Fertility tests for women: 10 types of checks to test your fertility

On this page:

Why test your fertility?

When to consider fertility testing

Key fertility tests for women

Anti-Müllerian hormone (AMH) test

Follicle-stimulating hormone (FSH) test

Estradiol (E2) test

Luteinizing hormone (LH) test

Progesterone test

Prolactin test

Ultrasound scan

Hysterosalpingography (HSG)

Sonohysterography

Hysteroscopy

What to do after fertility testing

Why test your fertility?

Getting pregnant is not always as easy as it seems. Fertility depends on many factors, including:

• Age – fertility naturally declines over time.
• Health conditions – issues like PCOS or endometriosis can affect conception.
• Lifestyle – factors like stress, diet, and smoking can play a role.
• Genetics – some fertility challenges may run in families.

A fertility test for women is really important. It can give you answers, whether you have been trying to conceive without success or just want to understand your fertility better.”

According to Dr Guimarães:

“testing can help spot any issues early, so you know what steps to take next”.

When to consider fertility testing

You may want to consider fertility testing if:

• You have been trying to conceive for over a year (or six months if over 35)
• You have irregular or absent periods
• You have a history of PCOS, endometriosis, or other reproductive conditions
• You have experienced multiple miscarriages
• You want to assess your fertility before planning for children

Key fertility tests for women

There are several tests available to assess female fertility. Some measure hormone levels, while others look at the structure and function of the reproductive system. Your doctor may recommend one or more of these tests based on your medical history and personal circumstances.

Some of these tests are part of the first fertility checks we do to understand what might be affecting your fertility. Others help us keep an eye on how your treatment is going.

1. Anti-Müllerian hormone (AMH) test

The AMH fertility test measures anti-Müllerian hormone (AMH) levels in your blood. AMH is produced by the small follicles in your ovaries and is a key marker of ovarian reserve, which refers to the number of eggs you have left.

Dr Guimarães explains:

“Women are born with all the eggs they will ever have, and this supply naturally declines over time. A higher AMH level suggests a greater egg supply, while a lower AMH level may indicate fewer remaining eggs.”

Why is the AMH test important?

• It helps estimate your ovarian reserve, giving you an idea of how many eggs you may have.
• It does not measure egg quality, but it can indicate how well your ovaries might respond to fertility treatments like IVF.
• It is often used to assess conditions like PCOS, which is linked to high AMH levels, or early menopause, which is associated with low AMH levels.

What to expect from an AMH blood test?

• The AMH blood test is a quick and simple lab test for AMH that requires a blood sample.
• Unlike some other hormone tests, you do not need to schedule it on a specific day of your menstrual cycle; it can be done at any time.
• Results help fertility specialists understand your reproductive potential and guide next steps if you are trying to conceive.

2. Follicle-stimulating hormone (FSH) test

The FSH test measures follicle-stimulating hormone (FSH), which is produced by the pituitary gland and plays a key role in regulating the menstrual cycle and egg production.

FSH helps stimulate the growth of follicles in the ovaries, which contain developing eggs. If FSH levels are high, it may mean the ovaries are not responding as well as they should, which could indicate a lower ovarian reserve.

Why is the FSH test important?

• FSH and ovarian reserve are closely linked. The body releases more FSH when it senses fewer remaining eggs, which is why high FSH levels may suggest a reduced ovarian reserve.
• High FSH means the ovaries need more stimulation to produce an egg, which can make conception more difficult. This is often seen in people with diminished ovarian reserve or those approaching menopause.
• Lower FSH levels are usually better for fertility because they indicate the ovaries are responding normally to hormonal signals, although there are conditions associated with FSH levels that are too low (like Kallmann syndrome, for example).
• The FSH blood test is often used alongside other fertility tests, like AMH, to get a clearer picture of reproductive health.

What to expect from a lab test for FSH?

• The FSH blood test is done with a simple blood sample.
• This test is usually taken on days 2-3 of your menstrual cycle for the most accurate results.
• It helps fertility specialists assess ovarian function and determine the best approach for conception or fertility treatments.

3. Estradiol (E2) test

The estradiol test measures estradiol (E2), a form of estrogen that plays a key role in egg development and ovulation.

