What Is Fertility Testing?

If you're thinking about getting pregnant or just want to know where you stand in terms of your fertility, understanding your fertility is the first step toward taking control of your reproductive journey. 

From hormone levels and ovulation to the shape of your uterus and the health of your vaginal microbiome, healthcare professionals have a well-rounded toolkit of tests that can shed light on what’s going on inside your body.

Below, we’ll walk you through the most common fertility tests, how they work, and how accurate they are, plus, how testing your vaginal microbiome can reveal new insights into your fertility.

Different types of fertility tests for women

Whether you’re having difficulty conceiving, planning ahead, or just want to know more about your body, getting a fertility test can help you make more informed decisions, on your timeline, and in your way. Keep in mind that a full fertility workup isn't fully recommended unless you've been trying to conceive for a year (or six months if you're over 35). 

To determine where to start, a fertility specialist will conduct a physical exam and gather information about your menstrual cycle, medical history (including any past pregnancies), and overall health, such as any previous surgeries or chronic illnesses. They’ll also ask about your current prescription medications, caffeine and alcohol consumption, and overall lifestyle. They may also ask you about your sexual history, including frequency of intercourse. 

Then, they might recommend different fertility tests to help you get a clearer picture. The most common types of fertility tests for women focus on key areas like ovarian reserve, ovulatory function, and structural health of the reproductive organs. 

Ovarian reserve testing

Women are born with all the eggs they'll ever have, and they don’t make new ones over time. As women age, both the number and quality of their eggs naturally decline, which can make it harder to get pregnant, especially after age 35. 

Ovarian reserve refers to the number of eggs you have left, and it’s one of the most important factors doctors look at when assessing fertility. The two most commonly used blood tests are anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH).

AMH is considered a reliable marker of egg quantity and can be measured at any point in your cycle. Higher AMH levels typically suggest a higher number of eggs, but it’s important to note that while AMH doesn’t tell us about egg quality, it can predict your chances of getting pregnant.

FSH is usually tested on the third day of your menstrual cycle. When FSH levels are elevated, especially in older women, it may indicate a diminished ovarian reserve. This test can be a strong indicator of an infertility diagnosis, but like AMH, it doesn’t guarantee anything in terms of actual pregnancy outcomes.

Another helpful (though less common) test is the clomiphene citrate challenge test (CCCT). This involves taking a fertility medication called clomiphene and measuring FSH levels before and after. It’s used to get a more nuanced view of ovarian reserve, especially when results from AMH and FSH are unclear.

Ovarian function

Even if you have a good ovarian reserve, you need to be ovulating regularly to get pregnant (on that note, if you’re having regular periods, chances are that you’re ovulating normally). To confirm ovulation, doctors typically do blood tests to measure serum progesterone (the amount of progesterone in the blood) in the mid-luteal phase, which is about a week after ovulation, when progesterone peaks.

Additionally, luteinizing hormone (LH) plays a key role in ovulation. An LH test is often performed to detect the surge of LH that triggers the release of an egg from the ovary. This surge usually occurs 24-36 hours before ovulation. LH tests can be done through blood work or at home with urine test kits. Elevated levels of LH can signal that ovulation is imminent, and if levels are abnormal or absent, it may indicate issues with ovulatory function. It's far more common to test LH than it is progesterone to confirm ovulation because ovulation predictor kits are available over the counter, therefore more accessible. 

Doctors may also test estradiol, a form of estrogen that rises as follicles develop. Measuring estradiol can help assess the quality of the ovulatory process and the timing of ovulation, especially when monitored alongside LH and progesterone.

If levels are too low, it may suggest that ovulation isn’t happening properly. In addition, doctors often check thyroid hormones (TSH and free T4) and prolactin. Imbalances in either can disrupt ovulation and affect your ability to conceive. These blood tests are generally accurate and are part of the standard workup for women struggling to get pregnant.

Structural abnormalities

Sometimes the reason behind infertility is structural. Conditions like uterine fibroids, polyps, or scar tissue can block the uterus and fallopian tubes. To assess for these, healthcare providers use several imaging tools.

• Transvaginal ultrasound (TVUS) is a first-line tool that provides a detailed look at the uterus and ovaries. It’s great for spotting things like ovarian cysts, uterine fibroids, or a thin uterine lining, and is recommended for detecting general pelvic abnormalities.
• Hysterosalpingography (HSG) is an X-ray test where dye is injected into the uterus to check if the fallopian tubes are open. If the dye flows freely, your tubes are likely not blocked. While HSG helps diagnose blockages, it doesn’t give a full picture of subtle inflammation or scarring.
• Hysteroscopy may be performed for more detailed uterine imaging only if specific problems are suspected. This involves inserting a thin camera through the cervix to get a close-up look inside the uterus and is particularly helpful when structural issues are suspected.

