How is Fertility Evaluation Done? A Step-by-Step Guide

Infertility. One minute you’re hopeful, maybe even excited. Next, you're staring at yet another stark white pregnancy test, wondering what on earth is going on. It’s a painful dance that so many couples know too well.

If you've been caught in that loop, you're not alone. The good news? Fertility testing exists not to scare you but to shed light on the mystery. Think of it as a guided investigation into your reproductive health. 

Before jumping headfirst into medications, treatments, or emotional what-ifs, there's power in knowing exactly what’s going on beneath the surface. Whether you're new to this journey or already knee-deep in ovulation kits and supplements, a fertility evaluation can help cut through the fog.

What is a Fertility Evaluation?

At its core, a fertility evaluation is a deep dive into your reproductive health. It’s a puzzle-solving session with lab tests, imaging, and some pretty sophisticated science, all designed to pinpoint why conception isn’t happening the way it’s supposed to.

It’s not a single test. It’s a sequence of tests looking for clarity. It looks at hormones, checks for structural issues, and examines gametes (that’s sperm and eggs, for the uninitiated), to figure out if something’s off, and what can be done about it.

Purpose of Fertility Testing

RPMG will request fertility testing to: 

• Uncover hormonal issues like low estrogen or high FSH that mess with ovulation
• Spot anatomical roadblocks in the uterus, fallopian tubes, or ovaries
• Evaluate sperm count, shape, movement, and other male factors
• Check for genetic issues that might be quietly disrupting fertility

When to Consider Getting Evaluated

Timing is everything, right? So, when should the alarm bells ring?

If you’re under 35 and have been trying for a baby for a year, with no luck, it’s time to get checked. If this is the case, don’t wait more than six months. Time is a crucial factor when eggs (and sperm) are involved.

Other reasons to consider evaluation:

• Irregular cycles 
• A history of multiple miscarriages
• Known health conditions like endometriosis or PCOS
• Prior surgeries that might have impacted reproductive organs

If something feels off, it probably warrants a second look.

Common Tests in a Fertility Evaluation

No two evaluations are the same. Still, there’s a pretty standard lineup of tests that help paint the fertility picture. 

Blood Tests (FSH, LH, AMH, and Friends)

Your blood holds a great view of what’s going on inside. Some key players include:

• FSH (Follicle-Stimulating Hormone). If levels are high, it might suggest your ovaries are working overtime to release eggs. That can signal low egg reserve.
• LH (Luteinizing Hormone). Helps trigger ovulation. Imbalances here could mean PCOS or other hormone hiccups.
• AMH (Anti-Müllerian Hormone). This one estimates how many eggs you’ve got left in your reserve.
• Estradiol & Progesterone. These give insight into how well your ovulation game is going and whether your cycles are balanced.

The timing of these blood draws isn’t random. They're usually done on specific days of your cycle to catch hormone levels at their most revealing.

Ultrasound and Imaging

Ultrasounds aren’t just for spotting tiny heartbeats. In fertility evaluations, they’re a behind-the-scenes look at your reproductive real estate.

• Transvaginal Ultrasound. Offers a clear view of your uterus, ovaries, and antral follicles
• Hysterosalpingogram (HSG). A dye-based X-ray test that checks if your fallopian tubes are open. Blocked tubes mean that sperm can’t meet the egg.
• Sonohysterogram (SHG). A saline scan that detects fibroids, polyps, or other uterine curveballs that could be messing with implantation.

Semen Analysis

Around 40–50% of infertility cases involve male factors. A semen analysis takes a good, long look at:

• Sperm Count. How many sperm are present in a sample
• Motility. The percentage of sperm that actually move 
• Morphology. Shape matters more than you’d think; oddly shaped sperm might struggle to fertilize an egg
• Volume, pH, and White Blood Cells. All of these play a role in overall ejaculate health.

If something’s off, your doctor might order a sperm DNA fragmentation test, which checks if the sperm’s genetic material is damaged. This can affect both fertilization and miscarriage risk.

