How Can Women Check Their Fertility? A Guide To Female Fertility Tests

Women can check their fertility with blood tests, a pelvic ultrasound scan and tests of the fallopian tubes. Blood, urine and saliva tests can be done at home, while scans and tubal tests need a clinic or hospital.

No single test can tell you for certain whether you’ll get pregnant, but together they give a clear picture of your reproductive health. This guide explains how each test works, whether it hurts, how to get it and what your results mean.

Quick facts

• Blood tests are usually the first step. They can show your ovarian reserve, whether you’re ovulating, and signs of conditions such as PMOS or thyroid problems.
• AMH and an antral follicle count (AFC)on a scan together give the clearest picture of your ovarian reserve, but neither can predict natural conception.
• A standard scan can’t show whether your fallopian tubes are open. That needs a specific tubal test.
• Urine and saliva tests help you track ovulation, but they can’t tell you about your ovarian reserve or hormone health.
• On the NHS, fertility tests are usually offered after a year of trying to conceive, or sooner if you’re 36 or over.
• Both partners should be assessed, as fertility problems can affect either or both of you.

How does female fertility work?

To get pregnant naturally, four things need to work together. Fertility tests are designed to check each of them.

1. You need to ovulate regularly. Across your menstrual cycle, which typically lasts 21 to 35 days, hormones from your brain called FSH and LH prompt one of your ovaries to release an egg. Ovulation typically happens around the middle of the menstrual cycle (around day 14 of a 28-day cycle, but it might be later or earlier depending on your cycle length)

Ovulation problems are one of the most common causes of difficulty getting pregnant, and they’re often linked to PMOS, thyroid problems or raised prolactin. Checked with: hormone blood tests, ovulation predictor tests and pelvic ultrasound scan.

You need a supply of eggs. You’re born with all the eggs you’ll ever have. Your supply, known as your ovarian reserve, falls gradually over time and more quickly from your mid-30s, and egg quality declines too. That’s why age is the single biggest factor in female fertility. Checked with: an AMH blood test and an antral follicle count on a scan.

2. Your fallopian tubes need to be open. The fallopian tubes are where sperm meets the egg, so if they’re blocked or damaged, fertilisation can’t happen. Checked with: a tubal test.
3. Your womb needs to be ready for pregnancy. After ovulation, oestrogen and progesterone prepare your womb lining so a fertilised egg can implant. Fibroids, polyps or differences in the shape of your womb can get in the way. Checked with: a pelvic ultrasound scan.
4. Sperm need to be healthy. Sperm problems cause fertility difficulties just as often as problems with ovulation. Checked with: a semen analysis.

Your general health plays a part too. Nutrition, sleep, stress, alcohol and smoking can all affect your fertility. Maintaining a healthy lifestyle is essential for optimising reproductive function.

When should you take a fertility test? // Why and when should you check your fertility?

There’s no single right time to get a fertility test, and you don’t need to be trying to conceive. It’s worth testing whenever the answer would help you plan, make a decision or get the right support. With fertility rates falling and many people starting families later, more people are choosing to understand their fertility earlier.

You might want a fertility test if:

• you’re under 36 and haven’t conceived after a year of regular unprotected sex
• you’re 36 or over and haven’t conceived after six months of trying
• you want to understand your fertility so you can plan for the future
• you’re thinking about freezing your eggs or embryos
• you want to know whether your ovarian reserve is typical for your age
• you have irregular periods, or a history of a condition that can affect fertility, such as PMOS (formerly known as PCOS), endometriosis, sexually transmitted infections, pelvic surgery or cancer treatment
• you’ve had recurrent miscarriages

You don’t need to be trying to conceive to get a fertility test. Understanding your fertility now can give you peace of mind and help you plan.

Before you start trying

Many people wait a few months after trying to get pregnant before they think about a fertility test. Testing at the start of your journey means you begin from a place of knowledge instead. It can pick up anything worth addressing early. That gives you time to get treatment or make lifestyle changes that could support your fertility before you start trying. The Advanced Hormone and Fertility Test gives you that baseline.

If you’re planning for the future

If you’re thinking about delaying pregnancy until later in life, or you’re concerned about how your fertility will change with age, testing can help you understand where you stand today. An ovarian reserve test shows whether your egg supply is typical for your age. That can help you understand how long you may have to plan and review the options available to you, including whether egg or embryo freezing is worth considering. Egg quality tends to be better the younger you freeze, so it is worth thinkingabout this early. A Fertility Advisor Call can help you weigh up your options based on your results.

