Fertility testing for women typically begins with blood work and an ultrasound, then moves to imaging of the uterus and fallopian tubes if needed. The standard trigger for testing is 12 months of unprotected sex without conception if you’re under 35, or 6 months if you’re 35 or older. Testing can also start sooner if you have a known risk factor like a history of pelvic infections, endometriosis, or irregular periods.
There’s no single test that declares a woman “infertile.” Instead, doctors work through a series of tests that evaluate ovulation, egg supply, hormone balance, and the physical structures involved in conception. Here’s what that process looks like.
Blood Tests on Day 3 of Your Cycle
The first round of fertility blood work is usually drawn on day 3 of your menstrual cycle (counting the first day of your period as day 1). This timing matters because hormone levels fluctuate throughout the month, and day 3 gives the clearest baseline picture of how your ovaries are functioning.
The key hormone is FSH, or follicle-stimulating hormone. This is the signal your brain sends to your ovaries telling them to develop an egg. A level under 6 is considered excellent, 6 to 9 is good, and anything above 10 suggests your ovaries are working harder than expected to produce eggs, a sign of diminished reserve. Levels above 13 generally indicate it will be very difficult to stimulate the ovaries, even with fertility drugs. Normal range overall is 3 to 20, but where you fall within that range matters a lot.
Estradiol is tested alongside FSH. Normal day 3 levels fall between 25 and 75 pg/mL. A reading that’s abnormally high can signal either a functional ovarian cyst or diminished egg reserve. Lower values within the normal range are actually preferable because they suggest the ovaries will respond well to stimulation.
Your doctor will also check thyroid hormones, prolactin, and sometimes testosterone and other androgens. Thyroid function gets special attention: while the traditional upper limit for TSH is around 4, research suggests that a TSH above 2.5 is associated with poorer fertility outcomes. Women with unexplained infertility are nearly twice as likely to have a TSH at or above 2.5 compared to women whose infertility has a clear, non-hormonal cause. High prolactin levels can interfere with ovulation as well, though this is less common.
Anti-Müllerian Hormone (AMH)
AMH has become one of the most widely used markers of ovarian reserve, meaning how many eggs you have left. Unlike most fertility hormones, AMH can be drawn on any day of your cycle, which makes it convenient. It measures a protein produced by the small follicles in your ovaries, giving an estimate of your remaining egg supply.
General ranges are straightforward. An AMH between 1.0 and 3.0 ng/mL is considered average. Below 1.0 is low, and below 0.4 is severely low. These numbers naturally decline with age. A 25-year-old might expect a level around 3.0 ng/mL on the lower end of normal, while a 35-year-old would expect around 1.5, and a 40-year-old around 1.0. A result that’s low for your age doesn’t mean pregnancy is impossible, but it does suggest a smaller window and may influence how aggressively your doctor recommends treatment.
Antral Follicle Count by Ultrasound
A transvaginal ultrasound performed early in your cycle lets your doctor count the small, resting follicles visible on each ovary. This number, called the antral follicle count, is a direct visual estimate of your egg supply and correlates strongly with the actual number of dormant eggs in your ovaries. Studies comparing ultrasound counts to microscopic examination of ovarian tissue found a correlation of 0.85, meaning the ultrasound is a reliable reflection of what’s really there.
The count also predicts how well your ovaries will respond to fertility medications if you pursue treatments like IVF. A higher count generally means better response. Like AMH, the antral follicle count declines with age and the two tests are often used together to build a complete picture of ovarian reserve.
Confirming Ovulation
Even if your hormone levels look normal, your doctor needs to confirm that you’re actually ovulating each cycle. The standard method is a blood draw around day 21 of your cycle (or about a week after you expect ovulation). This measures progesterone, the hormone your ovary produces after releasing an egg. A progesterone level below 3 ng/mL indicates ovulation did not occur that cycle.