Estradiol is produced by the follicles in your ovaries and helps regulate the menstrual cycle. This test is often done alongside FSH testing to give a clearer picture of ovarian function.

Why is the estradiol test important?

• It helps assess how well your ovaries are responding to FSH. If estradiol levels are too high early in the cycle, it may indicate reduced ovarian reserve or hormonal imbalances, while low levels later in the cycle can also be a sign of a problem.
• Estradiol plays a key role in follicle growth and the development of eggs, and also in endometrial growth.

What to expect from an estradiol blood test?

• The test is done with a simple blood sample.
• Like the FSH test, estradiol is usually tested on day 3 of the menstrual cycle for the most accurate results.
• Results help fertility specialists understand your ovarian function and guide any next steps if you are trying to conceive.

4. Luteinizing hormone (LH) test

The luteinizing hormone (LH) test measures the levels of LH, a hormone that plays a key role in ovulation.

LH is produced by the pituitary gland and triggers the release of a mature egg from the ovary. Tracking LH levels can help detect ovulation and identify potential hormone imbalances that may affect fertility.

Why is the LH test important?

• A surge in LH signals that ovulation is about to occur, which is why it is often used to predict the most fertile days in a cycle.
• An imbalance in LH levels may indicate ovulation issues, which can make conception more difficult.
• A low FSH/LH ratio may be a sign of polycystic ovary syndrome (PCOS), a common condition that affects ovulation.

What to expect from an LH test?

• LH can be measured through a blood test at a fertility clinic or lab.
• It can also be tested at home using ovulation predictor kits (OPKs), which detect LH surges in urine.
• Results help determine whether ovulation is happening regularly and can guide fertility planning or treatment.

5. Progesterone test

The progesterone test measures levels of progesterone, a hormone that plays a crucial role in preparing the uterus for pregnancy.

After ovulation, progesterone helps to transform the uterine lining, creating the right conditions for a fertilised egg to implant.

According to Dr Guimarães:

“Testing progesterone levels can confirm whether ovulation has occurred and assess the health of the luteal phase, the second half of the menstrual cycle.”

The luteal phase is the second half of the menstrual cycle, starting after ovulation and lasting until the next period begins. During this phase, the body prepares for a possible pregnancy.

Why is the progesterone test important?

• If progesterone rises too early, it can affect the endometrium and make it less receptive. When this happens, we may need to cancel the embryo transfer and freeze the embryos, then plan the transfer in a future cycle.
• It confirms ovulation by showing whether progesterone levels have risen after an egg is released.
• Low progesterone levels may indicate ovulation issues or a short luteal phase, which can make implantation more difficult.
• It can show if you have a luteal phase deficiency, which means the uterine lining is not developing well enough to support a pregnancy. In this case, we’ll need to add the right amount of progesterone to your cycle.

What to expect from a progesterone test?

• The test is done with a blood sample at a fertility clinic or lab.
• It is typically taken around day 21 of a 28-day cycle, when progesterone should be at its highest.
• Results help fertility specialists determine whether ovulation is happening and whether hormonal support may be needed.
• It can also be done in other parts of an IVF cycle or a frozen embryo transfer cycle, to allow doctors to confirm that there is no early rise of progesterone and that the levels of this hormone are appropriate for a given phase of the cycle.

6. Prolactin test

The prolactin test measures levels of prolactin, a hormone primarily responsible for stimulating milk production after childbirth.

While prolactin is essential for breastfeeding, high prolactin levels in non-pregnant women can interfere with ovulation and menstrual cycle regulation, making conception more difficult.

Why is the prolactin test important?

• High prolactin levels can disrupt the hormonal balance needed for ovulation, leading to irregular cycles or even anovulation (lack of ovulation).
• It can be a sign of hyperprolactinemia, a condition where the body produces too much prolactin, often caused by stress, medications, or issues with the pituitary gland (including microadenoma or macroadenomas of the pituitary).
• Testing prolactin levels can help diagnose hormonal imbalances that may contribute to infertility.

What to expect from a prolactin test?

• The test is done with a blood sample at a fertility clinic or lab.
• It is usually taken in the morning because prolactin levels fluctuate throughout the day.
• If levels are high, further testing may be needed to identify the cause and determine if treatment is necessary. In some situations of hyperprolactinemia, your fertility doctor can ask you to do an MRI, to confirm the origin of that problem.

