Ultrasound imaging is a cornerstone of modern fertility care. From initial assessments to advanced treatments like IVF, various ultrasound scans help doctors visualize reproductive organs and track crucial changes. Both partners in a couple typically undergo evaluation when facing infertility, but fertility testing for men vs women involves different approaches tailored to their anatomy.
Differences in Fertility Evaluations for Men and Women
When a couple has trouble conceiving, it’s important to investigate both partners. For roughly one-third of infertile couples, the issue is traced to the male partner, and in another one-third, it’s traced to the female partner. Because fertility problems can originate from either side, doctors design reproductive health tests by gender to thoroughly assess each partner. There are clear differences in fertility evaluations: men and women have distinct reproductive anatomies, so the tests used to diagnose infertility in each are quite different.
In approaching male vs female infertility diagnosis, specialists recognize that male fertility issues often relate to sperm quantity or quality, whereas female fertility issues may involve ovulation, egg supply, or structural problems in the reproductive tract. A man’s evaluation is usually less invasive and centers on analyzing his sperm and hormones, while a woman’s evaluation is more extensive and includes imaging of her uterus and ovaries. Standard tests include semen analysis and hormone bloodwork for men, versus ovulation checks, ovarian reserve tests, and pelvic ultrasounds for women. In both cases, doctors may also perform reproductive hormone testing for men and women, measuring key hormones that regulate reproduction, to identify any hormonal imbalances affecting fertility.
The Male Fertility Exam and Testing
It typically begins with a detailed medical history and a physical examination of the genitals. The cornerstone of male fertility testing is the semen analysis. For this test, the male provides a semen sample. The sample is examined under a microscope to measure several factors:
- sperm count – concentration of sperm
- sperm motility – the percentage that are moving actively
- sperm morphology – the shape of the sperm
A normal semen analysis will show a sufficient quantity of well-shaped, motile sperm. If the results are abnormal, the doctor may repeat the test to confirm and then investigate further.
Additional tests are used to pinpoint the cause of male infertility. Hormone blood tests are often done if sperm counts are low; these measure levels of testosterone and other hormones (like FSH, LH, and prolactin) that control sperm production. Abnormal levels could indicate an issue with the pituitary gland or testicular function. Genetic tests might be recommended in some instances to check for chromosomal abnormalities or Y-chromosome microdeletions that can impair fertility. The male exam also includes checking for physical problems such as varicoceles or blockages in the ducts that carry sperm. A urologist can often detect varicoceles by exam or confirm them with imaging.
Imaging plays a role in male fertility evaluation when needed. If a semen analysis shows significant abnormalities or there are signs of an obstruction, doctors may use an ultrasound exam to look at the male reproductive organs. A scrotal ultrasound is a noninvasive scan of the testes and surrounding structures. It can help identify issues like varicoceles, testicular cysts, tumors, or blocked ducts. Male fertility testing sometimes also includes a transrectal ultrasound (TRUS), where a probe in the rectum images the prostate and ejaculatory ducts. This can reveal blockages in the pathways that sperm travel through. In practice, if initial tests suggest a problem, a male fertility exam may be extended with these imaging studies. If a low sperm count is accompanied by other red flags, the doctor might order a scrotal ultrasound to visualize the testicles and the spermatic cord. When semen analysis results are abnormal, physicians often use a testicular ultrasound to examine the scrotum and testes for underlying issues. This ultrasound can detect correctable problems or congenital absences of ducts, guiding appropriate treatment.
The Female Fertility Exam and Evaluation
This exam typically involves a broader range of tests due to the complexity of the female reproductive system. It begins with a thorough review of the woman’s medical history, menstrual cycle patterns, and any symptoms. The doctor will perform a pelvic exam to check for any abnormalities in the reproductive organs. If anything unusual is noted during the physical exam, it raises suspicion of potential infertility causes that further tests can investigate.
One of the first steps is confirming whether the woman is ovulating regularly. Ovulation can be evaluated in a few ways. Often, a blood test for progesterone is done about one week before the expected period to see if ovulation occurred that cycle. Low progesterone could mean that ovulation is not happening consistently. In women with very irregular periods, doctors may instead measure hormones like follicle-stimulating hormone (FSH), luteinizing hormone (LH), and thyroid hormones to look for clues as to why ovulation might be impaired. Keeping track of basal body temperature or using ovulation predictor kits at home can also provide evidence of ovulation, though these are supplementary to clinical tests.
Another key component of the female evaluation is assessing ovarian reserve, which essentially involves estimating the remaining egg supply and quality. Reproductive hormone testing for men and women is relevant here: in women, blood levels of Anti-Müllerian Hormone (AMH) give a sense of how many follicles (potential eggs) are in the ovaries, and AMH testing has become a common part of fertility workups. FSH and estradiol levels measured early in the menstrual cycle (around day 3) also help measure ovarian reserve; if FSH is elevated, it can suggest the ovaries are working harder due to a lower egg supply. These hormone tests, combined with an antral follicle count via ultrasound, help doctors understand a woman’s fertility potential. An ultrasound evaluation for IVF or other fertility treatments often includes an antral follicle count.
