Fertility testing involves a combination of hormone blood tests, imaging, and lifestyle assessments that together reveal how likely you are to conceive. Some tests you can do at home, others require a doctor’s office or fertility clinic. The right starting point depends on your age, sex, and whether you’re actively trying or just planning ahead.
When Testing Makes Sense
The American Society for Reproductive Medicine recommends starting 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 and more aggressive evaluation is generally warranted. These timelines shorten to “right away” if you have a known condition linked to infertility, such as endometriosis, polycystic ovary syndrome (PCOS), a history of pelvic infections, or irregular periods.
But you don’t have to wait until you’re struggling. Many people test proactively, especially if they’re freezing eggs, planning pregnancy in a few years, or simply want a baseline understanding of their reproductive health.
Blood Tests That Measure Ovarian Reserve
For people with ovaries, the most informative single blood test is AMH, or anti-Müllerian hormone. AMH reflects how many eggs remain in your ovaries. It can be drawn on any day of your cycle, which makes it convenient. Average AMH falls between 1.0 and 3.0 ng/mL, with anything under 1.0 considered low and 0.4 or below considered severely low.
AMH declines naturally with age. A 25-year-old typically sits around 3.0 ng/mL, dropping to about 2.5 by age 30, 1.5 by 35, 1.0 by 40, and 0.5 by 45. These are lower-end estimates, so your number may be higher for your age. A low AMH doesn’t mean you can’t get pregnant. It signals that the window may be narrower and that egg freezing or fertility treatment discussions may be worth having sooner.
A second key test is FSH (follicle-stimulating hormone), drawn on day 3 of your menstrual cycle (counting the first day of your period as day 1). FSH is the hormone your brain sends to your ovaries to develop eggs. When ovarian reserve is declining, your body compensates by producing more FSH, so a higher number is actually a warning sign. Levels at or above 10 to 15 mIU/mL on day 3 suggest diminished reserve. Estradiol is often measured at the same time, because an elevated level (above about 50 pg/mL) on day 3 can mask a high FSH reading, making things look normal when they aren’t.
Confirming Ovulation
Releasing an egg each month is the most basic requirement for natural conception, and it doesn’t happen for everyone. The most reliable way to confirm ovulation is a progesterone blood test, drawn about 7 days after you ovulate. In a typical 28-day cycle, that means day 21. Normal luteal-phase progesterone ranges from 2 to 25 ng/mL, with levels above roughly 3 to 5 ng/mL generally confirming that ovulation occurred.
At-home options exist too. Ovulation predictor kits (OPKs) detect a surge in luteinizing hormone (LH) in your urine, which typically happens 24 to 36 hours before ovulation. They tell you ovulation is approaching but don’t confirm it actually happened. Basal body temperature tracking can confirm ovulation after the fact: your resting temperature rises by about 0.5°F in the days following egg release and stays elevated until your next period. Newer urine-based tests measure a progesterone metabolite called PdG over several days and can confirm ovulation at home without a blood draw.
Checking Your Fallopian Tubes and Uterus
Even with good hormone levels and regular ovulation, blocked fallopian tubes or structural issues in the uterus can prevent pregnancy. The standard test for this is a hysterosalpingogram, commonly called an HSG. During an HSG, a provider injects dye through your cervix while taking X-ray images. The dye fills the uterus and, if the tubes are open, spills out the ends. The whole procedure takes about 10 minutes.
HSG has high diagnostic accuracy, but it can be uncomfortable. Pain during the procedure averages around a moderate level, and some people experience cramping afterward. It also involves a small amount of radiation.
Ultrasound-based alternatives exist. HyCoSy uses saline-based contrast and ultrasound instead of X-rays, making it radiation-free and generally more tolerable. The trade-off is lower diagnostic accuracy: pooled sensitivity for detecting tubal blockages is around 69% compared to foam-based ultrasound methods at 87%. Your doctor may recommend one approach over another depending on your risk factors and comfort level. A standard transvaginal ultrasound can also check for fibroids, polyps, ovarian cysts, and signs of conditions like PCOS or endometriosis, though it can’t evaluate whether your tubes are open.
Fertility Testing for Men
Male factors contribute to roughly half of all infertility cases, so testing both partners matters. The cornerstone test is a semen analysis, which evaluates sperm count, motility (how well they swim), and morphology (their shape). A sample is collected through ejaculation, typically after 2 to 5 days of abstinence, and analyzed in a lab. Normal values include at least 15 million sperm per milliliter, 40% or more showing progressive movement, and at least 4% with normal shape.
At-home sperm test kits are now widely available and can measure concentration and sometimes motility. They’re useful as a first screen, but they don’t evaluate morphology, white blood cell count, or semen volume with the same precision as a lab analysis. If a home test comes back low, a full lab analysis is the logical next step.
Hormone testing in men is less routine but may be ordered if semen analysis results are abnormal. Testosterone, FSH, and LH levels can help identify whether sperm production problems originate in the testes or in the hormonal signals from the brain.
Genetic Carrier Screening
Fertility isn’t only about whether you can conceive. It’s also about whether you and your partner carry gene variants that could affect a future child. Carrier screening is a simple blood or saliva test that checks whether you carry recessive genes for serious inherited conditions. You can be perfectly healthy and still be a carrier.
The American College of Obstetricians and Gynecologists recommends that all people considering pregnancy be offered screening for cystic fibrosis and spinal muscular atrophy. Screening for Tay-Sachs disease is recommended when either partner is of Ashkenazi Jewish, French-Canadian, or Cajun descent. Expanded carrier panels now test for over 100 conditions at once and are increasingly offered as a standard option. If both partners carry the same recessive gene, each pregnancy carries a 25% chance of the child being affected, which is information that can guide decisions about genetic testing during pregnancy or using IVF with embryo screening.
What You Can Do at Home
Several tests are available without a doctor’s visit. At-home hormone kits from companies like Modern Fertility, LetsGetChecked, and Everlywell measure AMH, FSH, estradiol, thyroid hormones, and sometimes testosterone through a finger-prick blood sample mailed to a lab. Results typically arrive within a week. These kits are a reasonable starting point for people who want a general sense of their reproductive health before committing to a clinical workup.
Tracking your menstrual cycle is another free and underrated tool. Regular cycles between 24 and 35 days long are a strong signal that you’re ovulating. Cycles that are consistently irregular, shorter than 21 days, or longer than 35 days may point to ovulatory problems worth investigating. Cycle-tracking apps can help you spot patterns over several months.
Keep in mind that at-home tests have limitations. They can flag potential concerns, but they can’t evaluate your tubes, check for endometriosis, or provide the complete clinical picture a fertility specialist would assemble. Think of them as a screening tool, not a diagnosis.
Putting Your Results Together
No single test gives a complete fertility picture. AMH and FSH tell you about egg supply but nothing about egg quality, which declines with age regardless of hormone levels. Ovulation confirmation tells you eggs are releasing but not whether the tubes are clear for them to travel through. A normal semen analysis doesn’t rule out DNA fragmentation in sperm. Fertility is a system, and testing works best when it covers multiple parts of that system.
If you’re testing proactively and everything looks normal, that’s genuinely reassuring, but it’s not a guarantee. Roughly 10 to 15% of infertility cases remain unexplained even after full evaluation. If you’re actively trying and results come back with one or more red flags, a reproductive endocrinologist can help you understand what the findings mean together and what your realistic options look like, whether that’s timed intercourse, medication to support ovulation, intrauterine insemination, or IVF.