Fertility tests your doctor may order
A clear, evidence-based guide to every fertility test your doctor may order after a year of trying to conceive — ovulation, hormones, tubes, and semen analysis.
In short
Doctors usually start testing after a year of trying without success. That's the standard definition of infertility. The workup checks a few key links in the chain. It looks at whether you're ovulating, your hormone levels, whether your fallopian tubes are open, and a semen analysis for your partner. None of these tests are a mystery. Each one checks a specific, clear step needed for conception.
Sourced from StatPearls (NCBI Bookshelf), NICHD, Cleveland Clinic, ASRM (ReproductiveFacts.org) · Updated August 15, 2026
When months of trying start to add up without a positive test, it's natural to want answers instead of more waiting. The good news: fertility testing isn't a mystery. It's a fairly standard set of blood tests, one imaging study, and a semen analysis. Each one checks a specific link in the chain needed for conception. Doctors look at whether an egg is released. They also check whether it can travel to meet sperm, and whether the sperm itself is up to the job.
Doctors generally define infertility as not conceiving after one year of unprotected sex, according to StatPearls (NCBI Bookshelf). That one-year mark is usually the point where a doctor moves from watching and waiting to ordering tests. Here's what that testing roadmap actually looks like, test by test, and what each one checks for.
What does "not conceiving" actually mean, medically?
Before any testing starts, it helps to know the definition doctors are working from. Infertility is generally defined as not conceiving after one year of unprotected sex, per StatPearls (NCBI Bookshelf). This isn't a judgment on your body. It's simply the point where a doctor knows it's time to stop waiting and start investigating.
That single definition sets the whole roadmap in motion. Once you've reached it, the workup that follows checks each of the biological steps needed for pregnancy, one at a time. That way any issue can be found rather than guessed at.
How do doctors confirm you're actually ovulating?
The first question in most fertility workups is whether ovulation is happening at all. There are two different tools used to look at this from two angles. Over-the-counter ovulation predictor kits detect a rise in luteinizing hormone (LH) in urine one to two days before ovulation, according to ASRM (ReproductiveFacts.org). LH is a hormone that triggers your ovary to release an egg. This means the kits forecast that ovulation is about to happen.
To actually confirm that ovulation took place, rather than just predict it, doctors may order a blood test. It's done around day 23 of your cycle, to measure progesterone levels, per NICHD. Progesterone rises after an egg has been released. So a healthy level on that test is evidence the release already happened. That's a different kind of confirmation than a urine kit can offer on its own.
How do doctors check how many eggs you have left?
Beyond confirming ovulation cycle to cycle, doctors also want a sense of the bigger picture. That means how many eggs are left. Blood tests measuring follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH) help estimate the size of your remaining egg supply. This is known as ovarian reserve, according to NICHD.
These two hormone levels give a doctor context for the rest of the workup and for any conversations about next steps. That's because they speak to egg quantity rather than any single cycle's ovulation status.
Why do doctors also check thyroid and prolactin levels?
Fertility testing doesn't stop at the hormones directly involved in ovulation. It also checks hormones that can throw the whole system off indirectly. Blood tests for thyroid-stimulating hormone (TSH) and prolactin are part of a standard infertility workup. That's because they help identify thyroid disorders and high prolactin levels, per ASRM (ReproductiveFacts.org).
Including these two tests reflects how connected your hormone system is. A thyroid or prolactin imbalance elsewhere in the body can be part of the picture. So doctors check for it alongside the more obviously reproductive hormones.
What does the hysterosalpingogram (HSG) look for?
Once hormone levels have been checked, the next question is often structural: are your fallopian tubes actually open? In a hysterosalpingogram (HSG), X-rays capture a dye injected into your uterus as it travels through the fallopian tubes. The test looks for blockages, according to Cleveland Clinic.
This test matters. Even with normal ovulation and healthy hormone levels, a blocked tube can stop an egg and sperm from ever meeting. The HSG gives a direct, visual answer to that specific question.
What does a semen analysis check?
Fertility testing isn't only about the female partner's body. A semen analysis checks for problems such as low sperm count and poor sperm movement, per Cleveland Clinic. It's typically ordered early in the workup alongside the ovulation and hormone testing.
The results are measured against specific World Health Organization reference values. These are a total sperm count of 39 million sperm per ejaculate or more, and greater than 32% of sperm actively moving forward (progressive motility), according to StatPearls. Those two numbers are how many sperm there are, and how well they move. Together, they give a concrete, evidence-based read on this half of the fertility equation.
Frequently asked questions
How long should we be trying before a doctor starts running fertility tests?
Infertility is generally defined as the inability to conceive after one year of unprotected intercourse, according to StatPearls (NCBI Bookshelf). That one-year mark is the benchmark most doctors use. It's the trigger point for starting a formal diagnostic workup.
What test actually confirms that ovulation happened, not just that it's approaching?
To help confirm ovulation, doctors may order a blood test. It's done around day 23 of a woman's menstrual cycle, to measure progesterone levels, per NICHD. A progesterone rise after the expected ovulation window is the evidence that an egg was actually released.
Is an ovulation predictor kit the same thing as the progesterone blood test?
No. Over-the-counter ovulation predictor kits detect a rise in luteinizing hormone (LH) in urine. That rise occurs one to two days before ovulation, according to ASRM (ReproductiveFacts.org). They forecast ovulation is about to happen. The progesterone blood test, done later in the cycle, confirms it already did.
What does a hysterosalpingogram actually look for?
In a hysterosalpingogram, X-rays capture an injectable dye as it travels through the fallopian tubes. The test looks for blockages, per Cleveland Clinic. It's a direct, visual check of whether the tubes are open.
What counts as a normal result on a semen analysis?
A semen analysis is checked against World Health Organization reference values. These are a total sperm number of 39 million sperm per ejaculate or more, and greater than 32% progressive sperm motility, according to StatPearls. Cleveland Clinic notes the test is specifically looking for problems like low sperm count and poor sperm mobility.
Sources
- Infertility is generally defined as the inability to conceive after one year of unprotected sexual intercourse. — StatPearls (NCBI Bookshelf)
- A semen analysis is checked against a World Health Organization reference value of a total sperm number of 39 million sperm per ejaculate or more. — StatPearls (NCBI Bookshelf)
- Semen analysis results are also compared to a World Health Organization reference value of greater than 32% progressive sperm motility. — StatPearls (NCBI Bookshelf)
- To help confirm ovulation, doctors may order a blood test around day 23 of a woman's menstrual cycle to measure progesterone levels. — NICHD
- Blood tests measuring follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH) are used to help determine the quantity of a woman's remaining egg supply, i.e., ovarian reserve. — NICHD
- In a hysterosalpingogram, X-rays capture an injectable dye as it travels through the fallopian tubes, and the test looks for blockages. — Cleveland Clinic
- A semen analysis checks for problems such as low sperm count and poor sperm mobility. — Cleveland Clinic
- Blood tests for thyroid-stimulating hormone (TSH) and prolactin are part of an infertility workup because these levels help identify thyroid disorders and hyperprolactinemia. — ASRM (ReproductiveFacts.org)
- Over-the-counter ovulation predictor kits detect a rise in luteinizing hormone (LH) in urine that occurs one to two days before ovulation. — ASRM (ReproductiveFacts.org)
Educational information, not medical advice — always consult your doctor.