Fertility Tests

What is a fertility test?

Healthcare providers use fertility tests to find out why you’re having difficulty conceiving. Fertility experts generally recommend fertility testing if:

• You’re under 35 years of age and haven’t conceived after one year of unprotected sex (sex without any type of birth control).
• You’re over 35 years of age and haven’t conceived after six months of unprotected sex.
• You have irregular cycles (cycles that are more than 35 days apart).

There are many different types of fertility tests, depending on your needs. At-home fertility testing can tell you whether you’re ovulating, and if so, which days during the month your fertility is at its peak. In-office fertility testing can tell you why you’re having trouble conceiving and give your provider an idea of which treatments might help. To determine the type of fertility test you need, a fertility specialist will do a physical examination and ask about your:

• Menstrual cycle history.
• Gynecology history, including any prior pregnancy history.
• Health history, including any surgeries or long-term illnesses.
• Prescription medications.
• Caffeine and alcohol intake.
• Work environment (whether you have exposure to toxins or chemicals in your workplace).
• Sexual history, including how often you have sex now.

After gathering this information, your fertility specialist will recommend tests based on your situation. Keep in mind there’s no single best fertility test. Specialists use a wide range of diagnostic tools to find out why you and your partner haven’t conceived yet.

Fertility tests for women

Fertility tests for women and people assigned female at birth (AFAB) may include:

• Fertility blood tests. Certain hormonal imbalances can interfere with egg production and maturation. This type of test checks hormone levels in your blood at specific points during your menstrual cycle. Fertility specialists commonly check levels for progesterone, estradiol, thyroid stimulating hormone (TSH) and prolactin.
• Ovarian reserve testing. Also known as anti-mullerian hormone (AMH), this test combines fertility blood tests with a transvaginal ultrasound. This measures your antral follicle count (AFC) and the AMH hormone produced by your ovaries, which tells your provider whether you have a typical egg count compared to other people your age. This test is only necessary in women needing in-vitro fertilization (IVF), and isn’t necessary in other fertility treatments.
• Genetic testing. This can detect any mutations (changes) in your genes that could impact fertility.
• Pelvic ultrasound. Sometimes called a sonogram, this test generates detailed pictures of your female reproductive system. A provider uses this test to see if you have uterine fibroids, ovarian cysts or other abnormalities.
• Sonohysterogram. This is a type of imaging test. It helps your provider see inside your uterus and can help them determine a cause for infertility.
• Hysterosalpingogram. This imaging test uses fluoroscopy to take pictures of your uterus and fallopian tubes. It can help your provider determine if fertility issues are due to blockages in your fallopian tubes.
• Hysteroscopy. During this test, your provider inserts a hysteroscope (a thin, lighted tube) into your uterus. This allows them to examine your cervix and the inside of your uterus.

Male fertility tests

Fertility tests for men and people assigned male at birth (AMAB) may include:

• Semen analysis. One of the most common male fertility tests, semen analysis checks the number and quality of your sperm.
• Fertility blood tests. If there are issues with your semen analysis, your healthcare provider will check certain hormone levels in your blood, including testosterone, thyroid stimulating hormone, luteinizing hormone, prolactin, estradiol and follicle-stimulating hormone (FSH).
• Genetic testing. Anyone can get genetic testing to see if they have gene changes that could influence fertility.
• Testicular ultrasound. If there are issues with your semen analysis, this is done to take detailed pictures of your scrotum and testicles to identify possible infertility causes.
• Post-ejaculatory urinalysis. Your provider may recommend this test to see if you have sperm in your urine (pee). A condition called retrograde ejaculation can cause this.

How do fertility tests work?

It depends on which test you take. Some involve a blood draw, and some might involve imaging. But most of the time, it’s a combination of both. In some cases, your healthcare provider can determine a cause of infertility with just one test. Other times, it takes longer.

What’s right for you depends on several different factors, including your assigned sex at birth and confirmed gender, health history and sexual history. Your healthcare provider can give you more information about the tests they recommend, how they work, how you can prepare and what treatments are available.

If the results are abnormal what are the next steps?

If you get abnormal results of any kind, your healthcare provider will talk with you about possible next steps. Some people might need further testing before pursuing treatment. Others may be able to start fertility treatments right away. Your provider will let you know what to expect in your situation.

Remember, abnormal results don’t mean your journey is over. Getting pregnant naturally can be difficult, but your fertility specialist can help you conceive. There are numerous assisted reproductive treatments available, like IVF and IUI. Your provider can give you resources and help you find support.

Can I do a fertility test at home?

Yes, you can purchase at-home fertility tests online or at your local pharmacy. There are urine (pee) tests that can show your most fertile days each month. Other tests can check the health and volume of your semen.

It’s important to note that an at-home fertility test isn’t a substitute for a fertility specialist. If your test results suggest that conceiving could be challenging, schedule an appointment with a fertility specialist right away. They can run more tests and recommend personalized treatment.

Can you test fertility with an IUD?

It depends. An IUD doesn’t affect future fertility, but it can skew test results. In some cases, you may need to have your IUD removed and wait a while before testing. If you have an IUD, you should check with your healthcare provider before taking a fertility test.

A note from Cleveland Clinic

Starting a family is a sought-after milestone for millions of people. But if you’re having trouble getting pregnant, you might wonder if those dreams will ever come to fruition. If you’re having difficulty conceiving, talking to your healthcare provider is the first step. They can tell you which fertility tests to take and, if necessary, refer you to a specialist for treatment.