The vaginal microbiome & Evvy’s new Fertility Insights

One of the most exciting recent developments in fertility testing isn’t about your ovaries or hormones, but rather your vaginal microbiome. 

Your vaginal microbiome is a complex community of bacteria that plays a big role in reproductive health. Research shows that an imbalance, such as a decrease in Lactobacillus bacteria or an overgrowth of harmful microbes, can negatively impact fertility, increase the risk of miscarriage, and reduce the success of in-vitro fertilization (IVF).

Evvy’s Vaginal Health Test uses cutting-edge metagenomic sequencing to analyze your vaginal microbiome and now provides fertility-related insights based on this data. It’s a simple at-home test that helps you understand how your microbiome may be supporting (or potentially interfering with) your ability to conceive.

While this area is still growing, it adds an important and often overlooked layer to the fertility conversation. Addressing vaginal health could improve your chances of a successful pregnancy, especially if you’re undergoing assisted reproductive treatments.

Which fertility tests are most accurate?

Each test serves a different purpose, and none of them can tell the full story on their own. Here's what we know:

• AMH and FSH are reliable for assessing ovarian reserve, but they don’t necessarily predict whether you’ll get pregnant.
• LH tests can indicate issues with ovulation.
• HSG is a great tool for identifying structural abnormalities, though its ability to predict pregnancy outcomes is limited.
• Evvy’s Fertility Insights adds an innovative microbiome layer that may influence both natural and assisted conception success.

There’s no single fertility test for women that tells the whole story, but together, these tests can offer a powerful window into female fertility. 

Fertility is complex and is influenced by a variety of factors beyond just the results of medical tests. While tests like AMH, FSH, and ultrasound tests can provide valuable insights into your chances of conceiving, they’re only part of the bigger picture. 

Age, for example, plays a significant role, as fertility naturally declines as we get older, particularly after the mid-30s. Lifestyle factors, such as diet, exercise, stress levels, smoking, and alcohol consumption, can also have a profound impact on fertility. 

Additionally, it’s important to remember that fertility isn’t just about the woman. Partner factors, including sperm quality and overall health, are also crucial in the conception process. Ultimately, a combination of genetic, environmental, and lifestyle factors can affect fertility, and a holistic approach is often the best way to understand and optimize fertility. 

When should I check my fertility?

If you’re under 35 and have been trying for a year (or over 35 and trying for six months), it’s time to talk to your doctor about fertility testing. But even if you’re not actively trying, tests like AMH or Evvy’s Vaginal Health Test can give you helpful insights for future planning, especially if you have irregular cycles or other symptoms.

FAQ

What tests check female fertility? 

There are several tests used to check female fertility, each focusing on different aspects of reproductive health. Hormone tests, like anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH), assess ovarian reserve, or the number of eggs remaining in the ovaries. Serum progesterone is tested to confirm if ovulation is occurring regularly. Hysterosalpingography (HSG) checks the patency of the fallopian tubes, ensuring they are open and able to transport eggs. These tests help provide a comprehensive view of a woman’s fertility health.

How do doctors check if a woman is fertile? 

Doctors use a variety of tests to get a comprehensive picture of reproductive health. They often start with blood tests like AMH and FSH to check hormone levels and see how many eggs are available. Checking progesterone levels helps to ensure you're ovulating regularly. To learn more about the overall health of the uterus and ovaries, doctors may perform an ultrasound. This allows them to check for any issues like ovarian cysts or uterine fibroids that could impact fertility. Additionally, a hysterosalpingography test can be done to confirm that the fallopian tubes are open and working as they should. All of these tests come together to provide a clearer understanding of a woman’s fertility.

Can I test my fertility as a woman? 

You can test your fertility in a few different ways, both at home and with professional tests. Many women start by using ovulation predictor kits, which can show you when you’re most fertile by detecting hormone changes in your urine. You might also notice physical signs of ovulation, like changes in cervical mucus or fluctuations in your basal body temperature. If you’re interested in a deeper understanding of your fertility, Evvy’s Vaginal Health Test analyzes your vaginal microbiome and provides valuable fertility insights. But if you want a full fertility evaluation, it’s a good idea to chat with a fertility specialist. They can carry out blood tests like checking your AMH and FSH levels, as well as ultrasounds, to give you a complete picture of your ovarian reserve, hormone levels, and reproductive health.