If you’ve been trying for a while

NHS guidance is to see your GP if you’re under 36 and haven’t conceived after a year of regular unprotected sex.  If you’re 36 or over, or you have a known reason for concern, go after six months. But you don’t have to wait that long to find out what’s going on. Testing sooner can pick up causes such as ovulation problems early, so you can get the right support and treatment sooner. That matters, because fertility declines with age. If you need to go further, Hertility can arrange a Pelvic Ultrasound Scan, tubal testing and a semen analysis for your partner.

If you’ve had fertility difficulties before

If you’ve struggled to conceive in the past or had recurrent miscarriages, testing can help find an underlying cause. That might be a hormone imbalance, a structural problem with your womb or Fallopian tubes, or a genetic factor. Fertility problems can also happen after you’ve already had a baby, even if you conceived easily the first time. This is known as secondary infertility, and it’s more common than many people realise. A Private Gynaecologist Consultation can look at your history in depth and recommend the right investigations.

If you have symptoms or a health condition

Irregular, very painful or very heavy periods can be a sign of a condition that affects fertility. They’re worth investigating whether or not you’re trying for a baby. A Hertility Advanced Hormone and Fertility Test can help you understand what’s driving your symptoms.

If you have a condition that can affect fertility. This includes a diagnosis or history of PMOS (formerly known as PCOS), endometriosis, a thyroid disorder or a sexually transmitted infection. It also applies if you’ve had pelvic surgery or cancer treatment. Each of these can affect your hormones, ovaries, womb or Fallopian tubes, so it’s worth checking your fertility sooner rather than later.

Fertility worries can feel overwhelming, whatever stage you’re at. Talking to people you trust, or to one of our counsellors, can help.

What are the different types of fertility tests for women?

Blood tests for female fertility 

Blood tests are usually the first step in checking your fertility. They show whether you’re ovulating and how your reproductive hormones are working, and they can check other aspects of your health that matter before pregnancy. You can have them through your GP, at a clinic or at home with a finger-prick kit.

AMH (anti-Müllerian hormone) AMH gives an indication of your ovarian reserve: roughly, how many eggs you have compared with others your age. It’s useful if you’re planning ahead, considering egg freezing or preparing for IVF, where it helps predict how your ovaries will respond to fertility medication. A high AMH can also be one sign of PMOS, but it can’t diagnose PMOS on its own. It reflects egg quantity, not quality, and can’t predict whether you’ll conceive naturally. AMH isn’t usually offered by GPs, but it’s used by fertility clinics and available through at-home tests like Hertility.

FSH, LH and oestradiol. These show how your brain and ovaries are communicating. They’re usually tested early in your cycle, around day 2 to 5, when they’re at their baseline levels. Raised FSH can suggest your ovaries are working harder to respond, while low levels of all three can point to a problem with the signals from your brain. Find out why cycle day 3 matters for hormone testing.

Progesterone. This test confirms whether you’ve ovulated. Progesterone rises after ovulation, so it’s measured about seven days before your next period is dueThat’s around day 21 in a 28-day cycle, and later if your cycles are longer. If your cycles are irregular, the test may need to be repeated. It’s one of the first tests a GP usually offers.

Thyroid hormones, prolactin and androgens. An underactive or overactive thyroid and raisedprolactin can both disrupt ovulation. Androgens such as testosterone, along with SHBG, can point towards PMOS (polyendocrine metabolic ovarian syndrome, formerly known as PCOS).

Blood tests beyond hormones. Depending on your situation, blood tests may also check:

• Immunity to infections that can harm a pregnancy. This means rubella (German measles), and sometimes chickenpox if you’re not sure you’ve had it. If you’re not immune, you can be vaccinated before trying to conceive. You’ll be advised to avoid getting pregnant for a short time afterwards, usually a month.
• General health markers, such as iron, vitamin D and vitamin B12. These affect your energy and overall health and matter before pregnancy. 
• Blood sugar. A test such as HbA1c can check for diabetes or raised blood sugar. These are more common with PMOS and important to manage before pregnancy.

Waiting a year for NHS tests isn’t your only option. The Advanced Hormone and Fertility Test lets you check up to 10 hormones and 4 deficiency markers from home, whenever you’re ready, with a doctor-written report explaining your results.