Imaging tests for fertility

In addition to blood tests, imaging tests can help assess reproductive health.

7. Ultrasound scan

An ultrasound scan is a key fertility test that gives doctors a detailed view of the ovaries, uterus, and follicles.

A transvaginal ultrasound is commonly used because it provides clearer images of the ovaries compared to an abdominal ultrasound.

It can help check for cysts, fibroids, or abnormalities that may affect fertility.

Why is an ultrasound important?

• It provides insight into ovarian health, including the number of follicles present (antral follicle count) and other anomalies.
• It helps detect uterine conditions like fibroids, malformations or polyps that could impact implantation.
• It is often used to monitor ovulation and track follicle development during fertility treatments.
• It can be used to detect issues that affect other parts of the reproductive tract, like endometriosis, among other conditions.

What to expect from an ultrasound scan?

• A small probe is inserted into the vagina to capture images of the reproductive organs.
• The scan is painless, although some mild discomfort may be felt.
• It is a quick procedure and is often performed as part of routine fertility assessments.

8. Hysterosalpingography (HSG)

HSG is an X-ray test used to check if the fallopian tubes are open and to assess the shape of the uterus.

Since blocked tubes can prevent sperm from reaching the egg, this test is crucial for understanding potential barriers to conception.

Why is an HSG important?

• It detects blocked fallopian tubes, which can prevent fertilization.
• It identifies uterine abnormalities, such as adhesions, fibroids, or polyps, that may affect implantation.
• Some women experience increased fertility in the months following the test, as the dye may help flush out minor blockages.

What to expect from an HSG test?

• A contrast dye is injected into the uterus while X-rays are taken to track how the dye moves through the fallopian tubes.
• It is usually done after your period but before ovulation to avoid interfering with early pregnancy.
• Some women experience mild cramping during the procedure, while others feel a bit of pain/discomfort. However, it is generally considered a well-tolerated test.

9. Sonohysterography

Sonohysterography, or saline infusion sonography, is a special type of ultrasound that provides a detailed look at the uterine cavity.

A saline solution is introduced into the uterus to expand it, making it easier to spot abnormalities that a standard ultrasound might miss.

Why is a sonohysterography important?

• It provides a clearer image of the uterus than a regular ultrasound.
• It helps detect polyps, fibroids, adhesions, or other structural issues that may affect implantation.
• It is often used when an HSG shows abnormalities or when further investigation of the uterus is needed.

What to expect from a sonohysterography?

• A thin catheter is used to introduce saline into the uterus.
• A transvaginal ultrasound is then performed to capture images.
• The procedure is usually quick and causes only mild discomfort for most women.

10. Hysteroscopy

Hysteroscopy is a minimally invasive procedure that allows doctors to examine the inside of the uterus using a small camera.

Unlike HSG or sonohysterography, hysteroscopy provides a direct view of the uterine cavity, making it one of the most effective ways to diagnose and treat uterine abnormalities.

Why is hysteroscopy important?

• It can diagnose and treat conditions like polyps, fibroids, adhesions, and uterine septum in the same procedure.
• It is often used when other imaging tests show abnormalities that need further investigation.
• It can improve fertility outcomes by removing obstacles that might prevent implantation.
• It can be used to collect a small sample of the endometrium to check for infections, immune problems or other issues under the microscope.

What to expect from a hysteroscopy?

• A thin camera (hysteroscope) is inserted through the cervix to examine the uterus.
• If needed, small surgical tools can be used to remove polyps, fibroids, or scar tissue, or to retrieve a small piece of the endometrium.
• It is usually done as an outpatient procedure and may involve cramping, though anesthesia can be used for comfort.

What to do after fertility testing

If your test results indicate any issues, your doctor may recommend lifestyle changes, medication, or fertility treatments such as ovulation induction, intrauterine insemination (IUI), or in vitro fertilisation (IVF).

Even if results show a reduced ovarian reserve, many people can still conceive with the right support.

Final thoughts

Understanding your fertility can empower you to make informed decisions about your reproductive health.

Testing can help identify potential challenges early, allowing you to explore options for conception or fertility preservation.

If you have concerns about your fertility, speak with our doctors or fertility specialists to discuss the best approach for your situation.