A fertility test is any medical exam that evaluates your ability to conceive. There isn’t a single test but rather a collection of blood work, imaging, and physical exams that check different parts of the reproductive system in both women and men. Most people encounter fertility testing after trying to conceive without success, though some opt for proactive screening before they start trying.
The general guideline is to seek testing after 12 months of unprotected sex without pregnancy if you’re under 35, or after 6 months if you’re 35 or older. Some situations warrant earlier evaluation: very irregular periods (going 45 days or more between cycles), a history of cancer treatment with chemotherapy or radiation, or known reproductive health issues in either partner.
Blood Tests for Women
The core of female fertility testing is a panel of hormone levels drawn at specific points in the menstrual cycle. Most are taken on day 3 of your period, when baseline hormone levels reveal the most about how your ovaries are functioning.
FSH (follicle-stimulating hormone) is one of the primary markers of ovarian reserve, which is essentially how many eggs your ovaries still have available. A day-3 FSH under 6 mIU/mL is considered excellent, 6 to 9 is good, and levels above 10 suggest a declining egg supply. The higher your FSH, the harder your brain is working to stimulate your ovaries, which signals they’re becoming less responsive.
AMH (anti-Müllerian hormone) gives a more direct snapshot of ovarian reserve and can be drawn on any day of your cycle. AMH levels decline steadily with age. A 25-year-old has a median AMH of about 3.3 ng/mL, while a 35-year-old’s median drops to around 1.4 ng/mL and a 40-year-old’s to about 0.5 ng/mL. When AMH falls below roughly 1.2 ng/mL, it may be classified as diminished ovarian reserve. This number matters especially if you’re considering egg freezing or IVF, since it helps predict how your ovaries will respond to stimulation medications.
LH (luteinizing hormone) is tested both at baseline and around ovulation. On day 3, a normal level is under 7 mIU/mL. When LH is higher than FSH, it can be one indicator of polycystic ovary syndrome (PCOS). Mid-cycle, a surge above 20 mIU/mL triggers ovulation within about 48 hours, which is exactly what at-home ovulation predictor kits are detecting.
Estradiol is checked on day 3 as well, with normal values between 25 and 75 pg/mL. Abnormally high levels early in the cycle can signal a functional cyst or diminished ovarian reserve. Thyroid-stimulating hormone (TSH) is also part of the standard panel because an underactive thyroid can quietly interfere with ovulation and implantation. A normal TSH falls between 0.4 and 4 uIU/mL, with a midrange value around 1.7.
Confirming Ovulation
Even if your periods seem regular, your doctor may want to confirm that you’re actually releasing an egg each cycle. The standard method is a progesterone blood draw about seven days after ovulation, which typically falls around day 21 of a 28-day cycle. After an egg is released, the empty follicle transforms into a structure that produces progesterone. A level above 10 ng/mL on a natural cycle confirms normal ovulation. Levels below that suggest you may not be ovulating, or that the timing of the blood draw was off.
Imaging Tests
Blood work reveals hormonal health, but it can’t show whether your fallopian tubes are open or whether anything inside the uterus might prevent an embryo from implanting. That’s where imaging comes in.
A hysterosalpingogram (HSG) is the most common structural test. A small amount of dye is injected through the cervix while X-rays track it flowing through the uterus, into the fallopian tubes, and out into the abdominal cavity. If the dye flows freely, the tubes are open. The test also reveals fibroids, polyps, or scar tissue that could disrupt the uterine lining. Most women describe it as causing moderate cramping that lasts a few minutes.
A sonohysterogram is a similar concept using saline and ultrasound instead of dye and X-rays. Sterile saline is pushed into the uterus while a vaginal ultrasound captures the interior shape. If tube evaluation is needed, tiny bubbles are injected through the same catheter to check whether they pass through the ends of the tubes. Both tests are done in a clinic and take about 15 to 30 minutes.
Semen Analysis for Men
Male factors contribute to roughly half of all infertility cases, so a semen analysis is one of the first tests ordered. A standard lab analysis evaluates sperm count, motility (how well sperm swim), and morphology (sperm shape). The World Health Organization sets the lower reference limit for sperm concentration at 16 million per milliliter, though counts below that don’t necessarily mean natural conception is impossible.
At-home semen test kits have become widely available and can be a useful first screen if a partner is reluctant to visit a clinic. One clinical validation study of 323 samples found that a home testing kit matched lab results with about 95% accuracy, and it correctly identified low-count samples with 88% sensitivity. These kits are fast and discreet, but they only measure concentration. They can’t assess motility, morphology, or other factors that a full lab analysis covers, so they’re a screening tool rather than a replacement for clinical testing.
Genetic Carrier Screening
Carrier screening is a separate category of testing that checks whether you or your partner carry gene variants for inherited conditions you could pass to a child, even if neither of you has symptoms. The American College of Obstetricians and Gynecologists recommends this screening ideally be done before pregnancy so couples have the fullest range of reproductive options.
Standard panels test for conditions like spinal muscular atrophy (a progressive muscle-wasting disease), cystic fibrosis, sickle cell disease, thalassemia, and fragile X syndrome. Expanded panels can screen for over 200 conditions at once. If one partner tests positive as a carrier, the other partner is then tested. Only when both partners carry the same recessive gene variant is there a significant chance (typically 25% per pregnancy) of the child being affected.
What Testing Looks Like in Practice
A fertility workup doesn’t happen all at once. Because many blood tests need to be timed to specific days in your cycle, the process typically unfolds over one to two menstrual cycles. A common sequence starts with day-3 blood work for FSH, LH, estradiol, TSH, and AMH during one period, followed by a progesterone draw around day 21. An HSG or sonohysterogram is usually scheduled between days 6 and 12 of the cycle, after bleeding has stopped but before ovulation. A semen analysis can be done at any time, with two to five days of abstinence beforehand for the most reliable results.
Your doctor will look at all these results together rather than making a diagnosis from any single number. A low AMH alongside a normal FSH tells a different story than both being abnormal. Normal results across the board, which happens in about 10 to 15% of couples struggling to conceive, leads to a diagnosis of unexplained infertility, which still has treatment options but may require a different approach. The overall goal of testing is to identify the specific barrier, whether it’s an ovulation problem, a structural issue, a sperm factor, or a combination, so treatment can be targeted rather than guesswork.