy or difficult conception might be for you. I don't remember if it was expensive. I'm pretty sure my insurance covered it.

If you're planning to have children down the line, or even just considering it, I would strongly recommend starting to chart your temperature now. It takes at least a few months for the chart to start to make sense so you should not wait to do this until you're ready to conceive. This was the single best piece of advice I got. It is also something that a fertility doctor will want to see should you have problems conceiving. Start doing this now.

Good luck and feel free to email me if I can be of any help.
posted by Kangaroo at 6:48 AM on November 1, 2006

You should definitely talk to your gyn about this, and if s/he doesn't seem knowledgable, find a new one. When I inquired with my gyn to learn more about this issue, she said that "once you start trying, the average amount of time it takes is 9 months. If after 9 months of trying you still aren't pregnant, then you'd come back in and we'd talk about the options."

The specifics I was given are slightly different from, but consistent with, Lady Bonita's - all the more reason for you to talk to YOUR gynecologist so the advice can be more tailored to your body and your needs. I was surprised at how easy it was to have this conversation with my doctor (ok, actually it was her nurse practitioner), and how much I learned. It's worth your insurance co-pay.
posted by Sprout the Vulgarian at 7:14 AM on November 1, 2006

nixxon writes "But at my child's preschool, I'd estimate that about one third of the kids were born when their moms were over 40 (lots of moms with high-power careers) . "

This is the worst kind of anecdotal evidence. Those would be moms unable to conceive won't be hanging around day cares.
posted by Mitheral at 7:32 AM on November 1, 2006

Many of the answers above are not really answering the question.

For men: he can get a complete semen analysis done, which will tell you rather a lot about how many sperm he has and how deformed they are. (It's normal for many sperm to be created badly; the male reproductive anatomy favors quantity over quality. However, when almost all of them are deformed, reproductive odds go way down.) This costs around $75-$100. Contact a local fertility clinic, they'll be able to refer you to a lab that does these.

The semen tests available at CVS are very limited - they just give a yes/no answer, when the reality is a large curve of fertility.

For women, most basic: you can buy urine test strips that measure LH, a hormone that your body releases when it ovulates. (Buy them online cheap.) You can also measure your body temperature, and keep track of your menstrual cycle. A regular cycle and regular LH surge is a good basic indication of fertility. An irregular cycle and irregular LH surge is a good basic indication of fertility problems.

For women, moderate: Blood tests can measure your FSH level, and you can also do a clomiphene challenge test. These tests attempt to measure how far down the curve of declining fertility you are: a little bit, or a lot. They are not exact indicators of how much trouble you'll have conceiving, but they're a good general indicator. These tests aren't painful: drawing blood and injections, normal stuff. Again, contact a local fertility clinic.

For women, advanced tests: if fertility problems are suspected, there are several advanced tests - are you ovulating, are your ovarian tubes blocked, how does your uterus look, how does your cervical mucus look, etc. The hysterosalpingogram is an x-ray of your fallopian tubes that is both invasive and painful. These are rarely done unless you've already tried to conceive for six months or a year and failed.

This is by far the best answer so far. :)
posted by jellicle at 7:52 AM on November 1, 2006

Thirding the suggestion for Taking Charge of Your Fertility. There is a lot of good informaton here, but the best and simplest is to ask your OB to do the FSH test. High FSH numbers are the absolute most common cause of problems conceiving. Knowing what your FSH numbers are can help you decide when to start trying to conceive.

Encouraging anecdotal evidence - I followed this advice, had an FSH test at age 39 and scored a 14, a quite elevated number. So I started trying right away, and was able to get pregnant on the second cycle (I'm currently 5 months pregnant).

Of course YM will V, but mid-thirties are a good time to start looking at your fertility if you know you want to have kids. And as many have said above, there is no real way of knowing what your particular circumstance will be without trying. This much is true though - sooner is always better, from a fertility point of view. The younger you are - the better your egg quality, and the more time you have to try natually or with the least invasive techniques.

Random additional information - FSH results come on two different scales (explained in the book) - don't take a raw number result from your OB and try to interpret yourself without knowing which scale to use.

Finding a Fertility Clinic - not as scary as it sounds. Look for a doctor specializing in Reproductive Endocrinology (referred to as an RE) - thats who you want.
posted by AuntLisa at 8:34 AM on November 1, 2006

FYI - with regards to the Down syndrome article at wikipedia - some of the information is out-of-date, some is glossed over. For example, chorionic villus sampling is mentioned, but not really described in the Prenatal Screening section (where it really should be), nor are there associated risks for the screens, which are all important in making an informed decision.

I won't go into more detail about the article's deficiencies and inaccuracies since they aren't pertinent to the question.

Every woman is different, but in our case, Mrs. Plinth had very consistent menstrual cycles and no bad health problems. I think these are probably the largest contributing factors to ease of conception (other than, you know, the hydraulics).
posted by plinth at 8:35 AM on November 1, 2006