Pelvic ultrasound scan

A pelvic ultrasound scan also known as a baseline ultrasound, transvaginal ultrasound or endovaginal ultrasound, is an internal scan of your reproductive organs. It’s usually done transvaginally, with a small probe placed gently into your vagina, because this gives the clearest images. It looks at :

• Your ovaries. The scan counts the small follicles visible in your ovaries, known as your antral follicle count (AFC). This is usually done early in your cycle. Together, AMH and AFC give the clearest picture of your ovarian reserve. The scan can also pick up cysts, endometriomas (cysts linked to endometriosis) and polycystic ovaries.
• Your womb. It checks the size and shape of your womb and the thickness of its lining, and it can pick up fibroids, polyps, some types of endometriosis.
• Your cervix. It can show some structural problems with your cervix.

A standard scan can’t show whether your Fallopian tubes are open. It can, though, sometimes spot signs of a problem, such as a fluid-filled tube (hydrosalpinx).

You can have a scan through the NHS as part of fertility investigations, or book one privately. Hertility’s Pelvic Ultrasound Scan needs no GP referral. Every scan is reviewed by a Hertility gynaecologist, who writes a report explaining what it means for you.

Tests to look inside the uterus ( womb )

If your scan shows a possible problem, or you’ve had recurrent miscarriages or unsuccessful fertility treatment, you may be offered a closer look at the inside of your womb. There are two main tests:

• Saline infusion sonohysterogram (SIS). This is a type of pelvic ultrasound. Sterile salt water (saline) is passed into your womb through a thin tube. The saline gently expands the womb, which makes it easier to see its inner walls and spot problems such as polyps, fibroids or scar tissue.
• Hysteroscopy. A doctor passes a thin camera with a light through your vagina and cervix into your womb, so they can see inside it directly. No cuts are made in your skin. You’re usually awake and can go home the same day, although you can ask about pain relief or a general anaesthetic. A hysteroscopy can find polyps, fibroids and scarring. Some of these, such as small polyps, can be removed during the same procedure.

Tubal tests

Tubal tests check whether your Fallopian tubes are open. There are three main types:

• Hysterosalpingogram (HSG). A dye is passed through your cervix into your womb, and X-rays show whether it flows freely through your tubes.
• Hysterosalpingo-contrast-ultrasonography (HyCoSy). This works in a similar way, but it uses ultrasound instead of X-rays.
• Laparoscopy. This is keyhole surgery under general anaesthetic, where a small camera looks at your womb, tubes and ovaries. It’s usually offered if you might have endometriosis or scarring, and some problems can be treated at the same time. 

HSG and HyCoSy are usually done in the first half of your cycle, before ovulation. Tubal testing is available through Hertility, as part of joined-up care alongside your hormone test.

Infection and cervical screening

You’ll usually be tested for chlamydia, often alongside gonorrhoea, using a urine sample or a swab. Both infections can cause no symptoms while still damaging your fallopian tubes, so testing is especially important before a procedure such as an HSG.

If you go on to have IVF or other assisted treatment, both partners will also have blood tests for HIV, hepatitis B and hepatitis C, which is a legal requirement. The Human Fertilisation and Embryology Authority (HFEA), the UK’s fertility regulator, requires these screening tests to have been done no more than three months before your first course of treatment starts. Some clinics test for other infections too.

You’ll also usually be asked whether your cervical screening (smear test) is up to date. It isn’t a fertility test itself, but it’s recommended before trying to conceive and before fertility treatment.

At-home urine and saliva tests

Urine and saliva tests are mainly designed to track ovulation, not to assess your overall fertility:

• Ovulation tests are urine strips that detect the LH surge 24 to 36 hours before you ovulate, to help you time sex. A positive result shows the surge has happened, not that you’ve definitely ovulated.
• Urine progesterone tests detect a by-product of progesterone (PdG) that rises after ovulation, suggesting you’ve ovulated that cycle.
• Urine fertility monitors track several hormones across your cycle to map your fertile days.
• Urine FSH tests show whether your FSH is above a set level. They give only a rough, one-off indication and can’t measure your ovarian reserve.
• Saliva tests use a small microscope to look for a fern-like pattern that can appear before ovulation. They’re generally less reliable than urine or blood tests.

