The first fertility tests, for each partner

What a first evaluation looks at

Conception needs an egg to be released, sperm to reach it, open fallopian tubes for them to meet, and a uterus where an embryo can implant. A first evaluation checks each of these in turn, for both partners.

Testing both partners at the same time matters. Causes can lie with either partner, or both, and testing one person for months before the other is checked can delay answers.

It starts with a conversation

Before any test, a doctor will usually ask about:

• how long you have been trying, and how often you have sex
• your cycles: how long they are, how regular, and how heavy or painful
• past pregnancies, including any that didn't continue
• past infections, operations, and long-term health conditions
• medicines and supplements, for both partners
• smoking, alcohol and work, and any family history that may be relevant

That history often decides which tests are useful. At an in-person visit, there may also be a physical examination or an ultrasound scan. An online consultation covers the same conversation, and any tests are then arranged at a laboratory or clinic.

For the person with ovaries

Test	What it checks	When it is done
Mid-luteal progesterone	Whether ovulation happened in that cycle	About 7 days before the next expected period
Thyroid and prolactin	Hormones that can affect ovulation	Any day, if indicated
AMH, or a follicle count on ultrasound	Ovarian reserve: roughly how many eggs remain	AMH any day; scan early in the cycle
Transvaginal ultrasound	The uterus and ovaries	Often early in the cycle
Tubal test (HSG or a contrast ultrasound)	Whether the tubes are open	After the period ends and before ovulation

Each of these has more to it than a table can show. Hormone blood tests, the HSG, pelvic ultrasound and the antral follicle count, and checking for ovulation are each covered in their own guides.

Good to know. Not everyone needs every test. A doctor will choose based on your history, and should explain why each one is suggested.

For the male partner

A semen analysis looks at the volume of semen and the number, movement and shape of sperm. It is simple and non-invasive, so it is often one of the first tests. You will usually be asked not to ejaculate for a few days beforehand, as the laboratory advises.

Results vary from one sample to the next, so an unusual result is usually repeated before any decisions are made. Depending on the findings, a doctor may then suggest an examination, hormone tests, or a referral to a urologist or andrologist.

General health checks

Some tests are about preparing for a healthy pregnancy, not about fertility itself. A doctor may suggest checking immunity to rubella (German measles), a blood count for haemoglobin, and blood sugar or blood pressure where relevant. Before treatment such as IUI or IVF, clinics usually test both partners for infections such as HIV, hepatitis B and hepatitis C.

Planning around your cycle

Because some tests have to be done at a certain point in the cycle, it can take one or two cycles to finish the first set. It helps to:

• note the first day of each period, and tell the clinic when it starts
• ask which tests can be done on the same visit
• keep every report, with the date, for both partners

Tests that aren't usually needed at the start

Guidelines generally do not recommend some tests as routine first steps, because they haven't been shown to change what happens next. Examples include the post-coital test, and keyhole surgery (laparoscopy) just to look for a cause in people with no symptoms or history that suggest a problem.

Caution. If a long list of expensive tests is suggested at the first visit, it is reasonable to ask what question each one answers, and how the result would change your plan.

What the tests can't tell you

These tests show whether something might be making conception harder. They do not predict your individual chances, and normal results do not guarantee a pregnancy. Many couples have normal results and simply need more time, or are found to have what doctors call unexplained infertility.

No test result is anyone's fault. A result is information to plan with, not a judgement.

Before your appointment

• Note the first day of your last few periods.
• Gather any previous reports, for both partners.
• Ask for the cost of each suggested test in writing.
• Write down your questions. Our appointment question builder can help.

When to see a doctor

• You are under 35 and have been trying for 12 months, or in your mid-30s and have been trying for 6 months.
• You are 40 or over and want to try.
• At any age, your periods are very irregular or have stopped, you have known endometriosis or a past pelvic infection, or there is a known concern for the male partner.

The guide on when to see a fertility doctor covers these timings in more detail. Fever, severe pain or unusual discharge after a tubal test needs prompt medical advice. For severe pain, heavy bleeding or fainting, call 112 or go to the nearest hospital.