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:
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.
3. Fertility Tracker Devices:
These devices provide a more complete system in a way a digital version of the fertility awareness method. This is because they may collect a range of data from you including BBT, cervical mucus and days you have sex.
Over time the devices track your menstrual cycle and aim to estimate your fertile window and ovulation date. There are quite a number available. Some devices require a urine sample, may take your BBT directly or require you to input your BBT. Some of these gadgets can be quite expensive but some women sell them on after they’ve become pregnant or stopped trying to conceive.
These gadgets may not be as accurate in women with PCOS. Please read the manufacturers information before making a purchase.
Here are a few of the FDA cleared or CE marked fertility tracker devices here just to give you an idea of what’s available.
Ava Fertility Tracker (FDA cleared)
Ovusense (FDA cleared and CE marked)
myLotus by Concepta Plc (CE marked)
Other at home fertility tests
A number of test kits or services offer the ability to test a number of hormones. You may or may not complete a questionnaire in advance, you take the sample at home, it is sent to the laboratory for analysing and the test results are then reviewed by a doctor.
Depending on whether you have provided enough information, the doctor may write a report with specific advice for you. The tests offered may include one or more of the following:
The services may offer a special bundles named ‘female fertility test’ or ‘womens hormone check’, ‘womens wellness check’.
Services that offer these tests include:
· Vitall
In relation to female fertility testing, you may want to consider buying these tests only if you have been specifically advised by a fertility specialist, GP or gynaecologist. You may be able to save money by only doing the tests they have asked you to do. Where applicable take the test on the relevant day of your cycle.
Otherwise you may spend a lot of money unnecessarily and they may not provide you with the information you need.
*Please read the information on AMH testing in the next section BEFORE you make any purchase *
4. Should I do an Anti-Müllerian Hormone (AMH) test?
Anti-Müllerian hormone (AMH) is a hormone produced by the eggs within the ovaries. AMH levels correlate with the number of follicles in the ovary and this is known as the ovarian reserve.
AMH is released into the blood and can be measured by a blood test. Having this blood test serves as a guide of ovarian reserve.
Ovarian reserve tells you whether or not you have lots of eggs in your ovaries and whether this is within the normal range for your age.
Ovarian reserve does not give you information about the quality of your eggs or any other information about your ability to become pregnant.
In the UK GPs cannot routinely arrange AMH for their patients. This is because it’s a specialist test that was intended to be used and interpreted by specialist fertility doctors as part of assisted conception treatment.
Used by specialists, the AMH together with the antral follicle scan, could help predict cases where stimulation and egg retrieval as part of IVF was likely to be successful.
AMH is used by fertility specialists to help predict a woman’s response to ovarian stimulation by drugs during Assisted Reproductive Technology (ART) procedures such as IVF or egg freezing.
If a doctor tells you that you have a low AMH it does not mean that you won’t be able to have children in the future. It is more likely to mean that if you needed to have ovarian stimulation for egg freezing or IVF procedure that you are unlikely to get many eggs to freeze. These eggs would be fertilised with sperm to create an embryo or blastocyst (see part 1). You may be able to conceive with just one embryo transfer, but the fertility specialist will explain your chances of conception with ART and recommend the right procedure for you.
The AMH blood test should not be used to help you decide whether you can delay starting a family and does not predict whether you will or will not be able to conceive naturally now or in the future. It isn’t reliable enough to give you this information.
This paragraph is from a document called ‘What exactly is ovarian reserve?’ by the British Fertility Society.
‘It is important to remember that these tests were developed to inform IVF treatment and not your natural fertility. Many women with low ovarian reserve will conceive without any problems whilst others with a good ovarian reserve may take time and need fertility treatment. Their increasing use as a ‘fertility MOT’ test to reassure women that their fertility is normal or that they should consider treatment sooner rather than later is open to interpretation. There is no doubt that tests showing a good ovarian reserve are reassuring but they by no means guarantee a baby and equally a poor or impaired ovarian reserve does not mean you will struggle and need fertility treatment’
This is a helpful article from the New York Times about AMH tests ‘Raising Concerns About a Widely Used Test to Measure Fertility’
Fertility tests for women over 35
All of the tests described above and below can be performed on any female on any age, and your fertility specialist will advise you on the most relevant tests to assess you properly. There aren’t any specific tests for women over 35.
