Fertility Testing: Everything You Need to Know

There are so many different elements that can impact a couple’s fertility that, to get a clear picture of the issue, often many tests are necessary. This can be incredibly overwhelming for the couple, who are suddenly introduced to a new language of fertility and asked to undergo different, sometimes invasive, procedures. Being as informed as possible can help you understand the process.

When to Get Tested

It is easy to stress about being unable to conceive if you do not quickly become pregnant after you stop using birth control. At such a point, many couples wonder if it’s time to get tested. Most experts say that if you are under 35 and are having regular sex without birth control, you should get tested after twelve months if you do not become pregnant. If you are over 35, tests are recommended after six months.

Although you can get tested before these dates, you should note that many insurance companies do not cover these tests until the recommended period passes. During this time, you can make lifestyle changes to encourage fertility, such as drinking less alcohol and taking fertility supplements for women. Ask your doctor for more advice on steps you and your partner can take to improve your chances of conception.

Get Tested Together

Heterosexual couples struggling to conceive naturally should go for fertility tests together. Without a complete picture of both partners’ health, your doctor will be unable to assess your fertility and decide on appropriate action. In addition to results from fertility tests, your doctor may ask you and your partner questions about:

  • Your medical history and current medications
  • Your sex life; e.g., how often you have sex if either of you has other sexual partners, your birth control history and past STIs
  • Your lifestyle and habits; e.g., whether you smoke, drink alcohol, exercise or drink caffeine
  • If you have contact with radiation, chemicals or toxins
  • If you have been pregnant or got anyone pregnant before
  • Your menstrual cycle

Common Fertility Tests

Unfortunately, no one test definitively determines your fertility. Instead, doctors use the results of various tests to piece together evidence and assess if there is anything that could potentially make conceiving more difficult for you. Which tests you get depends on various factors, from lifestyle to age. Here is a breakdown of the most common tests currently used to assess fertility.

Anti-Mullerian Hormone Test

As part of your fertility assessment, your OBGYN may recommend a blood test to check for anti-mullerian hormone (AMH) produced by follicles in the ovaries. The test indicates a woman’s ovarian reserve — that is, how many eggs she has. The higher the level of AMH, the greater the number of eggs.

Follicle-Stimulating Hormone Test

The follicle-stimulating hormone (FSH) triggers your ovaries to prepare an egg to be released each cycle. FSH levels are tested with a blood test early in the menstrual cycle, usually on day three. As part of the test, you may be asked to take a clomiphene citrate test from day five to nine of your menstrual cycle, with your FSH levels being tested before and after.

High FSH levels could indicate that a woman may have difficulties getting pregnant. However, although it can be useful to know your ovarian reserve — mainly if you are interested in freezing your eggs or plan to undergo IVF — the quality of the eggs, rather than the quantity, has a greater bearing on fertility. A recent study on the impact of low ovarian reserve indicates that it may not play such an important role in conceiving as previously thought.

Hysterosalpingogram (HSG)

Doctors use HSGs to ascertain if you have any defects in the uterus or if your fallopian tubes are blocked, which can stop your eggs from traveling into the womb. Performed just after your menstrual period, the HSG involves the doctor injecting liquid dye through the vagina and taking a series of X-rays. Alternatively, they may use ultrasound with saline and air instead of dye.

Transvaginal Ultrasound

Transvaginal ultrasounds are used to assess the health of the womb and ovaries and check for blockages in the fallopian tubes. The doctor inserts an ultrasound wand into the vagina and scans the pelvic organs.


A hysteroscopy allows your doctor to view your uterus and take tissue samples if needed. A thin, flexible tube fitted with a camera is inserted through the cervix and into the uterus.


A laparoscopy is a procedure where the doctor makes small incisions into your lower belly and inserts a tiny camera to look at your womb, ovaries and fallopian tubes. This procedure checks for and can correct issues such as endometriosis. Doctors usually only perform laparoscopy if they have reason to believe there is an issue — for instance, if a scan reveals a potential blockage.

Chlamydia Test

Chlamydia is an STI that can affect fertility, and, as such, both women and men hoping to have a baby may undergo the simple test. For women, the test typically involves the nurse or doctor — or yourself if opting for an at-home test — using a swab to collect some cells from the cervix. Alternatively, you may be asked to do a urine test. For men, only a urine test is necessary. If the tests are positive, you will be prescribed a course of antibiotics. The longer chlamydia is left untreated, the more likely it is to affect fertility. Regular STI checks are recommended, particularly if you have more than one sexual partner.

Progesterone Tests

Your levels of the hormone progesterone increase when you are ovulating, so your doctor may perform a blood test to check how much progesterone you have in your blood to find out if you are ovulating regularly. You can keep track of when you ovulate at home by using home ovulation kits. Alternatively, you can check your body temperature every day for a few months; your body temperature rises just after ovulation.

Thyroid Tests

If you have irregular or missed ovulation, your doctor may run some tests to check your thyroid. This will assess if you have any hormone issues that could be affecting your fertility.

Semen Analysis

In addition to getting a chlamydia test, the male partner should have his semen analyzed. This test assesses how much sperm is released, how well they move and how they are shaped. You are usually asked to provide a semen sample at your doctor’s office. However, you may be able to collect the sample at home and deliver it to the lab within an hour at room temperature. Do not use lubricants when you collect the sample because they can affect the results. At-home tests are available to check your sperm count, but they do not provide the detailed information needed to get a clear picture of your fertility that a doctor-run test can. If your tests reveal you have a low sperm count, speak to your doctor about how you may improve it.

When It Comes to Fertility, Knowledge Is Power

Although it might not seem like it while experiencing uncomfortable procedures, undergoing fertility tests is a positive step toward your dream of having a child. The better your doctors understand your body, the more informed their recommendations will be.

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