These tests can help you understand your cycle, but only a blood test can measure your ovarian reserve and show how your hormones are working together. For a full comparison, read our guide to at-home fertility tests for women.

Other tests

Genetic tests. These can identify inherited conditions that may affect your fertility or be passed on to a baby. You may be offered them through a specialist if you or your partner have a family history of a genetic condition, or if you’ve had recurrent miscarriages.

Fertility add-ons. Some private clinics offer extra tests, such as endometrial receptivity testing, which takes a small sample of your womb lining. . The HFEA rates the evidence for many of these add-ons, so it’s worth checking its ratings before paying for one.

Semen analysis for your partner

Sperm problems cause fertility difficulties just as often as problems with ovulation, so both partners should be assessed. A semen analysis looks at the number, movement and shape of sperm. At-home sperm tests can give a basic first check, but a lab semen analysis gives the full picture. Your partner may also have a blood test to check for hormone problems that could affect their fertility.

Where can you get a fertility test in the UK?

You can get a fertility test through the NHS, at home or at a private clinic. Which is right for you depends on how long you’ve been trying, whether you have symptoms and how quickly you want answers.

On the NHS

NHS guidance is to see your GP if you haven’t conceived after a year of regular unprotected sex. See them sooner if you’re 36 or over, or if you have a known reason for concern, such as irregular periods, endometriosis, PMOS or previous cancer treatment.

Your GP will usually start with:

• a progesterone test to check you’re ovulating
• FSH and LH tests if your periods are irregular
• a check of your rubella immunity
• a chlamydia test
• a check that your cervical screening is up to date
• a semen analysis for your partner

Depending on your results, you may then be referred to a hospital gynaecology department or an NHS fertility clinic for a pelvic ultrasound scan, tubal tests and a specialist assessment. Waiting times for these appointments vary across the country.

NHS fertility treatment. If you need treatment, what’s available on the NHS depends on where you live. National guidance recommends IVF for women under 40 who haven’t conceived after two years of trying, or after 12 cycles of artificial insemination. But local funding decisions can mean fewer cycles, and extra criteria can apply. These may relate to your age, your BMI, whether you smoke, or whether you or your partner already have children. Criteria also differ between England, Scotland, Wales and Northern Ireland.

What the NHS doesn’t usually offer. NHS fertility tests are designed to investigate fertility problems, not to check your fertility proactively. So if you’re not trying to conceive yet, or you’d like to understand your fertility to plan for the future, you usually won’t be offered tests. AMH testing, which gives an indication of your ovarian reserve, isn’t routinely available through your GP. To check proactively, you’ll need to test at home or privately.

Fertility tests for women at home

At-home fertility tests let you check your fertility whenever suits you. You don’t need a referral, symptoms or months of trying first, and you can test privately without taking time off for appointments. Unlike the NHS at-home fertility tests empower you to explore your fertility without specific symptoms, age restrictions, or prolonged attempts to conceive.

There are two main types. Urine and saliva tests give you instant results, but they only track ovulation. Blood tests are analysed in a lab and give a much fuller picture of your hormones and ovarian reserve. They can also flag signs of conditions such as PMOS or thyroid problems.

With Hertility’s Advanced Hormone and Fertility Test, testing works like this:

1. Take the Online Health Assessment. It asks about your medical history, cycle, symptoms and goals, and builds a hormone panel personalised to you from up to 10 forms..
2. Collect your sample on the right day. Your test is timed to your cycle, and you can use an at-home finger-prick kit or book a nurse visit.
3. Get your results. On average, they’re ready 6 days after the lab receives your sample. They come with a doctor-written report and a personalised Care Plan explaining what they mean and what to do next.
4. Take the next step if you need to. You can book a Pelvic Ultrasound Scan, tubal testing, semen analysis for your partner or a specialist consultation, all without a GP referral. You can also share your report with your GP.

You can test at any life stage, with or without symptoms. You can also test if you use hormonal contraception, although your cycle hormones can’t be measured while you’re on it.

Whichever at-home test you choose, check that the lab is accredited. It’s also worth reading independent reviews on platforms such as Trustpilot.

At a private clinic

Private clinics offer fertility tests and assessments without NHS waiting times. You can usually book directly, without a GP referral. There are two main types:

• Private gynaecologists can investigate symptoms and fertility concerns, arrange scans and tests, and diagnose conditions such as endometriosis, fibroids or PMOS.
• Fertility clinics offer full fertility assessments and fertility treatment, such as IVF, IUI and egg freezing.

