Checking for infertility starts with understanding where you are in your timeline. If you’re under 35 and have been trying to conceive for 12 months without success, that’s the standard point to begin a medical evaluation. If you’re between 35 and 40, that window shortens to six months. If you’re over 40, evaluation should start right away. The American Society for Reproductive Medicine classifies infertility as a disease, not just a delay, so getting tested is a straightforward medical process with well-established steps.
When To Start Testing
The 12-month and 6-month timelines assume no other risk factors are present. Several situations call for an earlier or immediate evaluation, regardless of age: irregular or absent periods, a history of endometriosis, known uterine or fallopian tube problems, sexual dysfunction, or a suspected issue with the male partner’s fertility. Same-sex couples and individuals planning to conceive with donor gametes are also recommended for immediate evaluation, since waiting a year of trying wouldn’t apply.
If none of those risk factors apply and you’re still within the recommended timeframe, you can start with some basic tracking at home before seeing a doctor.
What You Can Check at Home
Home fertility kits exist for both men and women, but they give you a narrow slice of the picture. For women, over-the-counter ovulation predictor kits detect the surge of luteinizing hormone that happens right before ovulation. Tracking your cycle length and basal body temperature can also signal whether you’re ovulating regularly. These are useful starting points, but they can’t evaluate egg supply, fallopian tube health, or uterine structure.
For men, FDA-approved at-home sperm tests have been available since 2012. Some simply confirm whether sperm is present in semen, while more advanced smartphone-based versions estimate sperm concentration and motility. These kits aren’t inaccurate for what they measure, but what they measure is limited. A professional semen analysis evaluates sperm concentration, motility, vitality, volume, pH, and the size and shape of sperm (morphology). Even if an at-home test returns normal-looking numbers, male-factor infertility can still be present in ways the kit can’t detect. Home testing is a supplement to professional evaluation, not a replacement.
Blood Tests for Women
When you see a doctor, the first round of testing for women typically involves blood work to assess hormone levels. Each hormone tells a different part of the story.
- Anti-Müllerian hormone (AMH) reflects how many egg-containing follicles remain on your ovaries. A normal range falls between 1.0 and 3.0 ng/mL. Lower levels suggest a smaller egg supply and may predict lower success rates with treatments like IVF. AMH can be drawn on any day of your cycle.
- Follicle-stimulating hormone (FSH) controls the growth of follicles that contain eggs. A normal early-cycle level ranges from about 7 to 21.5 mIU/mL. Elevated FSH can signal that the ovaries are working harder to recruit eggs, which often points to diminished ovarian reserve.
- Estradiol provides insight into ovarian function and egg quality. Normal levels range from 10 to 300 pg/mL, depending on where you are in your cycle. When drawn early in the cycle alongside FSH, a high estradiol level can sometimes mask an elevated FSH, so doctors interpret the two together.
- Luteinizing hormone (LH) is tied to egg development and ovulation. In the first half of the cycle, a normal range is roughly 1.4 to 9.9 IU/L. An abnormal ratio of LH to FSH can point toward conditions like polycystic ovary syndrome.
Your doctor may also check thyroid hormones and prolactin, since abnormalities in either can disrupt ovulation without causing obvious symptoms.
Confirming Ovulation
Hormone levels tell you about your egg supply, but a separate test confirms whether you’re actually releasing an egg each cycle. A progesterone blood draw, typically done on day 21 to 23 of a 28-day cycle, measures the hormone your body produces after ovulation. A level above 10 ng/mL indicates that ovulation occurred normally. A level below 10 ng/mL suggests either that ovulation didn’t happen, that progesterone production after ovulation was insufficient, or that the blood was drawn on the wrong day. If your cycles are longer or shorter than 28 days, your doctor will adjust the timing of this test accordingly.
Structural Tests for the Uterus and Tubes
Blood work can’t tell you whether the physical pathway from ovary to uterus is clear, so imaging is a key part of the workup. The most common test is a hysterosalpingogram, or HSG. This is a specialized X-ray that maps the shape of your uterus and checks whether your fallopian tubes are open.
During the procedure, you lie on a table as you would for a pelvic exam. A speculum is placed, your cervix is cleaned, and a thin catheter is inserted through the cervix. A contrast dye is slowly pushed through the catheter while X-ray images are taken in real time. If the dye flows freely through both fallopian tubes, they’re open. If it stops or pools, a blockage may be present. The whole process takes about 15 to 30 minutes. Cramping during and shortly after is common, and most doctors recommend taking an over-the-counter pain reliever beforehand.
Beyond blocked tubes, an HSG can reveal structural uterine issues like fibroids, polyps, scar tissue (sometimes called Asherman’s syndrome), and congenital uterine shape variations such as a septate or bicornuate uterus. Some of these findings are treatable and some simply help explain why implantation has been difficult. A transvaginal ultrasound is often performed as well, sometimes with saline infused into the uterus for a clearer picture of its interior.
Semen Analysis
Male-factor issues contribute to roughly half of infertility cases, so a semen analysis is one of the earliest tests ordered. It’s noninvasive: a semen sample is collected (usually through masturbation at a clinic or at home with a short transport window) and analyzed under a microscope and by computer. The lab evaluates sperm concentration, what percentage are moving, what percentage are alive, the total volume of the ejaculate, and the shape and size of individual sperm. Abnormalities in any of these parameters can reduce the chances of natural conception.
If the initial analysis is abnormal, it’s usually repeated after a few weeks, since sperm production fluctuates. Two abnormal results typically prompt further investigation.
Advanced Male Testing
When semen analysis shows very low sperm counts or no sperm at all, doctors move to hormonal and sometimes genetic testing. A blood draw measuring testosterone and FSH helps distinguish between a production problem in the testes and a signaling problem from the brain. Men with very low sperm concentration (under 5 million per milliliter), elevated FSH, or small testes may also be recommended for karyotype testing, a genetic test that checks for chromosomal abnormalities like Klinefelter syndrome that can impair sperm production.
A physical exam is also part of the male evaluation. Doctors check for varicoceles (enlarged veins in the scrotum that raise testicular temperature), testicular size and consistency, and signs of hormonal imbalance like unusual breast tissue development.
What the Evaluation Typically Looks Like
For most couples, the initial workup happens over the course of one to two menstrual cycles. The first visit usually involves a detailed medical and sexual history for both partners, followed by blood work for the woman and a semen analysis for the man. Cycle-dependent tests like the day-21 progesterone draw and HSG are scheduled based on where you are in your cycle. Results from blood work come back within days; the HSG gives immediate visual results during the procedure itself.
In about 25 to 30 percent of cases, no clear cause is found. This is called unexplained infertility, and it doesn’t mean nothing is wrong. It means the standard tests didn’t identify the issue. Treatment options still exist in these cases, and many couples with unexplained infertility go on to conceive with medical assistance. The evaluation itself is the critical first step, because it narrows down the possibilities and points toward the most effective next move for your specific situation.