Hi GFGirl. You asked about the first steps in checking fertility. Many Canadian doctors will begin infertility workups for women over 35 who've been TTC 6 months or more (as opposed to the standard one year for women under 35). My husband and I started TTC in late 2010, and after about 8 months of unsuccessful TTC, we had the standard tests. For women, this would include checking:
-estradiol (the most prominent circulating estrogen)
-follicle-stimulating hormone (FSH) on day 3 of your cycle - this is done to assess egg reserve (important for 'older' women) and to assess whether there are any menstrual or ovarian irregularities that may be impeding conception (e.g., PCOS). FSH tests can help determine if a woman is ovulating.
-progesterone on day 21 of your cycle - assesses whether ovulation occurs, and can help assess whether there is progesterone insufficiency during luteal phase that may impede conception. (note: this assumes a 28-day cycle or thereabouts, which is not the case for all women, so some doctors will order tests for additional days during the post-ovulation phase).
-Many doctors will also order tests for blood serum testosterone, prolactin, etc., which can also interfere with conception. High levels of testosterone in women, for example, can be indicative of PCOS (but not always).
-Along with these blood tests, many doctors will also order ultrasounds to inspect a woman's uterus and ovaries. This can help determine, for example, how follicles are developing, whether a woman has PCOS, whether the uterus is of normal structure, and the like.
At the same time as women will undergo blood tests described above and possibly an ultrasound, her OH will have a semen analysis to check on his sperm count, motility (how many can swim), and morphology (how many are normal shape).