Fertility Tests for Men and Women

Couple and doctor in office talking about fertility tests
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Fertility tests are an essential part of fertility evaluation and treatment. Through testing, your doctor can possibly discover what's preventing you and your partner from achieving pregnancy.

Your regular gynecologist may do some basic testing. Or, you may be referred to a reproductive endocrinologist (a doctor specializing in fertility) or a urologist (for male infertility) for more thorough fertility testing.


Fertility testing involves both partners. While we may think of pregnancy as happening in the woman's body, conception takes two.

According to the American Society of Reproductive Medicine (ASRM), 25% of all infertile cases have one or more contributing infertility factors. For instance, the ASRM reports that 40% of infertility cases are due to male factor infertility while 25% of female infertility is due to abnormal ovulation.

Female Fertility Tests

Not every fertility test will be done for every case. The more invasive fertility tests, like diagnostic laparoscopy, are only done when symptoms or other tests point in that direction, or when a cause for infertility cannot be found otherwise.

For women, fertility testing may include:

  • A basic gynecological exam
  • Sexually transmitted disease testing (some STDs can cause infertility)
  • Blood work, which may check for thrombophilia and antiphospholipid syndrome (in cases of recurrent miscarriage), as well as a variety of hormones, including LH, FSH, thyroid hormones, androgen hormones, prolactin, estradiol (E2), and progesterone. AMH, or anti-mullerian hormone, may also be tested for.
  • Some of this blood work must be done on a particular day of your menstrual cycle. For example, FSH is usually checked on day 3 of your cycle. Progesterone is usually checked on day 21 or 22 of your cycle.
  • Ultrasound, to look for polycystic ovaries, larger ovarian cysts, fibroids, and, sometimes, to confirm ovulation is taking place.
  • Ultrasound is also used to check the shape of the uterus and the thickness of the uterine lining. An antral follicle count, which predicts the number of eggs available in a woman's ovaries, may also be done via ultrasound.
  • HSG, or hysterosalpingogram, to check that the fallopian tubes are open and not blocked, as well as to evaluate the shape of the uterus.
  • Endometrial biopsy, which involves taking a small amount of tissue from the uterine lining (or endometrium). This test is not commonly done.
  • Hysteroscopy, which involves placing a telescope-like camera through the cervix into the uterus to take a closer look at the inside of the uterus. This is done if an HSG exam showed potential abnormalities or was inconclusive. Your doctor may also do an endometrial biopsy during this exam.
  • Sonohysterogram, which involves placing sterile liquid inside the uterus (via a catheter), and then evaluating the uterus and uterine walls via ultrasound.
  • Diagnostic laparoscopy, which may be the most invasive of the fertility tests. This test is only done when symptoms point to possible endometriosis, as part of treatment for blocked fallopian tubes, or in some cases of unexplained infertility.

Male Fertility Tests

Semen analysis is the main fertility test for men. It involves the man providing a semen sample for a lab to evaluate.

Ideally, the test should be performed twice, on separate days, to confirm the results.

Usually, only a semen analysis is needed to diagnose male infertility.

However, further testing may also be performed, including:

  • A general physical exam by a urologist
  • Specialized semen analysis, including genetic testing of the sperm (looking for the presence of antibodies) and evaluation of immobile sperm (to see if they are dead or alive)
  • Blood work to check hormone levels, usually of FSH and testosterone, but sometimes also LH, estradiol, or prolactin
  • STD testing
  • Ultrasound, to evaluate the seminal vesicles and scrotum
  • Post-ejaculatory urinalysis (urine testing), to check for retrograde ejaculation
  • Testicular biopsy, which involves the removal of testicular tissue via a minor surgical procedure
  • Vasography, which is a specialized X-ray that is used to look for obstructions of the male reproductive organs

Couple Fertility Tests

Some fertility tests involve both partners. These tests include genetic karyotyping and post-coital testing (PCT).

If recurrent miscarriage is a problem, genetic karyotyping may be done to look for genetic disorders that may lead to miscarriage. This is done through a simple blood test.

Though rarely done anymore, PCT involves taking a sample of cervical mucus from the woman via a pelvic exam, several hours after the couple has sexual intercourse. It evaluates the interaction between the woman's cervical mucus and the man's sperm.

At-Home Fertility Tests

It can be emotionally difficult to go through fertility testing. Sometimes, people feel embarrassed. They'd rather not go through the discomfort.

You may feel tempted to purchase an "at-home" fertility test. For example, there are at-home FSH (follicle-stimulating hormone) tests you can take. For men, there are mail order sperm count test kits.

However, these tests can't fully evaluate your fertility and are not recommended. They look at one very specific aspect of fertility. An at-home FSH test can't tell you if your fallopian tubes are blocked, for example. Also, these tests aren't very accurate.

At-home sperm count tests can only do one thing—count how many sperm there are. But your sperm could be non-viable, and the kit can't tell you that. There are also other sperm health aspects to look at, including sperm shape and how the sperm swim. The mail-order male fertility tests don't look at these things. 

The at-home FSH tests only detect high levels of FSH, which can indicate low ovarian reserves. Your levels could also be low or abnormal, and these tests can't necessarily tell you that. The best thing to do is to see your doctor. Remember that the sooner you get help, the better your chances will be for pregnancy success.

Insurance Coverage

Will fertility testing be covered by your insurance? It depends. Sometimes, insurance companies won't cover tests that are specified as being for fertility purposes only. But they will cover that same test for a different reason.

So, for example, they may cover a diagnostic laparoscopy if you're having severe menstrual cramps. But they may not cover it if it's coded as being only for a fertility evaluation. 

It's very important you talk to your fertility clinic's financial department before you do any fertility tests. Be clear on what will be covered, and what may not be covered. You don't want to get surprised by a big bill.

After Fertility Testing

Once fertility testing is complete, you'll meet with your gynecologist or reproductive endocrinologist to discuss...

  • What the results mean
  • What further testing, if any, may be recommended
  • What treatment would be appropriate
  • Decide the next steps to take

Don't be afraid to ask your doctor questions before and after fertility testing. Your doctor should understand how sensitive these issues are. 

A Word From Verywell

Fertility testing can be complicated and stressful. A better understanding of the tests can help you feel more comfortable with the process and let you focus on working toward your pregnancy goal.

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14 Sources
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