Fertility Tests for Women: What Each One Checks, and When

Earlier than most people are told, and the threshold changes with age. ASRM advises beginning evaluation after twelve months of unprotected intercourse in women under 35, and after six months in women aged 35 or older.

Above 40, the guidance shifts again: more immediate evaluation and treatment may be warranted rather than waiting out a fixed window at all.

• Under 35 — after about 12 months.
• 35 and over — after about 6 months.
• Over 40 — sooner, without waiting a set period.
• Any age — sooner if periods are irregular or absent.

Being investigated is not the same as being treated. Most of the workup exists to find out whether anything needs treating at all.

How many eggs are likely to remain, and how a stimulation cycle would probably go. They are measured on days two to three of the cycle and correlate strongly with each other, which is why using both adds less than it appears to.

What they do not do is predict whether you will conceive naturally. That distinction is the single most misunderstood part of fertility testing, and it causes a lot of avoidable alarm.

• AMH — a blood test, stable across the cycle, estimates remaining follicles.
• Antral follicle count — an ultrasound count of visible small follicles.
• The two correlate strongly; one is usually enough.
• Neither describes the quality of the eggs.

Our article on what AMH does and does not measure covers this in detail, and diminished ovarian reserve covers what a low result does and does not mean.

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• Top Questions Couples Ask Fertility Doctors
• Recurrent Implantation Failure: What the 2023 Definition Changed

Usually by hysterosalpingography, an X-ray with contrast that shows whether the fallopian tubes are open and outlines the shape of the uterine cavity. It is typically scheduled seven to ten days after the first day of your period.

That timing is deliberate: it sits after bleeding has stopped and before ovulation, which minimises the chance of the test being done in an early pregnancy.

• HSG — checks tubal patency and the uterine cavity outline.
• Saline sonography — an alternative for assessing the cavity.
• Laparoscopy — direct visualisation, but surgery, so not first-line.
• A proximal blockage on one HSG frequently is not a blockage.

That last point matters enough to repeat: our article on tubal blockages covers why a single abnormal HSG usually warrants repeating rather than acting on.

Usually by a blood progesterone taken in the second half of the cycle, timed to roughly a week before the next period is due. A raised level indicates ovulation occurred in that cycle.

Regular, predictable periods are themselves reasonable evidence that ovulation is happening. That is why irregular or absent periods move testing earlier — they point at the mechanism directly, rather than requiring a year of trying to reveal it.

• Mid-luteal progesterone — confirms ovulation happened that cycle.
• Cycle regularity — informative on its own.
• Ovulation predictor kits — detect the LH surge, not ovulation itself.
• One anovulatory cycle is not a diagnosis; the pattern matters.

Thyroid function and prolactin are commonly checked alongside, because both can disrupt ovulation and both are straightforward to correct once identified. Our article on TSH levels and fertility covers where the thyroid thresholds actually sit.

A complete normal workup is common and does not mean nothing is wrong. It means the available tests found nothing, which is a narrower statement than it sounds.

• No test measures egg quality directly.
• Unexplained infertility is a real and frequent result.
• A normal result does not rule out a male factor — test both partners.
• Reserve testing should not be used to decide whether to try.

The partner's semen analysis is the fastest and cheapest test in the whole workup and is often left until last. Doing it early avoids months of investigating one person for a problem that involves both. Our guide to reading a semen analysis covers what those numbers mean.