One in six Australian couples are faced with infertility – the first step to overcoming the barriers is to find out why. If you are struggling to conceive, reach out to a fertility specialist.
Fertility testing can also be considered by couples and solo parents-to-be even before you start trying to conceive. Gaining insight into your fertility can give us the opportunity to address any issues in advance.
Infertility is defined as failing to conceive after 12 months of regular unprotected sexual intercourse if the female partner is aged 35 or younger, or after six months if aged over 35.
Fertility issues can be frustrating and emotionally difficult for both you and your partner. Dr Holland takes a methodical and pragmatic approach to investigating causes of infertility, with targeted investigations guided by your medical history, general health, and any signs or symptoms.
Difficulties with falling pregnant can be due to many causes. Around one third is attributed to female factors, one third male factors, and the remaining third due to a combination of fertility factors from both partners or for an unknown reason.
It can be particularly distressing to receive a diagnosis of unexplained infertility. But you do still have options for building your family through IVF and assisted reproductive technologies (ARTs).
Factors contributing to infertility can include:
Your chances of conceiving can also be influenced by lifestyle factors, such as recreational drug use, tobacco smoking or vaping, excessive alcohol consumption, and your BMI/weight.
With the right tests, Dr Holland can identify the cause of your fertility issues and put together a management plan to optimise your chances of conceiving. In some cases, these investigations may also identify an underlying women’s health condition you may not have been previously aware of, such as endometriosis.
AMH levels in your blood are an indicator of your ovarian reserve, that is, how many eggs you have remaining. However, it doesn’t give information about the quality of those eggs, which also plays an important role in female fertility. AMH results are achieved with a simple blood test.
This is a specialised X-ray procedure designed to visualise your uterus and fallopian tubes with the help of a contrast dye. This allows Dr Holland to identify blockages, distortions, or other abnormalities in these areas.
A laparoscopy is a minimally invasive surgical technique with many uses, including for performing treatment. A thin scope with a light is inserted into your abdomen through a keyhole incision while you’re under general anaesthesia. This enables a detailed examination of your reproductive organs, with the added advantage of potentially being able to treat any problems found at the same time.
A number of hormones are involved in fertility, regulating processes such as your menstrual cycle, ovulation, and thickening the lining of your uterus in preparation for pregnancy. Assessing key hormone levels with a blood test may involve testing for follicle-stimulating hormone, luteinising hormone, oestrogen, progesterone, prolactin, and testosterone.
A transvaginal ultrasound may be used for an antral follicle count to assess your ovarian reserve, and also provides information on the condition of your uterus and ovaries, identifying abnormalities such as fibroids, polyps, and cysts.
Dr Holland will organise some key male fertility tests to guide his treatment recommendations
Semen analysis is a first-line test for male fertility, assessing various parameters such as sperm count and concentration, motility (swimming ability), morphology (shape and size), and even semen volume and pH.
A simple blood test can identify imbalances in hormones critical for sperm production and healthy male fertility. These hormones include follicle stimulating hormone, luteinising hormone, and testosterone.
If needed, Dr Holland can order an ultrasound scan of your scrotum and/or prostate gland. This may reveal abnormalities impacting your fertility, such as varicocele (enlarged vein) in a testicle or a blockage of the channel carrying seminal fluid from the prostate.
Genetic testing for you and your partner in the pre-conception stage can identify risks early.
Though not specifically a fertility test, it gives you the opportunity to take steps to reduce your risk of having a child with a genetic condition, while also empowering you with insight into your own genetic status.
RGCS is an optional test but Dr Holland recommends it to all his patients as many people may be a carrier for a genetic disorder without being aware of it in the family. It would be especially beneficial if you have:
There are two types of available RGCS tests:
Understanding whether you are a carrier for a genetic disorder can guide your choices with fertility treatment, such as considering IVF with preimplantation genetic testing of the embryos or using a donor.
While many factors can affect fertility, age is one of the most common influences, as reproductive potential naturally changes over time. Egg quality and quantity both decline with age, and no new eggs are produced after birth – a girl is born with all the eggs she will ever have. Other common causes of female infertility include endometriosis, polycystic ovary syndrome, and disorders of the fallopian tubes.
Yes, male fertility does decline over time, though not as drastically as in women. Studies show that sperm quality decreases and sperm DNA fragmentation increases with age, particularly after 40-45 years old. This contributes to difficulties with conceiving and the risk of miscarriage.
The 3-panel screen (testing for the genes associated with cystic fibrosis, spinal muscular atrophy, and fragile X syndrome) is covered by Medicare for Medicare-eligible patients. If you prefer the peace of mind that comes with an expanded panel, this can cost upwards of $1000 depending on the provider.
Unfortunately, many couples are still left with questions despite comprehensive fertility testing. This is known as unexplained infertility. The good news is even if we can’t pinpoint a cause for your infertility, we often still have good success with IVF.
Dr Holland’s rooms will be closed on Friday, 15 August 2025