If your cycles are longer than 28 days, the timing of this test shifts accordingly. The goal is to test about seven days before your expected period, not strictly on calendar day 21. Your doctor may repeat this test over two or three cycles to see whether anovulation is a one-time event or a pattern.
Checking the Fallopian Tubes
Blocked or damaged fallopian tubes are one of the most common structural causes of infertility, and the primary test for this is a hysterosalpingogram, usually called an HSG. The procedure takes less than five minutes and is done in a radiology suite or your doctor’s office.
You lie on a table as you would for a pelvic exam. Your doctor inserts a speculum, cleans the cervix, and threads a thin catheter through it. A contrast dye flows through the catheter, filling your uterus and traveling into your fallopian tubes. A series of X-rays captures the dye’s path. If the dye flows freely through both tubes and spills out the ends, the tubes are open. If the dye stops at any point, that tube is blocked.
Cramping during the procedure is common, particularly when the dye enters the uterus. Most doctors recommend taking an over-the-counter pain reliever beforehand. The dye is absorbed naturally by your body afterward.
Evaluating the Uterus
The HSG provides a rough outline of the uterine cavity, but if your doctor suspects polyps, fibroids, scar tissue, or an unusually shaped uterus, they may order a closer look. Two common options are a saline infusion sonogram (SIS) and an office hysteroscopy.
A saline infusion sonogram involves filling the uterus with sterile saline and using ultrasound to visualize the cavity. A hysteroscopy uses a tiny camera inserted through the cervix. Both detect abnormalities at similar rates, but hysteroscopy has a practical advantage: if your doctor finds a polyp or small fibroid during the procedure, they can often remove it on the spot. In one clinical trial, 20% of patients who had SIS needed a second procedure to treat what was found, compared to only about 3% of those who had hysteroscopy with immediate treatment.
Surgical Diagnosis With Laparoscopy
Laparoscopy is the most invasive fertility test and is typically reserved for cases where less invasive testing hasn’t explained the problem. Your doctor is most likely to recommend it if you have chronic pelvic pain, a history of pelvic infection, or symptoms that suggest endometriosis or adhesions (scar tissue binding organs together).
The procedure is done under general anesthesia. A small camera is inserted through a tiny incision near the navel, giving your doctor a direct view of your ovaries, fallopian tubes, and the outside of your uterus. Endometriosis, blocked tubes, and adhesions that don’t show up on imaging can be identified and sometimes treated during the same surgery. It’s usually an outpatient procedure with recovery taking a few days to a week.
What About At-Home Fertility Tests?
At-home fertility kits have become widely available, and most measure one or two hormones, typically FSH or LH, from a urine or finger-prick blood sample. Some newer kits test AMH as well. While these can offer a general snapshot, they have real limitations. Most measure only a single biomarker, which can miss the bigger picture. There also isn’t strong research confirming their accuracy compared to clinical lab work.
The bigger risk is that a reassuring at-home result might delay a visit to a specialist, or a concerning result might cause unnecessary panic without the context a doctor would provide. These kits can be a reasonable first step if you’re curious, but they don’t replace a full clinical evaluation. A fertility workup interprets multiple test results together, alongside your medical history and your partner’s evaluation, which is something no single at-home test can replicate.
The Testing Timeline
A basic fertility workup can often be completed within one to two menstrual cycles. Blood work and an ultrasound happen during the first cycle, with the day 21 progesterone test later that same month. An HSG is typically scheduled during the first half of the following cycle (after your period ends but before ovulation) to ensure you’re not pregnant. If all initial results are normal and your doctor suspects a structural issue, a hysteroscopy or laparoscopy would follow.
It’s worth noting that in roughly 15 to 30 percent of cases, all tests come back normal for both partners, a frustrating diagnosis called unexplained infertility. This doesn’t mean nothing is wrong. It means current testing can’t identify the specific barrier, and treatment options like fertility medications or IVF may still be effective.