Fertility Tests and Investigations: What Gets Checked for Both Partners

Fertility tests and investigations are the checks that look for why a couple is not conceiving, and they assess both partners: a semen analysis for him, plus ovulation and hormone blood tests, ovarian reserve and tubal checks for her. The aim is not to assign blame but to build a picture, so your team can suggest the right next step. For us it took two appointments to get most of these done, and seeing the results written out was the first time the problem felt like something we could actually act on.

When fertility testing usually starts

Testing usually begins after a year of trying, or after about six months if you are over 36 or have a known reason for concern. NICE advises couples to seek help after a year of regular unprotected sex without conceiving, and sooner if there are red flags such as irregular periods, previous pelvic surgery or a diagnosed condition. Time matters here, especially with age, so do not put off that first appointment. Our guide to when to see a doctor about fertility walks through the timing, and causes of infertility covers what these tests are looking for.

Semen analysis (the male partner)

A semen analysis is usually the first and simplest test, measuring sperm count, movement and shape. It matters because a male factor is involved in roughly half of couples who have trouble conceiving, often alongside a female factor, so testing only one partner can miss the picture. A sample is produced and examined in the lab, and an abnormal result is normally repeated after a few weeks before any conclusions are drawn, because results vary. You can read more in male factor infertility.

Ovulation and hormone blood tests (the female partner)

Blood tests timed to your cycle confirm whether you are ovulating and check the hormones that drive it. The key one is a progesterone test taken about seven days before your period is due (often called a “day 21” test on a 28-day cycle); a raised level suggests you released an egg that cycle. Other bloods may check hormones such as FSH, LH, thyroid function and prolactin. If your periods are irregular, this is often where conditions like PCOS first show up.

Ovarian reserve testing (AMH)

An AMH blood test estimates your ovarian reserve, meaning roughly how many eggs you have left. Anti-Mullerian hormone can be measured at any point in your cycle, which makes it convenient, and it is sometimes combined with an antral follicle count on ultrasound. It mainly helps a clinic predict how your ovaries might respond to IVF stimulation. Two important limits: AMH does not measure egg quality, and a low result does not mean you cannot conceive naturally. Because reserve declines with age, see age and fertility for the bigger picture.

Tubal patency tests

Tubal patency tests check that your fallopian tubes are open, since blocked tubes stop egg and sperm from meeting. A common option is a HyCoSy, an ultrasound scan that passes fluid through the womb and tubes; another is an HSG, an X-ray using dye. Both look for whether the fluid flows through freely. Where endometriosis or scarring is suspected, a laparoscopy (keyhole surgery under general anaesthetic) may be used instead, as it lets the surgeon see the pelvis directly. My HyCoSy was uncomfortable for a few minutes rather than painful, and knowing what to expect beforehand helped a lot.

Pelvic ultrasound

A pelvic ultrasound scans the womb and ovaries to look for anything that might affect conception. It can pick up fibroids, polyps, ovarian cysts and the multiple small follicles that give ovaries a polycystic appearance, and it is often done early in the cycle (around days 2 to 5) because it is quick and non-invasive. It also lets the team count antral follicles alongside an AMH result. Findings here may lead on to further tests or to a specific diagnosis such as endometriosis.

What happens after the results

Once the tests are back, your fertility team puts them together to suggest a way forward. That might be lifestyle advice, medication to support ovulation, surgery, or assisted conception such as IUI or IVF. In around 1 in 4 couples every test comes back normal, which is called unexplained infertility and is still a recognised, treatable situation. Try not to read individual numbers in isolation; they make most sense interpreted together by your team.

This guide is general information and support, not medical advice or a diagnosis. Please see your GP or a fertility specialist to discuss testing and what your own results mean for you.