Female fertility testing typically starts with blood work and an ultrasound, then moves to more specialized imaging or procedures depending on what those initial results show. Most people begin testing after trying to conceive without success for 12 months (if under 35) or 6 months (if 35 or older), though you can request baseline testing earlier if you want a snapshot of where things stand.
The tests fall into a few categories: hormone levels that reveal your egg supply and whether you’re ovulating, imaging that checks whether your reproductive anatomy is structurally sound, and in some cases a minor surgery to look for conditions that don’t show up on scans.
AMH: Measuring Your Egg Supply
Anti-Müllerian hormone, or AMH, is one of the most common starting points in fertility testing. It’s a simple blood draw that can be done on any day of your cycle, and it estimates your ovarian reserve, meaning roughly how many eggs you have left. Higher AMH corresponds to more eggs; lower AMH means fewer.
General reference ranges put average AMH between 1.0 and 3.0 ng/mL, with anything under 1.0 considered low and 0.4 ng/mL considered severely low. But “normal” shifts with age. At 25, a typical AMH level is around 3.0 ng/mL. By 35, it drops to about 1.5 ng/mL, and by 40, it’s closer to 1.0 ng/mL. These numbers sit on the lower end of the expected range for each age, so many people will test higher.
One important caveat: AMH tells you about egg quantity, not egg quality. A high number also isn’t always reassuring. Unusually elevated AMH can signal polycystic ovary syndrome (PCOS), which brings its own set of fertility challenges. The number is most useful when interpreted alongside the rest of your test results.
Day 3 Hormone Panel
On the third day of your menstrual cycle (counting the first day of your period as day one), a blood draw can measure three hormones that together paint a picture of how well your ovaries are responding to signals from your brain.
- FSH (follicle-stimulating hormone): Normal range on day 3 is 3 to 20 mIU/mL. This hormone tells your ovaries to start maturing an egg each cycle. When the ovaries are struggling to respond, the brain pumps out more FSH to compensate, so a higher number can actually suggest declining ovarian function.
- LH (luteinizing hormone): Should be under 7 mIU/mL on day 3. This hormone triggers ovulation mid-cycle. An elevated baseline level, especially relative to FSH, can point toward PCOS.
- Estradiol: Normal range is 25 to 75 pg/mL on day 3. If estradiol is elevated early in the cycle, it can artificially suppress FSH, making that number look normal when it isn’t. That’s why these hormones are best interpreted together rather than in isolation.
Timing matters for this panel. Even a day or two off can skew results, so your provider will be specific about when to come in.
Confirming Ovulation With Progesterone
Knowing your hormone levels are in range doesn’t confirm you’re actually releasing an egg each month. Progesterone testing fills that gap. After ovulation, progesterone rises sharply. A blood draw about a week after expected ovulation (typically around cycle day 21 in a 28-day cycle) checks whether that rise happened.
At-home urine strips test for PdG, a metabolite of progesterone that shows up in urine. PdG typically reaches detectable levels (5 μg/mL or higher) about five days after ovulation. These strips can be a useful screening tool, but a blood draw in a clinic gives a more precise progesterone measurement. If progesterone is consistently low in the second half of your cycle, it may explain difficulty getting or staying pregnant.
Ultrasound and Antral Follicle Count
A transvaginal ultrasound, usually done early in the cycle alongside the day 3 blood work, lets your provider visually count the small follicles (fluid-filled sacs that each contain an immature egg) sitting on your ovaries. This antral follicle count is another way to estimate ovarian reserve, and it complements the AMH result. It also checks the ovaries and uterus for structural issues like fibroids, polyps, or ovarian cysts that could be affecting fertility.
The procedure takes about 10 to 15 minutes and is uncomfortable but not typically painful. No special preparation is needed.
Checking the Fallopian Tubes
Even with perfect hormone levels and regular ovulation, a blocked fallopian tube can prevent sperm from reaching the egg or stop a fertilized egg from traveling to the uterus. A hysterosalpingogram (HSG) is the standard test for this.
During an HSG, a provider threads a thin tube through the cervix and gently fills the uterus with an iodine-based contrast fluid while taking X-ray images. The fluid shows up white on the images, outlining the shape of the uterine cavity as it travels through. If the fallopian tubes are open, the fluid spills out the ends. If one or both tubes are blocked, the fluid stops, and the blockage is visible on the X-ray. The procedure also reveals abnormalities inside the uterus, like scar tissue or an unusual shape, because the flow of fluid gets disrupted around them.
Most people describe the HSG as causing moderate cramping that lasts a few minutes. Over-the-counter pain relief beforehand helps. The whole appointment is usually under 30 minutes, and you can go back to normal activity the same day.
When Laparoscopy Becomes Necessary
If your blood work, ultrasound, and HSG all come back normal but you’re still not conceiving, a diagnostic laparoscopy may be the next step. This is a minimally invasive surgery where a thin camera is inserted through a small incision near the navel to directly examine the pelvic organs.
The primary reason for laparoscopy in a fertility workup is to identify endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus. Endometriosis frequently doesn’t show up on imaging. In one study of women undergoing laparoscopy for unexplained infertility, 60% were found to have endometriosis. In another cohort of women with chronic pelvic pain, 98% had pathology that hadn’t been identified through their history, physical exam, or imaging beforehand.
Beyond endometriosis, laparoscopy can uncover pelvic inflammatory disease, pelvic venous congestion, adhesions, and structural abnormalities that blood tests and scans simply can’t detect. Recovery from a diagnostic laparoscopy typically takes a few days to a week, with small scars and mild soreness at the incision sites.
At-Home Fertility Kits: What They Can and Can’t Do
Several companies now sell finger-prick hormone test kits that measure AMH, FSH, and other fertility-related hormones from home. These can be a reasonable first step if you’re curious about your baseline numbers or want data before booking a clinic appointment. But they have real limitations.
At-home tests are more susceptible to user error during sample collection, which can lead to false positives or false negatives. A single hormone result without the context of your full medical picture, including imaging, partner testing, and cycle history, can be misleading. These kits cannot evaluate your fallopian tubes, check for structural issues, or diagnose conditions like endometriosis. Clinical testing, which combines blood draws, imaging, and physical examination, remains the gold standard. If your at-home results are concerning, or even if they look normal but you’ve been struggling to conceive, in-office testing is the logical next step.
What Testing Typically Costs
Costs vary widely depending on your insurance and location. With insurance coverage, many of these blood tests and ultrasounds may be partially or fully covered, especially if you have a documented history of infertility. Without insurance, expect the initial round of consults and diagnostics, including blood work, hormone panels, and pre-cycle evaluations, to run between $200 and $1,500. An HSG typically adds a few hundred dollars on top of that, and laparoscopy, being a surgical procedure, costs significantly more.
Some clinics offer bundled fertility evaluation packages that include the initial blood work, ultrasound, and HSG at a set price. It’s worth asking about these upfront, as well as whether your state mandates any fertility-related insurance coverage.
The Typical Testing Timeline
A standard fertility evaluation can often be completed within a single menstrual cycle. Your provider will schedule the day 3 blood draw and ultrasound early in your period, the HSG sometime in the first half of the cycle (after bleeding stops but before ovulation), and a progesterone check about a week after you ovulate. AMH can be drawn at any point. That means within about four weeks, you can have a fairly complete picture of your hormonal function, ovarian reserve, and tubal status.
If everything looks normal and you’re referred for laparoscopy, that adds a few more weeks for scheduling and recovery. But for many people, the initial round of testing is enough to either identify a treatable cause or guide the next steps in treatment planning.