What a private fertility assessment usually includes:

• a consultation with a specialist
• blood tests, including AMH
• a pelvic ultrasound scan with an antral follicle count
• a semen analysis for your partner

Costs vary widely, so check exactly what’s included before you book. Be cautious about paying for extra tests sold as “add-ons” without asking what evidence supports them, because the HFEA rates the evidence for many of them. If you go on to have fertility treatment, check that the clinic is licensed by the HFEA. You can see a clinic’s licensing status and success rates on the HFEA website.

What fertility problems can testing find?

Fertility tests can help identify a range of conditions:

• PMOS, a common hormonal condition that can stop you ovulating regularly.
• Thyroid problems, as an underactive or overactive thyroid can disrupt your cycle and ovulation.
• Raised prolactin, which can disrupt your cycle and ovulation.
• Fibroids or polyps, non-cancerous growths in or on the womb that can affect implantation.
• Endometriosis, where tissue similar to the womb lining grows elsewhere, which can cause pain and affect fertility. It’s usually confirmed with a laparoscopy.
• Blocked or damaged fallopian tubes, often caused by scarring from infection, endometriosis or previous surgery.
• Pelvic inflammatory disease (PID), an infection of the reproductive organs, often caused by untreated sexually transmitted infections, which can scar the fallopian tubes.
• Premature ovarian insufficiency (POI), where the ovaries stop working normally before the age of 40.
• Sperm problems in your partner, such as a low sperm count or poor sperm movement.

For around 1 in 4 couples, tests don’t find a clear cause. This is known as unexplained infertility. It can be frustrating, but it doesn’t mean there’s nothing that can help.

What happens after a fertility test?

Your next steps depend on what your tests show and what you want. Options include:

• Lifestyle support. Balanced nutrition, regular activity, good sleep, managing stress, cutting down on alcohol and stopping smoking can all support your fertility. If you’re carrying extra weight, your doctor may talk to you about whether weight loss could help.
• Supplements. Everyone trying to conceive is advised to take folic acid, and some people need a higher dose. If tests show a deficiency, such as low vitamin D, a supplement may help. Always check with a doctor, pharmacist or registered nutritionist before starting anything new.
• Treating an underlying condition. Treating a condition such as PMOS or a thyroid problem, sometimes with medication, can help restore regular ovulation.
• Ovulation induction. If you’re not ovulating regularly, medication to trigger ovulation is often effective.
• IUI or IVF. For blocked tubes, unexplained infertility or other causes, treatments such as IUI (intrauterine insemination) or IVF (in vitro fertilisation) may be recommended.
• Egg freezing. If you’re not ready for a baby yet, you might consider freezing your eggs. When you’re ready to use them, they’re thawed and fertilised in a lab, and the resulting embryo is transferred to your womb.

Fertility testing in special circumstances

Before and after cancer treatment

Chemotherapy, radiotherapy and some surgeries can affect your fertility. If you’re about to start cancer treatment, ask your care team about fertility preservation, such as egg or embryo freezing, before treatment begins. This can give you the best chance of having a baby in the future. NHS funding for fertility preservation is available in many areas.

After treatment, fertility tests can show how your ovaries have been affected and help you plan your options. These tests can feel emotionally difficult, so it’s worth having support in place.

If you have a known genetic condition

If you or your partner have a genetic condition, or a family history of one, preconception counselling with a genetics specialist can help you understand your options. These may include:

• carrier screening to see whether you carry a particular gene
• testing embryos during IVF
• prenatal testing during pregnancy

If you have symptoms, a history of cancer treatment or a known genetic condition, speak to a healthcare professional sooner rather than later, especially if you’re hoping to conceive soon.

Ready to understand your fertility with Hertility?

Hertility brings the key female fertility tests together in one place, without waiting lists or GP referrals. The Advanced Hormone and Fertility Test measures up to 10 hormones from a finger-prick sample, with a doctor-written report and a personalised Care Plan.

From there, you can add a Pelvic Ultrasound Scan, tubal testing and semen analysis for your partner. Specialists can guide you through what comes next, including referrals to trusted clinics for egg freezing or IVF.

Not sure where to start? Take the Online Health Assessment and we’ll recommend the right tests for you.

FAQs in fertility testing

References

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