Testing for female infertility

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 checked. 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 placed 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 or damage outside the fallopian tubes or endometriosis, which is better detected by laparoscopy. The advantage of a Hysterosalpingogram is that there is no recovery time and general anaesthetic is not required.

It is common for women to have laparoscopy as part of their infertility investigations. If endometriosis or tubal problems are present, further laparoscopic surgery may be advised. This operation is performed under a general anaesthetic. A small cut is made at your belly button (navel) and a tube-like instrument with a camera attached is inserted to view your pelvic organs.

Laparoscopy 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. Sometimes laparoscopy can include a dye test to check the patency (openness) of your fallopian tubes.  

In all women, the number of eggs declines with age and the decline occurs more quickly during your late thirties.

The following hormone blood tests are done to assess whether a women's ovaries have fewer eggs than expected:

• Anti-mullerian hormone (AMH) is produced by the ovary. AMH suggests how many immature eggs are ready to respond to the effects of FSH hormone. It can be checked at any time in your menstrual cycle. AMH levels decline naturally with age and are often 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. 
• Follicle stimulating hormone (FSH) and Estradiol (E2) are checked on day two or three of a menstrual cycle. FSH is produced by the pituitary gland and causes follicles in the ovaries to grow and develop a mature egg before ovulation. In women with a reduced number of eggs, higher levels of FSH are needed to promote follicles to grow, so the FSH levels are increased.

You may 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 an optimum numbers of eggs when stimulated with drugs.

Eligibility 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 currently used to decide on eligibility for public funding. Women who are not eligible for IVF with their own eggs may qualify for funded donor egg IVF treatment, if they meet other eligibility criteria.

For more on eligibility, see our page on public funding.