Before we recommend any treatment, we believe in understanding why. A thorough fertility evaluation is the foundation of every plan we build, whether it leads to surgery, medication, IUI, or IVF. Here’s what a fertility work-up actually involves and why starting here matters.
A fertility evaluation is a series of tests and exams used to understand what may be affecting your ability to conceive. For couples, this typically includes evaluation of both partners, since fertility challenges can involve either or both people in a relationship. The goal isn’t just to check a box before treatment, it’s to build an accurate picture so any treatment that follows actually addresses what’s happening. Learn more about understanding infertility.
Fertility testing is generally recommended for couples who haven’t conceived after a year of trying, or after six months for women over 35 (learn more about fertility and age). It’s also appropriate any time you have a specific concern, such as irregular periods, a history of pelvic surgery, or a prior diagnosis you want a second opinion on. You don’t need to have been trying for a specific length of time to start an evaluation if something feels off to you. An evaluation can also help identify conditions that may affect fertility, such as endometriosis, PCOS, and fibroids.
Your evaluation usually starts with a detailed conversation about your health history, menstrual cycle, and any previous fertility treatment. From there, your provider will recommend specific tests based on your situation, rather than a single standardized checklist for everyone.
Testing typically includes bloodwork to check hormone levels, a pelvic ultrasound, and for many patients, a hysterosalpingogram, or HSG, to check whether the fallopian tubes are open. For male partners, a semen analysis is usually one of the first steps, since male-factor infertility is involved in a substantial share of infertility cases.
Once your results are in, your care team will walk you through what they found and what it means for your options. This is the point where a clear, honest conversation matters most, since your results will shape whether surgery, medication, IUI, IVF, or a combination is the right next step for you.
An AMH test measures a hormone related to how many eggs remain in your ovaries, often called your ovarian reserve. It’s normal for ovarian reserve to decline with age, and the AMH test can help estimate the size of your reserve and how you might respond to fertility medications, though it can’t predict on its own whether you’ll conceive. This test is often paired with an antral follicle count, an ultrasound measurement that looks at the follicles visible in your ovaries.
An HSG is an X-ray procedure that checks whether your fallopian tubes are open and looks at the shape of your uterus. During the test, a contrast dye is placed into the uterus through a thin catheter, and X-ray images are taken as the dye moves through the tubes. Most patients experience cramping similar to a menstrual cramp during the procedure, and it’s generally scheduled in the first half of your cycle, after your period ends but before ovulation.
A semen analysis checks the number, movement, and shape of sperm in a sample, and it’s typically one of the first tests done to evaluate male fertility. This test can help identify whether a sperm-related factor may be contributing to infertility, and it’s a straightforward, non-invasive place to start.
Starting with a complete evaluation, rather than jumping straight to a treatment cycle, means any next step is based on your actual diagnosis rather than a guess. For patients who’ve had a prior failed cycle elsewhere, a fresh, thorough work-up can sometimes surface something that was missed the first time.
Coverage for fertility testing varies by insurance plan, and some states require certain fertility services to be covered. Our team can help you understand your specific benefits as part of your evaluation. Learn more on our insurance and financial page or take our fertility insurance coverage quiz.
Our diagnostic evaluations are led by board-certified reproductive specialists and supported by our integrated, on-site embryology lab, so testing, diagnosis, and any resulting treatment happen under continuous, coordinated care.
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