You might be here for many reasons. Maybe you’ve been trying to conceive and have questions about what comes next. Maybe you’re not trying yet but want to better understand your fertility. Or perhaps you’re simply curious about if your body is “normal.”
A fertility assessment is a helpful place to start. It includes a series of non-invasive tests designed to give a clearer picture of reproductive health. For females, this involves bloodwork and ultrasounds to evaluate the ovaries, uterus, hormone levels, and egg supply; the male partner’s fertility is measured by evaluating his sperm health.
This assessment can help you better understand your reproductive potential and, if relevant, how your body may respond to treatment whether you’re considering fertility preservation like egg freezing or think in vitro fertilization (IVF) may be your next step.
Here’s what to know about fertility assessments for women and men, how it helps take the guesswork out of infertility, when to get tested based on maternal age and other factors, and more.
What is fertility testing?
Fertility testing is a series of assessments that help uncover your reproductive potential, also known as your ability to conceive. Fertility testing for women evaluates hormone levels, egg quantity, and uterine anatomy, and male fertility testing examines sperm health.
The reasons to undergo fertility testing are to:
- Uncover why you’re having difficulty conceiving if you’re already trying to build your family
- Bring attention to any issues that may cause infertility down the line if you want to build your family in the future
- Get a snapshot of your reproductive potential and a better understanding of how your body would respond to treatment
It’s important to note that fertility testing doesn’t tell you whether you’ll be able to conceive spontaneously (without assisted reproductive technologies), but it does offer a glance at your reproductive health and help inform next steps.
Fertility testing for women
In addition to a general medical history and physical exam, communicable disease testing, and genetic carrier screening, a female fertility assessment involves:
Bloodwork to help evaluate:
- Anti-mullerian hormone (AMH), which determines the quantity or stockpile of the eggs in the ovaries (also known as ovarian reserve)
- Optimal range: > 1.0 ng/mL
- Luteinizing hormone (LH), which sends the signal to the brain to ovulate
- Optimal range for mid-cycle: 16-104 IU/L*
- Follicle-stimulating hormone (FSH), which stimulates the growth of follicles in the ovaries
- Optimal range: <10 mIU/mL
- Thyroid-stimulating hormone (TSH), which ensures the thyroid is functioning properly
- Optimal range: 0.4-4 mIU/L* (according to ASRM’s newest guidelines)
- Prolactin, which is evaluated in conjunction with the hormones above to ensure levels are optimal for ovulation
- Optimal range: < 25 ng/mL
*All ranges are approximate and will vary by lab
Transvaginal ultrasound to look at:
- Antral follicle count (AFC), which counts the number of follicles in your ovaries. This number is an estimate of your ovarian reserve relative to your age and predicts how well you may respond to fertility treatment such as intrauterine insemination (IUI) or IVF.
Tubal patency testing
If you’re planning to get pregnant, your doctor will also recommend tubal patency testing to determine whether the fallopian tubes are open so sperm can find its way to fertilize the egg. Your provider may prescribe any of these tests:
- Saline sonogram (SIS)
- Hysteroscopy
- Hysterosalpingography (HSG)
- Laparoscopy
These outpatient, minimally invasive procedures detect any blockages or obstructions in the tubes that could be making it harder to conceive.
Fertility testing for men
A semen analysis (SA) is the sole test used to measure a male partner’s reproductive potential. The SA tests multiple parameters of sperm:
- Sperm concentration (count): A minimum of ≥15 million sperm/mL is considered within the normal range.
- Semen volume: Total ejaculate volume should be ≥2 mL
- Sperm motility (movement): Forward progressive motility should be ≥40%, with ≥50% total motility considered normal
- Sperm morphology (shape): At least 14% of sperm should exhibit normal head and tail morphology; values ≤4% are typically associated with infertility
- Sperm viability: ≥75% of sperm should be alive
In addition to a semen analysis, your provider may also request blood tests to check hormone levels, a physical examination to look for structural abnormalities, and genetic testing to potentially help explain extremely low sperm counts.
When to get fertility testing
The American Society of Reproductive Medicine (ASRM) suggests testing your fertility if:
• You’re not pregnant after 6 months of trying if over age 35
• You’re not pregnant after 12 months of trying if under age 35
• You’re not pregnant after 3 months of trying if age 40+ or if recurrent assisted reproductive technology (ART) failures
Other reasons to undergo fertility testing
Age is not the only factor to consider. You may want to expedite your fertility assessment testing if you’re experiencing any of the following symptoms:
- Cycle irregularities. Intense period pain, flow changes, no period, or otherwise abnormal cycles can be early indicators of hormonal or ovulatory issues
- Ovulation concerns. Ovulation irregularities determined through at-home trackers including basal body temperature thermometers, apps, or ovulation strips may indicate hormonal or reproductive issues
The following factors and chronic conditions also require a fertility assessment sooner than later:
- Cancer diagnosis (oncofertility)
- Recurrent miscarriages
- Carrier of genetic hereditary condition like BRCA1
- Single parent by choice
- LGBTQIA+ individuals or couples
- Endometriosis
- Polycystic ovary syndrome (PCOS)
- Uterine fibroids
- Autoimmune disorders
- Pelvic inflammatory disease (PID)
Options for fertility testing
You may find it difficult to navigate the full range of fertility testing options available. You can undergo the testing with your OB/GYN, seek out a reproductive endocrinologist (fertility doctor), or use convenient at-home fertility tests such as ovulation predictor kits (OPKs).
However, at-home fertility tests have limitations; only a medical doctor can comprehensively assess your fertility and potentially surface findings that may indicate a need for immediate fertility treatment. If treatment or follow-up is recommended, a fertility specialist will come up with a personalized care plan based on your family-building goals and what your assessment reveals.
What can I learn from fertility testing?
Fertility testing is the best way to understand your reproductive potential now and as you age. It offers a complete look at a woman’s uterus, ovaries, hormone levels, fallopian tubes, and ovarian reserve, as well as an analysis of the male partner’s sperm. It can also help uncover causes of infertility in couples trying to conceive, as well as detect underlying conditions that may make it harder to get pregnant.
Testing is quick and painless and helps you look at your body and your reproductive future from a new lens, arming you with insights that can help improve the entire trajectory of your reproductive journey.
It’s never too soon to get started. To book a fertility assessment with a fertility specialist at your nearest CCRM Fertility location, click here.
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