Getting your fertility tested typically starts with a visit to your OB-GYN, who can order an initial round of blood work and imaging before referring you to a specialist if needed. The standard guideline is to seek testing after 12 months of regular, unprotected sex without conception. If you’re over 35, that window shortens to 6 months. If you’re over 40, don’t wait at all.
Testing isn’t one single appointment. It’s a series of blood draws, physical exams, and sometimes imaging procedures that together build a picture of what’s happening in your body. Both partners should be evaluated, since roughly half of infertility cases involve a male factor. Here’s what the process actually looks like.
Where to Start: OB-GYN or Fertility Specialist
Your OB-GYN can handle the initial workup: ordering hormone panels, performing a pelvic ultrasound, and reviewing your medical history. Many of the basic diagnostic tests happen right in their office. If those results come back normal and you’re still not conceiving, or if results point to something more complex, your OB-GYN will refer you to a reproductive endocrinologist, a doctor who specializes specifically in infertility.
You can also skip straight to a reproductive endocrinologist, especially if you already suspect an issue or if you’re over 35. Either way, bring copies of any previous blood work or imaging so you don’t repeat tests unnecessarily.
Blood Tests for Hormones and Ovarian Reserve
The core of a female fertility workup is a series of blood tests measuring hormones that control your menstrual cycle and reflect how many eggs your ovaries have left. These are usually drawn early in your cycle, around day 2 or 3, though your provider may ask you to start tracking your cycle before or after your first appointment.
FSH (follicle-stimulating hormone) signals your ovaries to develop eggs each month. As your egg supply declines with age, FSH levels rise because your body has to work harder to stimulate the ovaries. A high FSH level suggests diminished ovarian reserve.
AMH (anti-Müllerian hormone) gives a more direct snapshot of your remaining egg supply. Unlike FSH, AMH stays relatively stable throughout your cycle, so it can be drawn on any day. Low AMH suggests fewer eggs are available.
Estradiol is the main form of estrogen during your reproductive years. Low levels can signal the start of menopause or a condition called hypothalamic amenorrhea, where stress, excessive exercise, or undereating causes your brain to shut down your menstrual cycle.
LH (luteinizing hormone) triggers ovulation. Abnormal levels can cause irregular periods. Like FSH, LH rises as estrogen declines with age.
Progesterone is typically tested about a week after ovulation (around day 21 of a 28-day cycle) to confirm that ovulation actually occurred. If progesterone is low at that point, it may mean you’re not ovulating regularly.
Your provider may also check thyroid hormones and prolactin, since imbalances in either can quietly disrupt ovulation.
Imaging: Checking Your Uterus and Tubes
Blood work tells you about hormones. Imaging tells you about structure. Two common procedures look for fibroids, polyps, scar tissue, and blocked fallopian tubes.
A hysterosalpingogram (HSG) is an X-ray procedure done in a radiology department. A small catheter is inserted through the cervix, dye is injected into the uterus, and X-rays track the dye as it flows through the uterus, into the fallopian tubes, and out the other side. If the dye spills freely, your tubes are open. If it stops, that suggests a blockage. The whole thing takes about 15 to 30 minutes and can cause cramping similar to period pain.
A sonohysterogram (SHG) is a similar concept but uses saline and ultrasound instead of dye and X-rays. It’s typically done right in the office. Saline is injected into the uterus while a vaginal ultrasound captures images. If your provider also wants to check your tubes during this test, they’ll inject tiny bubbles through the catheter and watch to see if they pass through. Both tests evaluate the uterine lining for growths or scarring that could prevent an embryo from implanting.
Testing for the Male Partner
A semen analysis is the primary fertility test for men and one of the first tests ordered in any workup. It’s done at an andrology lab, where the sample is evaluated both under a microscope and by computer. The lab measures sperm concentration (how many sperm per milliliter), motility (the percentage that are actively swimming), morphology (size and shape), vitality (percentage that are alive), ejaculate volume, and pH.
At-home sperm tests exist and can give you a rough sense of sperm count or concentration. Some use a phone attachment to measure basic motility. But the information they provide is only a fraction of what a lab analysis covers. A home test might tell you your count looks normal while missing problems with sperm shape, movement quality, or other factors that affect fertility. They’re a reasonable first step if you want preliminary information, but they don’t replace a clinical semen analysis.
Genetic Carrier Screening
Many fertility clinics recommend expanded carrier screening for both partners. This is a blood or saliva test that checks whether you carry genes for inherited conditions you could pass to a child, even if you show no symptoms yourself. Modern panels screen for over 400 genetic conditions that are inherited in a recessive pattern, meaning both parents would need to carry the gene for a child to be affected. These conditions are typically serious and lifelong.
Carrier screening isn’t mandatory, but it’s especially valuable if you’re planning IVF, since embryos can be tested before transfer. It’s also useful simply for understanding your risk profile before conceiving.
What the Timeline Looks Like
Some tests may happen at your very first appointment, while others get scheduled for specific days of your menstrual cycle. A basic workup, including blood panels, a semen analysis, and imaging, can usually be completed within one to two menstrual cycles. If your provider suspects something specific, like endometriosis or a uterine abnormality, additional procedures could extend the process.
You don’t need to be at a particular point in your cycle to schedule your first visit. Your provider will coordinate the timing of individual tests from there.
Costs and Insurance Coverage
Diagnostic fertility testing is generally more affordable than treatment. A basic hormone panel might cost a few hundred dollars out of pocket. An HSG or sonohysterogram typically runs a few hundred more. A semen analysis is usually one of the least expensive tests in the workup. Costs vary widely by location and provider.
Insurance coverage depends heavily on where you live. About 20 U.S. states have laws requiring private insurers to cover some level of infertility services, including Massachusetts, New York, Illinois, Connecticut, Colorado, New Jersey, Delaware, and New Hampshire, among others. However, most of these mandates exclude self-insured employer plans, which cover a large share of working Americans. Even in states without mandates, many insurers cover diagnostic testing (figuring out why you’re not conceiving) more readily than they cover treatment (IVF, IUI, medications). Call your insurance company before your first appointment and ask specifically whether diagnostic infertility testing is covered and whether you need a referral or prior authorization.
If you’re paying out of pocket, ask your clinic about bundled pricing for a full workup. Some fertility clinics offer discounted packages that include the standard blood work and imaging together.