The Fertility Evaluation: Why Can’t I Get Pregnant?

Monday, April 22, 2019 | 2:23 am

When you’ve been struggling to get pregnant and realize you probably need professional assistance to have a baby, one of the first questions you want answered is why you can’t achieve what comes naturally to other couples.

The fertility evaluation is the first step your reproductive endocrinologist (RE) will take to find answers to the question of why you cannot conceive. Both you and your partner will need to be active participants in the assessment process. Though it is a common misconception that most infertility is female-related, one-third of couples will find they have a male fertility condition, another third will have issues traced to the female partner, and an additional third will have a combination of male and female reasons.

The age of the female partner also is an essential indicator of fertility health. Advanced maternal age is defined as 37 years old and when a significant decline in fertility begins. Many women don’t know that females are born with all the eggs they’ll ever have and these eggs are depleted each and every month during their reproductive years. A woman’s eggs are as old as she is and do not replenish their supply like men do with sperm.

Both prospective parents will need to provide medical histories, and the doctor will take an assessment of their current health status.

To make a diagnosis, your RE will be looking at several factors that indicate whether you or your partner’s reproductive systems are functioning correctly. First, is the intended mom ovulating (releasing) an egg each month? Second, does the dad-to-be have healthy sperm that can be transported easily? Third, can the fertilized egg move through the fallopian tubes and implant in the uterus?

Basic evaluation components

As part of your initial consultation and evaluation, your doctor might schedule a semen analysis for the male, as well as blood work and an ultrasound for the female.

Semen analysis

Most women will agree that men have the easy part of the evaluation. Their role is to provide a semen sample. The doctor’s office will schedule a time for the male partner to provide this sample in a private collection room at the clinic or he can take home a collection kit if it is easier to produce a specimen in a more familiar environment.

The semen analysis will look at three factors:
• Sperm count and volume: Is there enough sperm in the specimen? A normal count ranges from 20 to 80 million sperm per milliliter.
• Motility (speed): Are the sperm good swimmers moving in the right direction so they can reach the female egg?
• Morphology (shape): Are the sperm normally shaped? If they display abnormal characteristics in the tail or head, they may not be able to penetrate the egg.

Female hormonal evaluation

A fertility doctor will want to know if the female is developing eggs and ovulating as well as how she may potentially respond to fertility medications. Ovulation can be ascertained by ovulation testing kits or through more precise blood tests and ultrasound exams.

The clinic will perform the following blood tests on day 3 of the menstrual cycle after your period has started:

• Follicle-stimulating hormone (FSH): The FSH count is a predictor of how hard the pituitary gland has to work to release this hormone, which stimulates the ovary to produce a mature egg. Higher FSH levels might mean lower fertility.

• Anti Mullerian (AMH) hormone: AMH determines the size of a woman’s ovarian reserve or how many eggs she has left.

• Estradiol: Also known as an E2 test, it measures a form of estrogen and lower than normal levels suggest a woman may be entering menopause.

• Luteinizing hormone (LH): LH rises before ovulation.


A transvaginal ultrasound test visualizes the ovaries, uterus, and follicles and counts the antral follicles, another measure of ovarian egg supply.

Hysterosalpingogram (HSG)

An HSG is a specialized x-ray that examines the fallopian tubes and uterus to check for any blockages or growths and assesses the shape of the uterus.

For most couples, the basic fertility evaluation will provide answers to the questions about egg and sperm supplies as well as if the woman or man has any significant blockages in her reproductive organs. For others, it may signal that the fertility specialist needs to conduct more testing.

Even after a thorough assessment, approximately 15% of couples will learn there is no answer to why they are not conceiving. Their results will be normal, yet they still cannot get pregnant. Unexplained infertility can be the most frustrating diagnosis.

A general rule of thumb on when to seek a fertility specialist is the following:
- If a couple has been unsuccessful at becoming pregnant for over a year and the woman is under 35, or
- If a couple has been unsuccessful at becoming pregnant for over six months and the woman is over 35.

Timing is everything. Be proactive with your fertility health and knowledge. The field of reproductive endocrinology is always improving so don’t ever give up hope.


For more information, please contact HRC Fertility directly:

333 South Arroyo Parkway
Pasadena CA 91105

(626) 440-9161







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