Tests for Her: Ovarian Reserve
Ovarian reserve tests tell you how many eggs you have left and how your ovaries are likely to respond to stimulation. They don’t measure egg quality directly (only age does that reliably), but they’re essential for treatment planning.
The single most informative fertility test. AMH is produced by small follicles in the ovaries and correlates directly with your remaining egg supply. Higher = more eggs available. Low AMH (<1.0) suggests diminished reserve; very low (<0.5) indicates significantly reduced options. Unlike FSH, AMH can be drawn on any day of your cycle.
Your doctor counts the small (2–10mm) resting follicles visible on ultrasound at the beginning of your cycle. This number predicts how many eggs you’re likely to produce with stimulation. AFC <6 suggests poor response; >20 may indicate PCOS. Combined with AMH, this gives the most complete picture of ovarian reserve.
FSH (follicle-stimulating hormone) is your brain’s signal to the ovaries. When ovarian reserve is low, your body produces more FSH to compensate—like shouting louder when someone can’t hear. FSH >10 suggests declining reserve; >15 indicates significantly diminished reserve. Estradiol should be <80 pg/mL on Day 3; elevated estradiol can artificially suppress FSH, masking a problem.
Tests for Her: Structural & Hormonal
The HSG determines whether your fallopian tubes are open. Dye is injected through the cervix; if it flows through both tubes and spills into the abdomen, the tubes are patent. Blocked tubes mean IUI won’t work and IVF is needed. The test also reveals uterine abnormalities (fibroids, polyps, septum). Some studies suggest a slight fertility boost in the months following an HSG, possibly from the flushing effect.
Thyroid disorders are a surprisingly common and treatable cause of infertility. Both hypothyroidism and hyperthyroidism can disrupt ovulation and increase miscarriage risk. The fertility-optimal TSH range (1.0–2.5) is narrower than the general “normal” range. Easy to treat with medication if out of range.
Elevated prolactin can suppress ovulation. Causes include stress, certain medications, and rarely a small pituitary tumor (prolactinoma, which is benign and treatable). If elevated, your doctor will likely recheck and may order an MRI.
Tests for Him: Semen Analysis
The most important male fertility test. Evaluates sperm count (≥15M/mL), total motility (≥40%), progressive motility (≥32%), morphology (≥4% normal forms by strict criteria), and volume (≥1.5 mL). Male factor contributes to approximately 40–50% of all infertility cases. This test should be done early—not as an afterthought after months of female testing.
A semen analysis is cheap ($100–$300), non-invasive, and results come back in days. Yet many couples spend months and thousands of dollars on female testing before checking sperm. Male factor is present in nearly half of infertility cases. There’s no reason to wait. Test both partners simultaneously from the start.
Standard semen analysis doesn’t assess DNA integrity within the sperm. High DNA fragmentation can cause fertilization failure, poor embryo development, and miscarriage even with normal-looking semen analysis results. Consider this test if you have unexplained infertility, recurrent pregnancy loss, or repeated IVF failure with good-looking embryos.
The Testing Roadmap: What Order to Get Tested
| Priority | Test | Cost | Why First |
|---|---|---|---|
| 1st | AMH + AFC (her) + Semen Analysis (him) | $200–$500 | Most critical info, lowest cost |
| 2nd | Day 3 hormones + Thyroid + Prolactin | $200–$500 | Treatable hormonal causes |
| 3rd | HSG (tube test) | $500–$1,500 | Determines if IUI is viable |
| If needed | DNA fragmentation, genetic carrier screening, sonohysterogram, hysteroscopy | $300–$2,000 | Based on initial results |
What Testing Costs (and What Insurance Covers)
Good news: most fertility testing is covered by insurance under diagnostic codes, even in states without fertility treatment mandates. Blood work (AMH, FSH, thyroid, prolactin) is typically covered as part of a gynecological evaluation. Semen analysis is usually covered. The HSG is covered by most plans as a diagnostic procedure.
What’s often NOT covered: genetic carrier screening (though increasingly included), advanced sperm testing like DNA fragmentation, and repeat testing within short intervals. Always ask your clinic to verify coverage before scheduling.
At-home fertility test kits (like Modern Fertility, Natalist, or LetsGetChecked) offer AMH and basic hormone panels for $100–$200. These are legitimate lab tests using the same methodology as clinic tests. Limitations: no ultrasound (AFC), no HSG, and results need expert interpretation. They’re a reasonable first step if you want data before committing to a full RE consultation, but they don’t replace a comprehensive workup.
FAQ
Medical Disclaimer
For informational purposes only. Test interpretation depends on individual clinical context. Consult a reproductive endocrinologist for personalized assessment.
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