Ultrasound Monitoring During IVF Cycles
When a couple proceeds to IVF (in vitro fertilization) or other assisted reproduction treatments, ultrasound scans become even more frequent and critical. In an IVF cycle, a woman’s ovaries are stimulated with fertility medications to mature multiple eggs at once. Throughout this process, doctors rely on IVF cycle ultrasound monitoring to guide decisions on medication dosing and timing. During the ~10–14 days of ovarian stimulation, the patient comes in regularly (often every day or every other day) for transvaginal ultrasounds and blood tests. These ultrasounds allow the medical team to measure the growth of ovarian follicles, which are the fluid-filled sacs on the ovaries that contain the developing eggs. Frequent transvaginal scans over the course of about two weeks are used to track the number and size of these follicles. By measuring follicle diameters, doctors can assess how close the eggs are to maturity. Typically, once the leading follicles grow to around 18–20 mm in size, it indicates the eggs inside are likely mature or nearly mature. This careful ultrasound evaluation for IVF is essential to ensure that the eggs are neither retrieved too early (before maturity) nor too late. It enables the IVF team to time the “trigger” injection that induces final egg maturation. About 36 hours after the trigger shot, the egg retrieval procedure is scheduled.
Ultrasound not only guides the monitoring phase of IVF but is also instrumental during the egg retrieval itself. The egg retrieval is performed with the patient under sedation. Using a transvaginal ultrasound probe with a special needle guide attached, the fertility doctor can visualize the ovaries and follicles in real time on a screen. The doctor advances a long, thin needle through the vaginal wall directly into each follicle, one by one, under live ultrasound guidance. This way, they can accurately target each follicle and aspirate the fluid within, which carries the egg. Ultrasound guidance is crucial for navigating safely and retrieving all available mature eggs. After retrieval, the next steps also involve an ultrasound at certain points. For instance, before an embryo transfer, the uterus may be assessed by ultrasound to check the endometrial lining thickness, ensuring it is optimal for implantation.
Many clinics also perform the embryo transfer itself under abdominal ultrasound guidance: with a full bladder to straighten the uterine angle, an external ultrasound on the abdomen helps the doctor visualize the uterus and guide the catheter tip to the ideal spot for releasing the embryo. A couple of weeks after the embryo transfer, an early pregnancy ultrasound is often done to confirm that the embryo has implanted in the uterus and to detect a heartbeat. IVF cycle ultrasound monitoring tracks follicle development closely, and additional scans ensure that each step is performed with precision.
What to Expect at a Fertility Ultrasound Appointment
Navigating fertility treatment often involves various diagnostic procedures, with ultrasound appointments being a common and crucial component. Understanding what to expect during these scans can help alleviate anxiety and prepare you for the process. While specific preparations may vary, the overall goal is to gather detailed images of the reproductive organs to aid in diagnosis and treatment planning.
- Understanding Your Transvaginal Ultrasound: For women, fertility ultrasounds are typically performed transvaginally, using a slender probe inserted into the vagina for optimal imaging of the pelvic organs. You’ll be positioned similarly to a Pap smear, and the technician will use a lubricant for comfort. While some pressure or discomfort may be felt, it should not be painful. This quick and minimally invasive procedure is considered a highly valuable diagnostic tool, usually taking 15-30 minutes. Communicate any significant tension or pain to your provider so they can make adjustments.
- Specific Instructions for Specialized Ultrasounds: Certain ultrasounds, like a sonohysterogram, may require specific timing within your menstrual cycle, often right after your period, to ensure you are not pregnant and the uterine lining is thin for clear visualization. You might also receive special instructions, such as taking a pain reliever an hour beforehand, as the uterine filling during a sonohysterogram can cause cramping.
- Preparing for a Pelvic Scan: In a standard transvaginal pelvic scan, specific preparation is generally not needed. However, you might be asked to have an empty bladder, as a full bladder can sometimes obstruct the view of pelvic organs during this type of scan. Conversely, for an abdominal pelvic ultrasound, which is more common in pregnancy or when a very large pelvic mass is suspected, you might be advised to drink water beforehand. In such cases, a full bladder acts as a “window” for the sound waves, enhancing image clarity.
- Post-Ultrasound Experience and Follow-Up: Following most fertility ultrasounds, there is no downtime, allowing you to resume normal activities immediately. After a transvaginal scan, you might notice a slight watery discharge from the gel. If you had a sonohysterogram or HyCoSy, mild cramping or spotting for a day is possible. Your practitioner can often provide initial findings during the scan, and a formal report will be added to your medical record. Don’t hesitate to ask questions; understanding the examination can significantly ease any anxiety.
These ultrasound procedures are a routine part of fertility care, and the medical staff is dedicated to ensuring your comfort throughout the process. Open communication with your healthcare provider will help you navigate these appointments with greater ease and understanding.
Ultrasound scans are invaluable in diagnosing and managing infertility. They provide real-time insight into reproductive anatomy and function without any radiation, comparing fertility assessments and treatments. Fertility specialists use ultrasound findings alongside other tests to form a complete picture and tailor a plan for each couple. Clinics like IVF Center Hawaii are equipped to perform all the necessary fertility ultrasounds, from initial pelvic exams to advanced IVF monitoring, as part of a comprehensive evaluation. If you are concerned about your fertility, don’t hesitate to book a fertility ultrasound test and consult a specialist. An ultrasound-based assessment can identify potential issues early and set you on the path toward practical solutions, bringing you one step closer to achieving a successful pregnancy.
Sources
- MedlinePlus (NIH) – Male Infertility (infertility overview and statistics) medlineplus.gov
- Mayo Clinic – Infertility: Diagnosis & Treatment (overview of fertility tests for men and women) mayoclinic.org
- Cleveland Clinic – Fertility Tests: What They Are & How They Work (explanation of male and female fertility testing) my.clevelandclinic.org