Female fertility tests: what you should know
Updated: Nov 18, 2021
This article has a specific focus on female fertility tests and is part 2 of a 3-part-series on fertility testing.
This article discusses:
· How a Woman’s Fertility is Tested
· Fertility Test for Women at Home
· Information about Anti Müllerian Hormone tests
· Fertility Test for Women Over 35
· Female fertility testing by the Doctor
If you haven’t read part 1 be sure to have a read. Part 1 covers the basics of conception, provides a definition of fertility, explains how fertility tests work and discusses whether you should have a fertility check before you start trying to conceive.
Part 3 of the series focuses on male fertility tests.
Speak to or see a GP or Practice Nurse for a preconception review consultation, if possible at least 3-6 months before you start trying to conceive and ideally earlier. You will be able to discuss your overall health and receive preconception advice. They can check your blood pressure, weight and height and may arrange blood tests to check your iron levels or vitamin D.
If you have menstrual symptoms e.g. heavy and painful periods and you haven’t had
investigations before your GP can arrange an ultrasound scan or referral to a
Gynaecologist. If you have a known cause of infertility or history of predisposing
factors for infertility e.g. endometriosis, polycystic ovarian syndrome you may require
early referral to the relevant specialist.
Your healthcare professional may also recommend taking a prenatal supplement and suggest lifestyle changes. A dietician can also provide you with more detailed nutrition advice.
There are only a few days within the menstrual cycle where the egg and sperm have a chance of meeting and fertilising. This time of your cycle is referred to as the ‘fertile window’.
The fertile window can start from 5 days before ovulation and last until the day after ovulation. The length of the fertile window depends on how long the sperm and egg survives in the female uterus.
The fertile window can be estimated using natural fertility awareness methods including measuring basal body temperature, assessing the consistency of cervical mucus and identifying other symptoms of ovulation.
The national institute of clinical excellence (NICE) does not recommend the use of basal body temperature charts to confirm ovulation. The guidance states that it does not reliably predict ovulation. NICE recommends regular sex twice a week throughout the year.
If having sex twice a week throughout the year is not practical. Then having sex during this fertile period may also be effective. Having sex at least every other day during the fertile period is likely to be sufficient.
The most useful self-administered at-home fertility tests are those that help you predict your fertile window and ovulation date. These include fertility awareness and natural family planning methods, an app like Natural Cycles, ovulation testing kits and fertility devices.
Anti-müllerian hormone (AMH) does not predict your ability to become pregnant in the future. The blood test should not be used to help you decide whether you can delay starting a family. It only gives you a fraction of the picture of your fertility. There is no single fertility test available to ascertain your overall fertility or to estimate your chances of becoming pregnant.
I advise against buying female fertility blood test kits that test your AMH unless you have been specifically advised by a fertility Specialist, GP or gynaecologist. Only do the tests that your doctor has asked you to do and where applicable have them done on the relevant day of your cycle. I set up Your Trusted Squad to empower women and I don’t believe doing the AMH test empowers women. It is being misused and often causes unnecessary anxiety and false assurance without providing valuable and actionable information.
There aren’t any specific fertility tests for women over 35. However if you have been trying to conceive and have not become pregnant
*After 6 months if you are 36 years old and over
*After 12 months if you are 35 years old or younger
*Have not conceived after 6 cycles of artificial insemination
You should arrange to visit your GP, ideally with your partner, for a review for
assessment and investigations.
What tests can be done to find out if I can get pregnant?
In part 1 of this series on fertility testing I described the complex process of conception and the events leading up to conception. I explained that, because there are so many different parts to conception, that there is no single fertility test available to look at your overall fertility or to estimate your chances of becoming pregnant.
This table shows the tests that are available to assess a female. Most of the processes are explained in part 1 so please read this article first if you aren’t sure.
I have also provided a table summarising key tests
The ‘fertile window’
Just to recap from part 1, that over 8 out of 10 couples (80%) having sex every 2-3 days throughout the month will conceive in 1 year and over 9 in 10 (90%) will conceive within 2 years.
