Should you have had 12 months of regular unprotected sex if you’re under 35 years old or 6 months of regular unprotected sex if you’re over 35 years old, and you are not getting pregnant, it is recommended that you consult a fertility specialist, particularly if your gynaecologist has also not had any success with you. The specialist may perform some tests to identify the specific reason for your inability to conceive.
Fertility testing is a series of medical evaluations used to identify why pregnancy has not occurred despite regular, unprotected intercourse. Rather than relying on a single test, healthcare providers assess both partners using a combination of medical history, physical examination, laboratory tests, and imaging studies to determine whether there are problems affecting ovulation, sperm production, fertilisation, or the reproductive organs. The results help guide personalised treatment and improve the chances of conception.
WHEN SHOULD YOU HAVE FERTILITY TESTING?
Most fertility specialists recommend evaluation if:
- You are under 35 years old and have not conceived after 12 months of regular, unprotected intercourse.
- You are 35 years or older and have not conceived after 6 months.
- You have irregular menstrual cycles, particularly cycles longer than 35 days.
- Either partner has known risk factors that may affect fertility, such as previous reproductive surgery, certain medical conditions, or a history of cancer treatment.
Seeking evaluation early can help identify treatable causes before fertility declines further.
THE FIRST FERTILITY CONSULTATION
The fertility assessment begins with a comprehensive consultation rather than immediate testing. A fertility specialist will review factors that may influence reproductive health, including:
- Menstrual and ovulation history
- Previous pregnancies or miscarriages
- Medical and surgical history
- Current medications
- Lifestyle habits such as smoking, alcohol, caffeine intake, exercise, and weight
- Occupational exposure to chemicals or toxins
- Sexual history, including frequency and timing of intercourse
This information helps determine which investigations are appropriate, as fertility testing is tailored to each individual rather than following a one-size-fits-all approach.
FERTILITY TESTS FOR WOMEN
Female fertility testing focuses on evaluating hormone function, ovarian reserve, uterine health, and whether the fallopian tubes are open.
Hormone Blood Tests
Blood tests measure hormones that regulate ovulation and reproductive health. These tests are often performed at specific stages of the menstrual cycle and may include progesterone, oestradiol (oestrogen), thyroid-stimulating hormone (TSH), and prolactin. Abnormal hormone levels can interfere with egg development, ovulation, implantation, or pregnancy maintenance.
Ovarian Reserve Testing
Ovarian reserve testing estimates the number of remaining eggs and helps predict how the ovaries may respond to fertility treatment, particularly IVF. This assessment combines Anti-Müllerian Hormone (AMH) blood testing and Antral Follicle Count (AFC) using transvaginal ultrasound. Ovarian reserve testing is primarily useful for women considering IVF and is not routinely required for all fertility evaluations.
Pelvic Ultrasound
A pelvic or transvaginal ultrasound provides detailed images of the reproductive organs and can identify conditions such as ovarian cysts, uterine fibroids, structural abnormalities and other pelvic conditions that may impair fertility. It is a routine, non-invasive component of many fertility assessments.
Sonohysterogram
A sonohysterogram uses sterile fluid and ultrasound to obtain a clearer view of the uterine cavity.
It can detect abnormalities, including uterine polyps, fibroids, and scar tissue, among others. These conditions may interfere with embryo implantation or increase the risk of miscarriage.
Hysterosalpingogram (HSG)
An HSG is an X-ray procedure in which contrast dye is injected through the cervix to examine the shape of the uterus and whether the fallopian tubes are open. Blocked fallopian tubes are a common cause of infertility because they prevent sperm from reaching the egg or stop the fertilised egg from reaching the uterus.
Hysteroscopy
A hysteroscopy involves inserting a thin camera through the cervix to directly examine the inside of the uterus. This procedure can identify and sometimes treat polyps, fibroids, adhesions (scar tissue) and other abnormalities affecting implantation or pregnancy.
Genetic Testing
In selected patients, genetic testing may be recommended to identify inherited conditions or chromosomal abnormalities that could affect fertility, pregnancy outcomes, or the health of future children.
FERTILITY TESTS FOR MEN
Male fertility contributes to approximately half of infertility cases, making evaluation of both partners essential.
Semen Analysis
Semen analysis is the cornerstone of male fertility testing. It evaluates sperm concentration (count), motility (movement), morphology (shape) and overall semen quality. Abnormal findings can indicate issues with sperm production or function.
Hormone Blood Tests
If semen analysis identifies abnormalities, blood tests may assess hormones involved in sperm production, including testosterone, follicle-stimulating hormone (FSH), luteinising hormone (LH), prolactin, oestradiol and thyroid-stimulating hormone (TSH). Hormonal imbalances can significantly affect sperm production and male fertility.
Testicular Ultrasound
An ultrasound of the scrotum and testicles may be used to detect varicoceles, structural abnormalities, testicular masses or other conditions that may contribute to infertility.
Post-Ejaculatory Urinalysis
This test checks whether sperm are present in the urine after ejaculation. It helps diagnose retrograde ejaculation, a condition in which semen flows backwards into the bladder instead of leaving the body through the penis.
Genetic Testing
Genetic testing may also be recommended for men with severe sperm abnormalities or suspected inherited conditions affecting fertility.
HOW FERTILITY TESTS WORK
There is no single fertility test that identifies every possible cause of infertility. Instead, diagnosis typically requires a combination of blood tests, ultrasound scans, specialised imaging, and laboratory analysis. Some couples receive a diagnosis after one or two investigations, while others require a more comprehensive evaluation. The exact testing pathway depends on age, symptoms, medical history, and initial findings.
WHAT HAPPENS IF TEST RESULTS ARE ABNORMAL?
Abnormal test results do not necessarily mean pregnancy is impossible. Depending on the findings, your fertility specialist may recommend:
- Additional diagnostic tests
- Lifestyle changes
- Medication to improve ovulation or hormone balance
- Surgical treatment to correct anatomical problems
- Assisted reproductive technologies such as intrauterine insemination (IUI) or in vitro fertilisation (IVF)
Treatment plans are individualised according to the underlying cause of infertility and the patient’s reproductive goals.
KEY TAKEAWAY
Fertility testing is a comprehensive process designed to identify the factors preventing pregnancy. Rather than relying on a single investigation, specialists combine medical history, hormone testing, imaging, semen analysis, and other targeted assessments to evaluate both partners. Early evaluation, particularly for those over 35 or with known risk factors, can help identify treatable conditions and guide personalised treatment, including lifestyle changes, medication, surgery, IUI, or IVF. Although the process may seem overwhelming, fertility testing is an important first step toward understanding reproductive health and developing an effective plan to achieve pregnancy.
Read more about fertility testing in this article by the Cleveland Clinic.
