Checking your fertility starts with understanding what doctors actually measure and when it makes sense to get tested. For most people, fertility testing involves a combination of blood work, imaging, and (for men) a semen analysis. The specific tests differ depending on whether you’re trying to assess egg supply, sperm health, or structural issues in the reproductive tract.
When Testing Makes Sense
The American Society for Reproductive Medicine recommends starting a formal 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 immediate evaluation is warranted. These timelines assume nothing else is going on. If you have irregular periods, cycles shorter than 25 days, a history of endometriosis, prior chemotherapy or radiation, or a known issue with your partner’s sperm, testing should start right away regardless of how long you’ve been trying.
You don’t need to be actively trying to conceive to check your fertility. Many people pursue testing simply to understand where they stand, especially if they’re planning to delay pregnancy or considering egg freezing.
Blood Tests for Ovarian Function
The core blood panel for female fertility measures four hormones, and timing matters. FSH and estradiol need to be drawn on day 3 of your menstrual cycle (day 1 is the first day of your period). These two hormones work together to paint a picture of how hard your body is working to produce eggs. As your egg supply declines with age, your brain ramps up FSH production to compensate. Elevated FSH on day 3 signals reduced chances of live birth compared to other people the same age. High estradiol can actually mask an elevated FSH reading, which is why both are tested together.
Anti-Müllerian hormone (AMH) is produced by the small follicles in your ovaries and serves as a marker of your remaining egg supply. Unlike FSH and estradiol, AMH can be drawn on any day of your cycle. Values between 1.0 and 3.5 ng/mL are generally considered normal. Levels below 1.0 ng/mL are often classified as low, and extremely low values (below 0.16 ng/mL) are associated with significantly reduced success in fertility treatments. One important study found that women with low AMH who were trying to conceive naturally had similar pregnancy rates to women with normal AMH after 6 to 12 months, which brings up a critical distinction covered below.
Luteinizing hormone (LH) triggers ovulation and can also be tested via blood draw. Abnormal LH levels sometimes point to polycystic ovary syndrome (PCOS), one of the most common causes of irregular ovulation.
What These Tests Can and Cannot Tell You
Ovarian reserve testing estimates the relative number of eggs you have left. It does not measure egg quality. A person can have a normal egg count but poor-quality eggs that don’t fertilize well, or a low egg count with perfectly healthy eggs. There is currently no test that checks egg quality directly. You only learn about egg quality once fertilization is attempted during IVF.
These tests also cannot predict exactly how long you have to conceive, how many eggs remain in total, or when you’ll enter menopause. They’re best understood as a snapshot of where you are right now relative to others your age, not a definitive fertility forecast.
Ultrasound: The Antral Follicle Count
Alongside blood work, a transvaginal ultrasound gives your doctor a direct look at your ovaries. The goal is to count antral follicles, which are small fluid-filled sacs (about 2 to 9 mm in diameter) that each contain a developing egg. The number visible on ultrasound reflects the much larger pool of microscopic follicles still dormant in your ovaries.
A higher antral follicle count generally predicts a stronger response to fertility medications if you pursue treatment like IVF. Fewer than 4 total antral follicles is considered extremely low and often means a very poor response to stimulation. Counts in the middle range are harder to interpret, and outcomes become less predictable.
Checking Your Fallopian Tubes
Even with healthy eggs and normal hormone levels, blocked fallopian tubes can prevent pregnancy. A hysterosalpingogram (HSG) is the standard test to check whether your tubes are open. During the procedure, a small catheter is inserted through your cervix and a contrast dye is slowly pumped into your uterus. A series of X-rays tracks the dye as it moves through your uterine cavity and into your fallopian tubes. If the dye flows freely and spills out the ends of the tubes, they’re open. If it stops at any point, there’s a blockage. Your body absorbs the dye naturally afterward.
The procedure takes about 10 to 15 minutes. Some people experience cramping similar to period pain during and shortly after.
How Male Fertility Is Tested
A semen analysis is the primary test for male fertility and evaluates several factors at once. Normal parameters include a volume greater than 2 mL, sperm concentration above 20 million per milliliter, motility (the percentage of sperm that are moving) above 50%, and normal morphology in at least 30% of sperm. Stricter criteria used in IVF settings set the morphology threshold at 14% normal forms.
These numbers work together. A high sperm count means very little if none of the sperm are moving. A lab analysis performed in a clinical setting uses both microscopic examination and computer-assisted analysis to evaluate concentration, motility, vitality, volume, pH, and shape all at once.
At-Home Fertility Kits: What They Miss
At-home options exist for both egg supply (hormone test kits that use a finger-prick blood sample) and sperm health (home sperm count tests). They can be a reasonable first step if you want a general sense of where things stand, but they have real limitations.
For sperm testing, home kits typically measure only concentration. As Cleveland Clinic specialists note, the information from a home kit is “only a fraction of what’s reported on a formal semen analysis.” You could have 100 million sperm but zero motility and still get a “normal” result from a home test. Lab testing evaluates concentration, motility, vitality, morphology, volume, and pH together, giving a far more complete picture.
For hormone testing, at-home kits can measure AMH and sometimes FSH, but they don’t include an antral follicle count, can’t assess your fallopian tubes, and lack the clinical context a reproductive endocrinologist provides when interpreting borderline results. Normal results on an at-home test don’t rule out fertility issues, and low results don’t necessarily mean you can’t conceive naturally.
Putting the Results Together
No single test gives you a complete fertility picture. Doctors interpret these results as a set: hormone levels alongside ultrasound findings, tube patency, semen analysis, your age, cycle regularity, and medical history. A low AMH with a good antral follicle count and open tubes tells a very different story than a low AMH with blocked tubes and irregular cycles.
If you’re not yet ready to see a specialist, tracking your cycle length and regularity for a few months gives you useful baseline information. Cycles that consistently fall between 25 and 35 days with predictable timing suggest regular ovulation. Over-the-counter ovulation predictor kits, which detect the LH surge in your urine before ovulation, can confirm whether you’re ovulating each month. These are inexpensive, widely available, and a practical first step before any clinical testing.