All women of any age should have a pre-conception review with the Practice Nurse at their GP surgery or their GP before you start trying to conceive. If you live in the US, you may see your GP or ObGyn.
If you have a condition that is known to cause infertility, then your healthcare professional will refer you to a specialist at this stage.
Otherwise, when you are ready and have optimised your health (had your smear, started taking your folic acid supplements etc) you can start to try to become pregnant.
You should arrange to visit your GP, ideally with your partner, for a review 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 be offered a clinical assessment with your GP who will start preliminary investigations.
If it’s required, you will be referred to a fertility specialist for further testing and possibly fertility treatment.
The rest of the information below is only relevant if you require further assessment because you have not become pregnant during the timeframes above.
Initial Assessment by the Doctor (GP or Gynaecologist)
If you see a specialist, you will have an assessment and set of tests. Your partner will also be assessed and tested. (Male fertility testing will be discussed in part 3)
The doctor will ask questions and perform a clinical examination. Questions will include information about
· Your menstrual cycle e.g. length and duration
· Frequency that you have sex and when in your cycle
· Any medical conditions that you have or that run in the family
· Previous pregnancies, terminations & miscarriages
· Occupation: potential exposure
· Smoking, alcohol intake, over the counter medicines, illicit drug use etc
· Previous and current medications and contraception
· Previous sexually transmitted infections
· Last smear test
The examination will include measuring your weight and height and a pelvic examination to feel the size of uterus- check for any lumps or enlarged uterus e.g. fibroids
Seeing the specialist doctor for investigations
This is a brief overview of the tests that may be done by your fertility specialist. A number of additional specialist tests may be performed especially if you are due to have ART.
Blood tests
Blood test may be taken which will include hormone tests and may include Screening for sexually transmitted infections such as HIV, Hepatitis B and C if you are undergoing IVF.
The hormone tests may already have been performed by your GP but if they haven’t, they may include one or more progesterone blood tests (taken in the mid-luteal phase) to check whether you have ovulated, a prolactin test, a thyroid function test, an FSH test. Oestradiol levels may be taken.
Testosterone tests may be relevant if you have symptoms suggestive of polycystic ovarian syndrome.
Swab test for Chlamydia
Chlamydia is the most common STI in the US and Europe. One single infection with chlamydia can lead to chronic inflammation such as pelvic inflammatory disease in women which can cause infertility, failed IVF attempts, miscarriages and pregnancy complications.
You can be infected with chlamydia but not have any symptoms at all. Therefore, it’s important to be screened for it as it’s easy to treat but if left untreated can cause long term damage.
You should have a chlamydia test and if it’s positive both you and your partner will require a course of antibiotics.
Ultrasound scan
An ultrasound scan can be arranged to check the lining of the womb and look for any findings in the ovaries e.g. cysts or womb e.g. fibroids or possibly adenomyosis.
The scan may also be performed separately at the fertility clinic to count the number of antral follicles, which can indicate the likely response to ovarian stimulation by hormones for IVF.
Hysterosalpingo Contrast Sonography (HyCoSy)
A HyCoSy test is used to check the fallopian tubes for abnormalities or blockages. A contrast dye is injected into the womb and travels into the fallopian tubes.
An ultrasound scan is used to see if the dye travels through the tubes and out into the pelvis. This confirms that the fallopian tubes are patent.
If the dye does not pass through, this suggests there is a blockage and a laparoscopy may be arranged.
Hysterosalpingogram (HSG)
Alternatively, an HSG may be performed. The HSG also checks whether the fallopian tube is open but also looks at the shape of the uterus to identify any uterine anomalies.
Dye is injected into your womb and fallopian tubes and x-rays are taken to see if dye flows through. Blockages in the fallopian tube can therefore be identified.
Hysteroscopy
A hysteroscopy uses a camera to look inside your womb. It may be offered to better identify polyps, fibroids, look at the endometrial lining also identify any uterine anomalies.
Laparoscopy (with or without dye test)
A diagnostic laparoscopy (keyhole surgery with a camera) may be performed if you have symptoms that are suggestive of endometriosis.
At the same time a dye test may be performed to see if you have a blockage in your fallopian tubes.
Scar tissue in the pelvis could be seen. Lesions of endometriosis may be seen. Treatment may be discussed and if required surgery booked at a later date.
Thank you for reading this article!
I really hope it’s been useful xx
Also check out the blog article on male fertility tests.
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