The recommendation for best success with becoming pregnant is to have regular sex every 2-3 days a week or at least twice a week, 52 weeks of the year.
For some couples, it isn’t practical to have sex twice a week. There are only a few days within the menstrual cycle where the egg and sperm have a chance of meeting, fusing and fertilising. This timeframe is the ‘fertile window’.
Ovulation, when the egg (or more than one egg) is released from one ovary, occurs once during each menstrual cycle. Once the egg has been released from the ovary is can live for a period of around 12-24 hours.
In the average sperm sample, around 40 million or more sperm cells are released. Once the sperm has travelled into the female body and travels towards the fallopian tube, it’s possible for a percentage of the sperm to survive inside a woman’s body for up to 5 days although many do not survive for this period of time.
Therefore, if you have sex up to 5 days before ovulation and any of the sperm survive for 5 days and they can be ready in the fallopian tube to meet the egg. Only one sperm can fertilise one egg.
If you also have sex on any of the 2, 3 or 4 days before ovulation or on the day of ovulation your chances of the sperm surviving and meeting the egg are highest. Having sex, the day after ovulation may also be successful depending on how long the egg survives.
BUT should you have sex every day during the fertile window?
Since sperm can survive for up to 5 days it is not necessary to have sex every day during the fertile window to try to maximise your chances of becoming pregnant. But it isn’t harmful or detrimental either.
This research suggests that the number of sperm in the ejaculated semen is lower if ejaculation occurs every day on consecutive days. However, the overall quality of the sperm is not affected. Therefore sex 2-3 times e.g. alternate days during the fertile window can be sufficient.
Female Fertility testing at home
This particular section requires a whole separate article, so I’ll write one in the near future. In the meantime, I’ll direct you to the manufacturers websites where possible. However right now I don’t have access to independent data. I will be working on this for a future post.
I wanted to add here that the national institute of clinical excellence (NICE) does not recommend the use of basal body temperature monitoring to confirm ovulation stating that using them does not reliably predict ovulation.
NICE recommend having regular sex twice a week.
Tests are available for home use and several services offer tests where samples can be collected at home and sent to a certified laboratory for testing either by post or by courier.
The tests available for home use allow you to predict when you are going to ovulate and understand when, during your menstrual cycle, a sperm and egg could successfully meet if you have sex during this particular time.
All of these tests aim to help you estimate when you are going to ovulate and/or when your ‘fertile window’ begins (see next section). These tests include:
1. Natural ‘bedside’ tests (this is a phrase used by doctors as the tests can be done by your bedside) and includes:
a. Tracking your menstrual cycle
b. Checking your cervical mucus and your basal body temperature (BBT) which is your
temperature first thing in the morning as soon as you wake up and before you get
out of bed.
c. Checking for other symptoms you may experience e.g. ovulation symptoms.
These help you predict your fertile window and when you ovulate. You can read more information about measuring your natural fertility indicators and you can find a fertility awareness practitioner to teach you how to use fertility awareness methods.
You can chart your data onto a paper chart or you can use an app like Natural Cycles, which uses your BBT to help you calculate your fertile window. Natural Cycles is highly rated by ORCHA and is the only app that is both CE marked (Europe) and FDA cleared (US) for natural birth control methods.
2. Ovulation Predictor Kits or Ovulation Monitors:
These tests are used to give you an idea of when you may ovulate so you can identify some of your fertile window. The tests either require a saliva or urine sample.
‘These tests are approximately 99% accurate in detecting the LH surge that precedes ovulation. However, these tests cannot confirm whether ovulation actually occurs a day or two later.’ American Pregnancy Association.
Women with polycystic ovarian syndrome (PCOS) are advised NOT to use these kits. Women with PCOS may have high baseline levels of LH and may also have natural fluctuations in LH levels. This may lead to misleading results.
I’ve included links to a few products below to give you an idea of what’s available, but I will write a dedicated review post soon. The digital types are more expensive and provide a bit more guidance. If you want, you can use the ovulation kits alongside your BBT checks or together with your period tracker app if it isn’t Natural Cycles.