Fertility tests for couples

When an assessment is usually advised

The World Health Organization defines infertility as no pregnancy after 12 months or more of regular unprotected intercourse, and estimates that about one in six people of reproductive age experience it at some point in their lives. Most couples conceive within a year of trying.

NICE, in the UK, advises offering both partners an assessment after a year of trying, and a specialist referral straight away when the woman is 36 or older or when either partner has a known or suspected cause. The American Society for Reproductive Medicine (ASRM) suggests starting at six months when the woman is 35 or older.

• Couples who have been trying for a year, or for six months when the woman is 35 or older
• Irregular or absent periods, or known PMOS/PCOS or endometriosis
• A history of pelvic infection or pelvic surgery, or treatment such as chemotherapy, in either partner
• A known sperm problem, or previous testicular surgery or injury

Why both partners are tested

According to the European Association of Urology, a male factor is found in about half of couples who have difficulty conceiving. For this reason, guidelines assess both partners from the start, and NICE advises offering further assessment and investigation to both.

What the standard tests look at

For the woman: a medical history (cycles, previous pregnancies, general health and medicines) and blood tests chosen to answer specific questions. A progesterone test in the second half of the cycle checks whether ovulation is happening; with irregular cycles, the hormones FSH and LH are measured too. An ultrasound scan looks at the uterus and ovaries. NICE advises adding thyroid and prolactin tests only when symptoms or an ovulation problem suggest them.

Ovarian reserve: AMH (anti-Müllerian hormone) and the antral follicle count on ultrasound estimate how the ovaries are likely to respond to stimulation in IVF. NICE advises against using AMH to predict the chance of natural conception; age remains the main guide to that.

The fallopian tubes: when nothing in the history suggests tubal damage, an X-ray with dye (hysterosalpingography) or a contrast ultrasound checks whether the tubes are open; laparoscopy is used when other pelvic problems are suspected. Screening for chlamydia is advised before any procedure that passes through the cervix.

For the man: a semen analysis, compared with the World Health Organization reference values, and a short history. An abnormal analysis is repeated, ideally about three months later, before conclusions are drawn; see male infertility.

General checks: rubella immunity, with vaccination for anyone who is not immune, and whether cervical screening is up to date. When infertility remains unexplained, NICE suggests considering a blood test for coeliac disease.

What the assessment can and cannot tell

The assessment answers practical questions: is ovulation happening, are the tubes open, does the uterus look normal on imaging, and is the semen analysis within the reference range. It cannot measure egg quality directly, and normal tests do not mean that a pregnancy will follow. When all the standard tests are normal, the diagnosis is unexplained infertility, which means that these tests have not found a cause.

What comes next depends on the findings, on age and on how long you have been trying. It can range from continuing to try, with intercourse every two to three days as NICE advises, to ovulation induction, IUI or IVF. Your doctor can explain which of these applies to you.