You can check your fertility through a combination of blood tests, imaging, and at-home tracking methods. The specific tests depend on whether you have a uterus or produce sperm, but most people start with simple hormone panels and ovulation tracking or a semen analysis. Many of these can be done before you ever suspect a problem.
When to Start Testing
The American Society for Reproductive Medicine recommends a formal fertility evaluation after 12 months of unprotected sex without pregnancy if you’re under 35, or after 6 months if you’re 35 or older. If you’re over 40, earlier evaluation is reasonable.
That said, certain situations warrant testing right away, regardless of how long you’ve been trying. These include irregular or absent periods, cycles shorter than 25 days, bleeding between periods, a history of endometriosis, prior chemotherapy or radiation, known uterine or tubal problems, sexual dysfunction, or a partner with suspected fertility issues. If any of those apply, there’s no reason to wait.
At-Home Fertility Tracking
Before scheduling any medical appointments, you can gather useful information on your own. Tracking your menstrual cycle for a few months reveals patterns that tell you a lot about whether you’re ovulating regularly.
Ovulation predictor kits (OPKs) detect a surge in luteinizing hormone in your urine, which typically happens 24 to 36 hours before you ovulate. They’re widely available at pharmacies and give you a basic yes-or-no answer about whether your body is gearing up to release an egg. Basal body temperature tracking is another option: your resting temperature rises slightly after ovulation, so charting it daily can confirm that ovulation actually occurred.
Newer at-home urine tests measure a progesterone metabolite called PdG. When PdG levels stay above 5 micrograms per milliliter for three consecutive days after a suspected ovulation, that’s a strong signal ovulation happened. This threshold confirms ovulation in about 82% of cycles, so it’s helpful but not perfect. Some monitors track your personal baseline rather than relying on a fixed cutoff, which can improve accuracy.
At-home hormone test kits are also available from several companies. These typically involve a finger-prick blood sample mailed to a lab, testing hormones like AMH, FSH, and others. They’re a reasonable screening tool, but the results still need interpretation in context, ideally with a clinician who can factor in your age and health history.
Blood Tests for Ovarian Reserve
If you have ovaries, two blood tests form the backbone of a fertility workup: AMH and FSH. Together, they estimate your ovarian reserve, which is the approximate number of eggs remaining.
AMH (anti-Müllerian hormone) can be drawn on any day of your cycle, which makes it convenient. Expected levels vary by age:
- Under 33: 2.1 ng/mL or higher
- 33 to 37: 1.7 ng/mL or higher
- 38 to 40: 1.1 ng/mL or higher
- 41 and older: 0.5 ng/mL or higher
Lower AMH suggests a smaller egg supply for your age, while higher values suggest a larger one. AMH doesn’t tell you anything about egg quality, which is a separate factor that declines with age regardless of how many eggs remain.
FSH (follicle-stimulating hormone) needs to be tested on day 2 or 3 of your menstrual cycle to be interpretable. Higher FSH values suggest your brain is working harder to stimulate the ovaries, which can indicate diminishing reserve. Ideal day-3 FSH is below 7.0 mIU/mL for women under 33, below 7.9 for ages 33 to 37, below 8.4 for ages 38 to 40, and below 8.5 for women 41 and older.
Your doctor may also check estradiol (a form of estrogen), thyroid hormones, and prolactin. Thyroid dysfunction and elevated prolactin can both interfere with ovulation and are treatable once identified.
Pelvic Ultrasound and Antral Follicle Count
A transvaginal ultrasound, usually performed early in your cycle, lets a clinician count the small follicles visible on each ovary. This antral follicle count provides a real-time snapshot of ovarian reserve that complements your blood work. The ultrasound also checks for structural issues like ovarian cysts, fibroids, polyps, or uterine abnormalities that could affect implantation or pregnancy.
Checking Your Fallopian Tubes
Open, functioning fallopian tubes are essential for natural conception, since that’s where the egg and sperm meet. Two common tests assess whether the tubes are clear.
An HSG (hysterosalpingography) is the traditional approach. A contrast dye is injected through the cervix, and X-ray images track the dye as it flows through the uterus and tubes. If the dye passes freely out the ends of both tubes, they’re open. The procedure takes 15 to 30 minutes and can also reveal abnormalities in the shape of the uterine cavity.
A HyCoSy (hysterosalpingo-contrast sonography) is a newer, ultrasound-based alternative. Instead of X-rays, it uses a contrast agent visible on ultrasound, allowing real-time monitoring with no radiation exposure. Both tests detect tubal blockages, fluid-filled tubes (hydrosalpinx), and uterine structural issues with similar accuracy, around 85 to 95% sensitivity. Your doctor may recommend one over the other based on what equipment is available and whether additional uterine detail is needed.
Both procedures can cause cramping similar to period pain. Some people find it mildly uncomfortable, others more so. Taking an over-the-counter pain reliever beforehand can help.
Semen Analysis for Male Fertility
If you’re a person who produces sperm, a semen analysis is the single most informative first step. It evaluates sperm count, motility (how well they swim), and morphology (their shape). Male factors contribute to roughly half of all infertility cases, so this test is just as important as any evaluation of the partner with a uterus.
A semen analysis involves providing a sample, typically after two to five days of abstinence. Results come back within a few days and are straightforward to interpret. If the first result is abnormal, a repeat test is usually recommended since values can fluctuate based on recent illness, stress, or heat exposure. Hormonal blood work (testosterone, FSH, and others) may follow if the analysis shows concerning numbers.
What the Results Actually Tell You
Fertility testing gives you a probability picture, not a definitive yes or no. A low AMH, for example, means fewer eggs remain, but people with low AMH conceive naturally every day. Similarly, a normal workup doesn’t guarantee pregnancy. It means no obvious barriers were found.
Results are most useful when viewed together. A single borderline number means less on its own than it does in combination with your age, cycle regularity, partner’s semen analysis, and imaging results. That’s why working with a reproductive endocrinologist or fertility-focused OB-GYN helps you turn raw numbers into an actual plan, whether that’s timed intercourse, medication to support ovulation, or assisted reproduction.
If you’re not ready to see a specialist, starting with cycle tracking and an at-home hormone panel gives you genuinely useful baseline data. You can bring those results to any future appointment and skip the waiting-and-wondering phase entirely.