Do you suspect that you and your partner are having fertility issues?

If so, your next step is to speak with your OB/GYN and get referrals to fertility specialists in your area. In most cases, we recommend couples see a fertility specialist if the woman is 34 or younger and has tried to conceive for 12 months or more. For women 35 years and older, we recommend seeing a specialist after trying unsuccessfully for six months or longer. You may also opt to see a specialist if you have had more than three miscarriages in a row.

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6 of the Most Common Infertility Tests

Once you get to this point, a fertility specialist will want to run a full fertility workup on both you and your partner to see where the complication(s) originates. This series of tests can raise alarm bells when couples falsely envision multiple, expensive tests that their insurance may not cover. DO NOT BE ALARMED!

In most cases, couples will only need a few diagnostic procedures performed to run a semen analysis in the male and to evaluate the ovulatory, uterine and tubal status in the female, none of which are expensive. However, there are situations where further testing and diagnostic evaluation may be necessary, in which case we will recommend additional testing.

Here is a list of the six most common infertility tests:

  1. A thorough physical examination. While not necessarily a test, a full physical can play a critical role in early infertility testing since the health of the mother is integral to fertility and a healthy pregnancy. Issues like obesity, diabetes, lifestyle habits, etc., may help us develop a fairly straightforward fertility plan before moving on to more complicated and expensive testing or medical procedures.
  2. Sperm and Semen Analysis. Typically, male infertility is the result of low sperm count, abnormally shaped sperm, and/or sperm that don’t swim as well as they should. All of these can be evaluated with a sperm analysis. If there are no sperm present at all, the doctor may recommend further exams/diagnostic procedures to see if there are any blockages, anatomical abnormalities, or genetic issues that prevent the sperm from showing up in the semen after ejaculation.
  3. Ovarian Reserve Testing (ORT). The remaining tests will be performed on the female half of the equation. First and foremost, your doctor will perform a test to see if you have a low egg reserve. The doctor will test FSH and estradiol levels on the third day of your cycle. You will be given a dose of clomiphene citrate, which stimulates egg maturity/release, and then she’ll test FSH and estradiol levels again on day 10 to see if further tests are required.
  4. Hysterosalpingogram (HSG). This is a special version of an X-Ray which will provide a detailed image of your uterus and fallopian tubes. Your doctor will use dye to test whether or not your fallopian tubes are blocked, which is one of the most common reasons for infertility and can occur for a variety of reasons, ranging from congenital abnormalities to endometriosis or scarring.
  5. Ultrasound. An ultrasound is a relatively inexpensive test that can provide a wealth of information, including any abnormalities in the shape of your cervix or uterus, the presence of endometriosis, polyps or fibroid tumors, and multiple other anatomical, structural or medical issues that may be a source of infertility.
  6. Laparoscopy/Hysteroscopy. In both procedures, doctors use a very small camera attached to very small surgical instruments to remove, repair or amend any anatomical or structural issues in the fallopian tubes or uterus that may be causing fertility. Successful repair of these issues may be all you require.
  7. Cervical mucus test and postcoital test. These tests are done to test the quality and production of your cervical mucus, as well as how it reacts in the presence of your partner’s sperm. Sometimes, there isn’t enough mucus to form the web-like structure that assists sperm to their target. In other cases, the chemical balance in the mucus acts like a spermicide, either killing the sperm or compromising its shape and/or its ability to swim.

Are you concerned about your ability to conceive a baby? Schedule an appointment with RRC and we’ll follow a conservative and standardized approach to determine the cause with as few tests as possible.

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Even those who are desperate to conceive a baby know that parenting is no easy feat. Parenting a singleton is hard enough work without the demands placed on parents by twins, triplets and other multiple sets. So, it’s no surprise to us when one of the first questions from our patients is regarding infertility treatments and their risk of conceiving multiples.

Does Participating in Infertility Treatments Mean I Might Have Twins, Triplets or More?

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Multiple births are by no means a given of infertility treatments. However, some treatments put you at higher risk than others. Please note that at RRC, our doctors are first and foremost dedicated to the health and well-being of our mothers – and their baby – from the beginning of the mother’s fertility treatment to their exciting live birth at the end.

For this reason, we typically avoid any treatments that will place a patient at higher risk for a multiple birth. Multiple births are considered high-risk pregnancies by nature. Pregnancies in women who are 35+ are also considered high-risk. Therefore, our goal is to help each of our clients conceive healthy babies – one at a time!

With that said, let’s move on to the treatments that are more likely to create a multiples pregnancy scenario.

Drugs that trigger ovulation or superovulation. If you start by using a drug that stimulates ovulations – such as Clomid – there is no way to control the number of eggs released by your ovaries. If two eggs are released, you could conceive twins; if three are released, you may have triplets, etc.  According to the American Society of Reproductive Medicine (ASRM), women who use fertility drugs with clomiphine citrate have a 5% to 12% chance of having twins and a 1% or less chance of having triplets.

Elective multiple IVF transfers. It’s no mystery that IVF is a cost-intensive procedure. For many couples, cost is the most prohibitive factor and, since IVF success rates are nowhere near 100% (yet!), this means most couples have to go through more than one IVF cycle in order to become pregnant. Since the more embryos that are implanted, the better chance there is of IVF success, some couples will opt to implant more embryos to increase their chances of success the first time around. However, there is also a much greater chance of having multiples if all of those embryos attach and make it through the pregnancy.

Day 2-3 embryo transfers. Until relatively recently, those of us who provide assisted reproductive technologies transferred the embryos when they were two to three days old. These embryos were only two to eight cells “big”! The more cells visible to our embryologist, the more successful they can be at selecting the most viable embryo. So, if there were 2- or 4-cell embryos available and the mother was in exceptional health, the doctor might opt to transfer more embryos to compensate for the lack of visible embryo viability. In most cases, only one – or none-  of the embryos would attach and become a full-term baby. In others, two or more could potentially be successful – leading to a multiples pregnancy.

Blastocyst Transfer on Day Five Provides the Best Means Of Singleton Pregnancy Success

The wonderful news is that the evolution of culture media and modern technology make it possible for us to wait until Day 5 before transferring the blastocyst – an 8-cell embryo. This timeline is much closer to the natural human body’s timeline. If you were to conceive without ART, odds are your fertilized egg would emerge from the oviducts and into the uterus. Furthermore, your 5-day old blastocysts are large enough that our embryologists can do a better job selecting the most viable candidate for transfer. Together, these improvements make it increasingly possible for us to transfer a single embryo for a successful IVF singleton pregnancy. To date, Blastocyst Day 5 Transfers have allowed us to implant no more than two embryos per transfer for the last three years – and we’ve had the pleasure of watch 1400 babies come into the world as a result.

To learn more about enjoying the benefits of ART without the risk of multiples, contact RRC. We’re happy to let tabloid octuplets become a thing of the past!

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5 Highest Rated Books About Fertility

February 10, 2015

This is the era of knowledge. You can find information pertaining to any subject on the planet with a quick Google search or a visit to We appreciate when our clients come to us well-informed because it helps us to maximize our time together, reviewing the results of the fertility workups and determining the [...]

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Top Medical Conditions That Contribute to Low Sperm Count

February 3, 2015

Low sperm count is becoming an epidemic. While scientists are scrambling to identify and notify the public about environmental causes, there are bona fide medical conditions that can negatively impact the quantity and quality of sperm that are produced. 10 Medical Reasons That Cause Low Sperm Count Sperm production is a complex process. It includes [...]

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