Fertility testing typically starts with a combination of blood work, imaging, and tracking tools that give you and your doctor a picture of how your reproductive system is functioning. For women, the core tests measure hormone levels, check whether your fallopian tubes are open, and confirm that you’re ovulating. For men, the process is simpler: a semen analysis covers most of the basics. You can begin some of these steps at home, but a full evaluation requires a clinic visit.
When to Start Testing
The American Society for Reproductive Medicine recommends starting a fertility evaluation after 12 months of trying to conceive if you’re under 35, and after 6 months if you’re 35 or older. If you’re over 40, earlier and more immediate evaluation is warranted. These timelines assume there’s nothing in your medical history that would prompt earlier testing, like irregular periods, a history of pelvic infections, or known conditions affecting the reproductive organs.
You don’t have to wait for those timelines if you already suspect a problem. If your cycles are very irregular or absent, if you’ve had prior surgeries in the pelvic area, or if your partner has a known reproductive health issue, starting sooner makes sense.
Blood Tests for Ovarian Reserve
One of the first and most informative blood tests measures Anti-Müllerian Hormone, or AMH. Your ovaries contain tiny fluid-filled sacs called follicles, and the cells inside those follicles produce AMH. The level of AMH in your blood corresponds to how many eggs you have left, which is known as your ovarian reserve. Higher AMH means more eggs; lower AMH means fewer.
An average AMH level falls between 1.0 and 3.0 ng/mL. Below 1.0 ng/mL is considered low, and 0.4 ng/mL or below is severely low. AMH can be drawn on any day of your cycle, which makes it one of the most convenient fertility tests to schedule. It tells you about egg quantity, not egg quality, so it’s one piece of a larger puzzle.
Your doctor will likely also check follicle-stimulating hormone (FSH) and estradiol, usually on day 2 or 3 of your period. FSH is the hormone that tells your ovaries to start developing an egg each cycle. When the ovaries have fewer eggs to work with, the brain sends more FSH to compensate, so a high FSH level can signal diminished reserve. Estradiol is checked alongside FSH because an elevated level can artificially suppress FSH, masking a problem.
Ovulation Tracking
Confirming that you’re actually ovulating is a key part of any fertility workup. The simplest at-home method uses ovulation predictor kits, which are urine test strips that detect a surge in luteinizing hormone (LH). This LH surge triggers ovulation about 36 to 40 hours later in the bloodstream. Since LH builds up in urine slightly after it appears in blood, a positive urine test means ovulation typically happens within 12 to 24 hours. That surge generally occurs about 14 days before the start of your next period.
These kits are inexpensive and available at any pharmacy. You test once a day starting a few days before you expect to ovulate (based on your average cycle length). A positive result means you’re in your most fertile window.
For a more clinical confirmation, your doctor can order a blood test for progesterone about a week after suspected ovulation, usually around day 21 of a 28-day cycle. Progesterone rises after an egg is released, so a sufficient level confirms that ovulation occurred. A transvaginal ultrasound earlier in the cycle can also track follicle growth in real time, showing whether an egg is developing on schedule.
Checking the Fallopian Tubes
Even if your hormones look normal and you’re ovulating, a blockage in one or both fallopian tubes can prevent the egg and sperm from meeting. The standard test for this is a hysterosalpingogram, commonly called an HSG. It’s a short imaging procedure done in the first half of your menstrual cycle, between days 1 and 14.
During the procedure, you lie on your back as you would for a pelvic exam. A speculum is inserted, the cervix is cleaned, and a local anesthetic may be injected into the cervix. You might feel a slight pinch or tug at that point. A thin tube or instrument called a cannula is then placed into the cervical opening, and a contrast dye is slowly pushed through. This dye shows up on X-ray, outlining the inner shape of your uterus and fallopian tubes in real time. If there’s no blockage, the dye spills out the far ends of the tubes and is absorbed naturally by the body. If the dye stops, that indicates a blockage.
The whole process takes about 15 to 30 minutes. Cramping during and after is common, similar to period cramps, and most women return to normal activities the same day. Beyond checking tubal patency, the HSG also reveals the shape and structure of the uterus, which can identify fibroids, polyps, or other structural abnormalities that might affect implantation.
Semen Analysis for Male Partners
Male factor issues contribute to roughly half of all infertility cases, so testing both partners early saves time. A semen analysis evaluates sperm count, motility (how well the sperm swim), and morphology (the shape and structure of the sperm). The sample is typically collected at the clinic or at home and delivered within a specific time window, usually under an hour.
Your doctor will generally ask for abstinence from ejaculation for two to five days before the test to get an accurate reading. If the first result comes back abnormal, a repeat test is standard since sperm production varies and temporary factors like illness or heat exposure can skew results. The test itself is straightforward and noninvasive, making it one of the easiest and most cost-effective steps in a fertility evaluation.
Ultrasound and Physical Exam
A transvaginal ultrasound is often part of the initial workup. It gives your doctor a direct look at the ovaries and uterus. One common measurement is the antral follicle count, where the doctor counts the small resting follicles visible on each ovary early in your cycle. This count, combined with your AMH level, provides a clearer picture of ovarian reserve than either test alone.
The ultrasound can also identify ovarian cysts, uterine fibroids, polyps, or signs of endometriosis. In some cases, a specialized ultrasound called a sonohysterogram is used, where saline is gently pushed into the uterus to get a better view of its lining and inner cavity. This serves a similar purpose to the HSG but without radiation.
What Testing Costs
If you have insurance, many fertility diagnostic tests are covered at least partially, though coverage varies widely by state and plan. Without insurance, initial consultations and diagnostic bloodwork (including hormone panels and semen analysis) typically run between $200 and $1,500 in the United States. An HSG procedure adds roughly $500 to $1,500 depending on the facility. At-home ovulation predictor kits cost between $15 and $50 for a month’s supply.
Some direct-to-consumer hormone testing kits now let you check AMH, FSH, and other markers with a finger-prick blood sample mailed to a lab. These can cost $100 to $250 and offer a starting point if you want preliminary information before committing to a full clinical workup. Keep in mind that interpreting these results in isolation has limits. A low AMH on a home test, for example, tells you something about egg quantity but nothing about tubal health, uterine structure, or your partner’s sperm quality.
What Happens After Results Come In
Fertility testing rarely gives a single, definitive answer. Instead, it builds a profile. You might have normal hormones but a blocked tube, or open tubes but low ovarian reserve. In about 15 to 30 percent of couples, no clear cause is identified, a diagnosis called unexplained infertility. That doesn’t mean nothing can be done; it just means the standard tests didn’t pinpoint a specific barrier.
Once results are in, your doctor will walk through what the findings mean together, not in isolation. A mildly low AMH in a 29-year-old has different implications than the same number in a 41-year-old. Treatment options range from timed intercourse with ovulation tracking, to medications that stimulate egg production, to procedures like intrauterine insemination or in vitro fertilization. The path forward depends entirely on what testing reveals and how long you’ve been trying.