Infertility is medically defined as the inability to achieve a pregnancy after 12 months of regular, unprotected intercourse or after 6 months if you’re age 35 or older. For women over the age of 40, seeking an evaluation as soon as possible would be beneficial due to the natural decline in fertility with age.
What Tests Might Be Performed?
A fertility evaluation for women typically includes a set of tests designed to assess several key aspects of reproductive health.
Ovulation and Hormonal Balance
To determine whether ovulation is occurring regularly, your doctor may recommend:
- Blood tests that measure hormones such as follicle-stimulating hormone (FSH), estradiol, thyroid-stimulating hormone (TSH), and prolactin
- Ovulation tracking via blood progesterone measurement during the luteal phase of the cycle
These tests help identify whether your menstrual cycle is functioning in a way that supports conception. Results can help pinpoint hormonal imbalances that could interfere with egg development, ovulation, or implantation.
Ovarian Reserve Testing
Your “ovarian reserve” refers to the number and quality of eggs available. While egg quality cannot be measured directly, several tests provide insight into egg quantity and how the ovaries may respond to fertility treatment. These tests may include:
- Anti-Müllerian Hormone (AMH) level to provide a snapshot of egg quantity
- Antral Follicle Count (AFC) using a transvaginal ultrasound to estimate the number of small, resting follicles in the ovaries
- Day-3 hormone panels, measured early in the menstrual cycle (typically cycle day 2 or 3)
Day-3 hormone testing evaluates baseline hormone levels when the ovaries are least hormonally active. These panels often include estradiol (E2), FSH, luteinizing hormone (LH), AMH, and other hormones as specified by the fertility specialist. Testing at this point in the cycle allows for more accurate interpretation of ovarian and reproductive hormone function.
Importantly, these values are interpreted together to diagnose and determine appropriate fertility treatment plan. For example, a normal FSH level paired with elevated estradiol may still suggest diminished ovarian reserve. While ovarian reserve testing does not predict whether a woman can conceive naturally in a given month, it plays a critical role in guiding treatment recommendations and timing, especially for women in their late 30s and beyond.
Together, these tests provide a clearer picture of reproductive potential and help fertility specialists design personalized care plans.
Assessment of the Uterus and Fallopian Tubes
Since structural factors can affect female fertility, tests conducted to evaluate reproductive anatomy may include:
- Hysterosalpingogram (HSG): An X-ray study that checks whether the fallopian tubes are open and evaluates the shape of the uterine cavity
- Saline Infusion Sonogram (SIS): An ultrasound technique that provides a detailed view of the uterine lining and can identify fibroids, polyps, or other abnormalities
- Laparoscopy: A minimally invasive surgical evaluation for conditions such as endometriosis, pelvic adhesions, or tubal disease, typically performed only when warranted by symptoms or prior findings
These assessments help determine whether blockages, scarring, or uterine issues may be interfering with fertilization or implantation.
What to Expect During Fertility Testing
For most patients, fertility testing is completed over one or two menstrual cycles and involves a combination of bloodwork, ultrasound imaging, and specialized diagnostic procedures. Many tests are outpatient and minimally invasive, allowing patients to continue their normal routines with minimal disruption.
In many cases, fertility evaluations are coordinated so that both partners are assessed simultaneously, helping providers gain a complete understanding of factors that may be affecting conception. Once testing is complete, results are reviewed in detail and next steps are discussed, ensuring that patients can move forward with clarity and confidence.
Age Matters: Tailoring Testing and Timing
One of the most important factors in female fertility is age. Women are born with a finite number of eggs, and both egg quantity and quality decline over time, particularly after age 35. For this reason, it is recommended that women age 35 and older seek help from a fertility specialist if they have been unable to conceive after six months of trying. Austin-based reproductive endocrinologist Dr. Shahryar Kavoussi emphasizes, “Because fertility naturally declines with age, I often recommend earlier and more comprehensive evaluation for women in their mid-30s and older. As time is of the essence, identifying potential issues sooner allows us to pursue the most effective strategies promptly.”
What If All Tests Are Normal?
In some cases, all fertility tests return within normal ranges, yet pregnancy still hasn’t occurred. These cases are categorized as unexplained infertility, meaning no clear cause has been identified through standard testing.
While this diagnosis can be frustrating, it does not mean treatment options are limited. In these situations, a fertility specialist may discuss options such as:
- Ovulation induction using medications to enhance egg development and timing
- Intrauterine insemination (IUI) to increase the chances of sperm meeting the egg
- In vitro fertilization (IVF), which allows for close monitoring of fertilization and embryo development
These treatments are highly individualized, and many patients with unexplained infertility go on to conceive with the right combination of timing, support, and care.
Further Reading:
Understanding When It’s Time to Seek Fertility Help
Understanding Unexplained Fertility: What You Need to Know
