When Richard Paulson, M.D., was training to specialize in fertility medicine, he offered a long list of diagnostic tests to couples trying to become parents. Some were allergy tests; others involved hamster eggs or even minor surgery. All sought to determine the possible causes of a couple's difficulty in conceiving.

That was more than three decades ago. Paulson says fertility experts now know that most fertility tests that were once routine are no longer useful for determining whether a couple can become pregnant or what the barriers to pregnancy might be. He's a professor of obstetrics and gynecology at the University of Southern California Keck School of Medicine and president of the American Society for Reproductive Medicine (ASRM). 

Nevertheless, some of these tests are still being offered today to couples. They can be costly and even occasionally risky, leading to unnecessary procedures and mistaken results.

According to ASRM recommendations, couples should generally see a fertility specialist after a year of trying to get pregnant or after six months if the woman is older than 35.

If a woman has had abdominal or gynecological surgery, or if she has endometriosis or an irregular menstrual cycle, a fertility specialist should be consulted even sooner, the ASRM says.

At your appointment, the doctor will examine both partners and get their medical, family, and sexual histories. Then they'll be offered a number of tests.

For Infertility Awareness Week, we've outlined the basic diagnostic tests to consider—and the ones that are often unnecessary or overused—based on recommendations from the Choosing Wisely campaign (Consumer Reports is a partner) and the American Society for Reproductive Medicine.  

Baseline Fertility Tests to Consider

  • A semen-sample test: Checks the number and quality of the man's sperm to gauge whether they're capable of reaching and fertilizing an egg. (Depending on the results, a doctor may follow up with tests of hormone levels or genetic abnormalities.) Men contribute to infertility in about half of all cases, according to the ASRM (PDF).
  • Ovarian reserve test: A blood test that checks a woman's hormone levels to assess the number and quality of the eggs in her ovaries, something that’s especially necessary in women over 35. The most common such test measures the levels of follicle stimulating hormone (FSH).
  • A hysterosalpingogram (HSG): A type of X-ray that shows if the woman's fallopian tubes are damaged or blocked, which can impede the passage of an egg from the ovaries to the uterus. This usually takes less than 5 minutes but involves a speculum and a catheter placed into the cervical opening. It can cause cramping and sometimes spotting.
  • A transvaginal ultrasound: Uses sound waves to check the uterus and ovaries for potential problems, such as fibroids or ovarian cysts.

Fertility Tests Most People Don't Need

  • Laparoscopy: This test is used to look for anatomical problems in the woman that might be causing infertility. Through an incision typically less than an inch, a doctor uses a small camera to examine the pelvic area for problems such as blocked fallopian tubes, scar tissue, or endometriosis. Because this is invasive, costly, and requires general anesthesia, laparoscopy should not be used as part of an initial fertility screening. (It is recommended only as a follow-up procedure if initial tests or medical history suggest such problems.) 
  • Postcoital test (PCT): Right after intercourse, the woman goes to the doctor, who takes mucus from her cervix and checks for moving sperm. Previously common, this test "was shown to not have any predictive value," Paulson says, and should be avoided. It can also lead to additional unnecessary tests, the ASRM warns.
  • Sperm penetration assay: The man submits a fresh semen sample, which is then paired with hamster egg cells to see how well the sperm cells penetrate the eggs. Paulson recalls spending a lot of time reviewing these results as a young specialist. "It didn't do anything," he says now. (The ASRM says such assays are unreliable, inconsistent, and not cost-effective.)
  • Immunological tests: The idea behind these tests is that perhaps the woman’s immune system is attacking her partner's sperm. Paulson says he still occasionally sees patients who bring expensive reports of blood tests meant to check for this. But according to the ASRM, the results don't accurately predict whether a woman will become pregnant.

An Extra Word of Caution

Men who are sometimes prescribed or obtain testosterone as a “booster” when they’re having fertility problems should avoid it, according to the American Society of Reproductive Medicine.

"It's a disaster," Paulson says. Instead of helping, testosterone can shut down sperm production, sometimes irreversibly.