Women are usually evaluated for infertility with a mix of blood tests, imaging, and procedures that check hormones, ovulation, the uterus, and the fallopian tubes.

What infertility means and when testing starts

  • Infertility is typically defined as no pregnancy after 12 months of regular unprotected sex (or 6 months if over 35).
  • Doctors often start with history and a physical exam, then decide which tests make sense for that specific woman.

Think of it as “layers” of evaluation: simple blood work and ultrasound first, then more targeted procedures if needed.

Step 1: History, exam, and basic labs

A doctor usually starts with a detailed medical and menstrual history plus a pelvic exam.

They may ask about:

  • Age, how long you’ve been trying, past pregnancies or miscarriages.
  • Period patterns (regular, very long cycles, very painful periods).
  • Past pelvic infections, surgeries, endometriosis, fibroids, or sexually transmitted infections.
  • Lifestyle factors (weight changes, smoking, intense exercise) and medications.

Basic labs can include:

  • General blood work (complete blood count, metabolic panel) as part of overall health assessment.
  • Screening for sexually transmitted infections, if relevant.

Step 2: Hormone and ovulation testing

These tests look at whether you’re ovulating and whether hormone levels are in a healthy range for conception.

Common tests:

  1. Progesterone blood test (mid‑luteal)
    • Done about a week before your expected period to confirm ovulation.
 * Low levels suggest you may not be ovulating regularly.
  1. Day‑3 FSH and estradiol (ovarian reserve)
    • Blood drawn on cycle day 3 (third day of bleeding).
 * Higher FSH and sometimes abnormal estradiol can suggest fewer remaining eggs or lower ovarian reserve.
  1. Anti‑Müllerian hormone (AMH)
    • Can be measured any day of the cycle.
 * Reflects the approximate quantity of remaining follicles (egg “pool”), often used to assess ovarian reserve.
  1. LH, prolactin, thyroid (TSH), and others
    • LH (luteinizing hormone) may be checked for ovulation problems like polycystic ovary syndrome (PCOS).
 * Prolactin and thyroid tests are important because thyroid disease or high prolactin can disrupt ovulation.

Step 3: Imaging of uterus and ovaries

Imaging looks for structural problems that might interfere with pregnancy.

  1. Transvaginal ultrasound
    • A small ultrasound probe is placed in the vagina to view the uterus and ovaries.
 * Can detect fibroids, polyps, ovarian cysts, endometriomas (endometriosis‑related cysts), and can estimate the number of small follicles (antral follicle count).
  1. Sonohysterography (saline infusion ultrasound)
    • Sterile saline is infused into the uterus during ultrasound.
 * The fluid outlines the uterine cavity, making it easier to see polyps, fibroids that distort the cavity, or scar tissue.

Step 4: Tubes and uterine cavity tests

These tests focus on whether the fallopian tubes are open and whether the inside of the uterus is normal.

  1. Hysterosalpingogram (HSG)
    • An X‑ray test where dye is injected through the cervix into the uterus and fallopian tubes.
 * Shows if tubes are open and whether the uterine cavity has an abnormal shape or filling defects (like polyps or fibroids).
  1. Hysteroscopy
    • A thin camera is passed through the cervix into the uterus.
 * Lets the doctor see the uterine lining directly and often treat problems (remove polyps, cut scar tissue or some fibroids) at the same time.
  1. Laparoscopy
    • A minor surgery where a camera is inserted through small incisions in the abdomen.
 * Used to look for and sometimes treat endometriosis, adhesions (scar tissue), and other pelvic issues that can cause infertility.

Example “testing journey”

A common scenario: first a woman has blood tests for hormones and a transvaginal ultrasound. If those look okay but she still isn’t conceiving, an HSG might be done to check if her tubes are open. If pain or suspected endometriosis is a big factor, laparoscopy could be recommended later on.

Special tests and situations

Not every woman needs every test; doctors tailor the work‑up to the person.

Some additional or situation‑specific tests:

  • Clomiphene citrate challenge test – FSH is checked before and after taking clomiphene; high FSH may indicate reduced ovarian reserve.
  • Genetic tests – may be suggested if there’s very low ovarian reserve at a young age or strong family history of premature menopause.
  • Immunologic or clotting‑related tests – sometimes in cases of recurrent pregnancy loss rather than basic infertility.

Age, medical history, and how long you’ve been trying all influence which tests are chosen and in what order.

Emotional and practical side

Going through infertility testing can feel invasive and emotionally heavy, especially because some tests involve internal exams and procedures.

Many women:

  • Feel anxious while waiting for results and may blame themselves even when they’ve done nothing wrong.
  • Benefit from support groups, online forums, or counseling while navigating decisions about testing and treatment.

If you or someone you know is considering infertility testing, it’s important to talk directly with an OB‑GYN or fertility specialist, who can explain which tests are appropriate and what they mean in that individual case.

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Learn what kind of testing a woman undergoes to check for infertility, including hormone tests, ultrasounds, HSG, hysteroscopy, laparoscopy, and when each is used.

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