Genetic Testing

Sometimes, the issue goes deeper, right into your DNA. Genetic testing can reveal inherited disorders like cystic fibrosis or chromosomal abnormalities that impact fertility. It’s especially helpful for couples with recurrent miscarriages or a family history of genetic conditions. This isn’t a test everyone needs, but when it's relevant, it can be a total game-changer.

How to Prepare for a Fertility Test

Preparing for a fertility test is important, and it’s not just physical preparation; it’s emotional and mental too. 

Diet and Lifestyle Tips

Before you even walk into a clinic, there are steps you can take to set yourself up for success:

• Eat clean. Think antioxidant-rich foods, lean proteins, and healthy fats
• Cut back. Avoid (or drastically reduce) alcohol, caffeine, and processed junk
• Stop smoking. 
• Move your body. Regular exercise boosts circulation and hormone balance
• Manage stress. Yoga, prayer, therapy, and journaling.

What to Expect on the Day of the Test

Some tests are no big deal. Others may feel a bit more personal.

• Blood Work: May need to be done fasting, depending on what’s being tested.
• Semen Sample: Avoid ejaculation for 2–5 days beforehand for the most accurate results.
• Imaging Tests: You may need a full bladder, especially for ultrasounds. 
• General Anxiety: This is normal. Deep breaths help. So does asking your provider to explain every step as they go.

Following the clinic’s instructions is a great way to ensure your tests aren’t altered.

Understanding Your Results

Once the results are in, now what? If your results are abnormal, don’t panic. This doesn’t mean you can’t be able to have children.

What Abnormal Results Might Mean

• Low AMH/High FSH: This could point to low ovarian reserve, but it doesn’t mean you’re out of options.
• Imbalanced LH/FSH Ratio: This may indicate a potential PCOS flag.
• Blocked Tubes (from HSG): It might mean surgery or IVF is your best bet.
• Poor Sperm Morphology/Motility: You may benefit from ICSI, a form of assisted fertilization.

No single test defines your fertility status. It’s the full picture that matters.

Next Steps for Treatment

Once everything’s on the table, you and your doctor will determine a treatment plan tailored to your specific scenario. This might include:

• Supplements like CoQ10, prenatal vitamins, and antioxidant support
• Ovulation induction, where medications like Clomid or Letrozole are given to boost egg release
• Intrauterine Insemination (IUI). Here, sperm is directly placed into the uterus
• In Vitro Fertilization (IVF).
• Surgery to fix fibroids, endometriosis, or tubal blockages
• Donor Eggs/Sperm
• Surrogacy

Final Thoughts

Getting a fertility evaluation might feel overwhelming. You’re laying your hopes on the table and asking science for answers. But answers are powerful. They shift the narrative from “why not” to “what now.” With a solid team, honest data, and a willingness to explore all avenues, you’re not just navigating infertility. You’re reclaiming control. 

FAQs

What is the purpose of a fertility evaluation?

A fertility evaluation helps identify potential reasons you might be struggling to conceive. It assesses hormone levels, reproductive anatomy, sperm health, and more. The goal is clarity, so your medical team can guide you toward treatments that work.

How long does a fertility test take?

Depends on the test. Blood draws take just a few minutes. Ultrasounds or semen analyses take about 20–30 minutes. More complex procedures like HSGs can take up to an hour. A full evaluation may span a few days or weeks, depending on your cycle.

What tests are included in a fertility evaluation?

For women:

• Blood tests (AMH, FSH, LH, estradiol, progesterone, thyroid)
• Ultrasound
• HSG or SHG
• Antral Follicle Count

For men:

• Semen analysis
• Hormone tests (testosterone, FSH, LH)
• DNA fragmentation testing (if needed)

Can fertility evaluations predict my chances of getting pregnant?

Not exactly. They can’t predict the future, but they do highlight issues that might be getting in your way. That information is key when choosing a treatment path.

Does insurance cover fertility testing?

It depends on your plan. Some cover basic diagnostics like blood work or semen analysis. Others require a diagnosis of infertility before approving anything. Always check with your insurer or speak to a financial advisor at your clinic.