Fertility Testing: Making Sense of the Numbers
Blood work, ultrasounds, and test results can feel overwhelming, especially when everything comes with a number or a range. You may receive results for AMH, FSH, AFC, semen analysis, and many other tests, each with its own set of values that can seem confusing or even alarming if they fall outside what you expect to see. These numbers are important, but they are only one part of your fertility picture.
This article explains common fertility tests in easy to understand language, what these results can tell you, and why they are only one piece of the bigger picture. Understanding what the numbers mean—and what they do not mean—can help you feel more informed and empowered as you work with your care team to understand your fertility journey.
Understanding Common Fertility Tests
What tests are typically included in fertility evaluation?
Fertility testing aims to discover why you may be having difficulty conceiving. Because infertility affects both partners roughly equally, tests focus on hormone levels, structural health of reproductive organs, and sperm health for male partners. The goal is to gather information that helps your care team understand your unique situation and develop a plan that makes sense for you.
Common tests include blood work to check hormone levels, ultrasounds to view your reproductive organs, and semen analysis for male partners. Each test provides a piece of information, but no single test tells the whole story. Your care team will interpret these results in the context of your age, medical history, and overall health.
Female Fertility Tests: Hormone Levels and What They Mean
What do AMH, FSH, and other hormone tests tell you?
Hormone tests are a key part of fertility evaluation. They help assess ovarian reserve, which refers to the number and quality of eggs you have remaining. However, it is important to remember that these tests measure quantity more than quality, and they cannot predict exactly how your body will respond to treatment.
AMH (Anti-Müllerian Hormone) can be measured at any time during your cycle. Higher AMH levels generally indicate more follicles, but there is no single "normal" value that applies to everyone. Different labs use different ranges, and what matters most is how your AMH fits with your age and other factors. Low AMH may suggest diminished ovarian reserve, while very high AMH may indicate polycystic ovary syndrome (PCOS).
FSH (Follicle-Stimulating Hormone) is typically measured on day 3 of your cycle. Normal ranges are usually around 3 to 20 mIU/mL. Elevated FSH (especially 10 to 20 or higher) may suggest poor ovarian reserve or older age. Very high FSH (30 or higher) combined with low estradiol may indicate ovarian failure. However, FSH can vary from cycle to cycle, so one elevated reading does not always mean the same thing as consistently high levels.
Estradiol (E2) is often measured on day 3 and during stimulated cycles. On day 3, normal ranges are typically around 25 to 75 pg/mL. Elevated estradiol early in your cycle may suggest cysts or diminished reserve. High estradiol can also mask high FSH, which is why your care team looks at these values together rather than in isolation.
Additional Hormone Tests: LH, Progesterone, Thyroid, and Prolactin
What do these other tests reveal about your fertility?
LH (Luteinizing Hormone) and the LH:FSH ratio are often checked, especially if PCOS is suspected. LH levels are typically similar to FSH, and a surge above 20 mIU/mL triggers ovulation. A ratio where LH is much higher than FSH (greater than 1) may suggest PCOS. If there is no LH surge, it may indicate ovulatory problems.
Progesterone is usually measured about 7 days after ovulation (mid-luteal phase). Levels above 15 ng/mL in medicated cycles, or above 10 ng/mL in natural cycles, generally indicate that ovulation occurred. Levels above 5 ng/mL suggest some ovulation, while low progesterone may indicate anovulation or a luteal phase defect.
TSH and thyroid hormones are important because thyroid function affects ovulation and menstrual cycles. Normal TSH is typically around 0.4 to 4.0 µIU/mL. Both hypothyroidism and hyperthyroidism can disrupt fertility, so checking thyroid function is a standard part of fertility evaluation.
Prolactin is usually checked if you have symptoms like galactorrhea or infrequent periods. Normal levels are typically under 24 ng/mL. Elevated prolactin may interfere with ovulation and could signal a pituitary issue that needs attention.
Antral Follicle Count (AFC) and Ultrasound Testing
What does an antral follicle count tell you?
Antral Follicle Count (AFC) is measured by transvaginal ultrasound, usually done early in your cycle (around day 2 to 5). This test counts the small follicles (antral follicles) visible in your ovaries. A higher count generally suggests better ovarian reserve, while a lower count may indicate diminished reserve.
Like AMH and FSH, AFC helps assess ovarian reserve, but it does not tell you about egg quality. You can have a good AFC but still face challenges if egg quality is a concern. Similarly, a lower AFC does not mean you cannot get pregnant—it is one piece of information that your care team uses to understand your situation.
Transvaginal ultrasound also helps identify structural issues such as cysts, fibroids, or polyps that might affect fertility. It provides a visual view of your uterus and ovaries, which complements the information from blood tests.
Other imaging tests may include a hysterosalpingogram (HSG), which uses X-ray to check whether your fallopian tubes are open and to examine your uterine shape. A sonohysterogram or hysteroscopy provides more detailed imaging or a direct view inside your uterus to look for issues that might affect implantation.
Male Fertility Testing: Semen Analysis and Hormone Tests
What tests are used to evaluate male fertility?
For male partners, fertility testing typically starts with a semen analysis, which assesses sperm count, motility (movement), and morphology (shape). This test provides important information about sperm health, but like female fertility tests, it is one piece of a larger picture.
If the semen analysis shows abnormalities, your care team may recommend additional tests such as hormone testing (FSH, LH, testosterone, prolactin, estradiol) to check for underlying endocrine factors. Other tests might include a testicular ultrasound, genetic testing, or post-ejaculatory urinalysis to check for retrograde ejaculation.
It is important to remember that sperm parameters can vary from sample to sample, and lifestyle factors, recent illness, or stress can temporarily affect results. Your care team will interpret these results in context and may recommend repeat testing if needed.
Because infertility affects both partners roughly equally, comprehensive evaluation includes testing for both partners. Understanding both sets of results helps your care team develop a treatment plan that addresses all relevant factors.
Understanding What the Numbers Mean—and What They Don't
How should you interpret your test results?
It is natural to focus on numbers, especially if some of your results fall outside expected ranges. However, it is important to remember that:
- Your age is a major factor. Even "normal" ovarian reserve may mean less fertility potential as you get older. Age affects egg quality in ways that tests like AMH, FSH, and AFC cannot fully capture.
- One abnormal test does not necessarily mean infertility. Tests are pieces of a bigger puzzle. Your cycle regularity, medical history, physical exams, and overall health all matter. Your care team will look at everything together, not just individual numbers.
- Tests like AMH, FSH, and AFC track reserve but tell you little about egg quality. You can have good reserve numbers but still face challenges if egg quality is a concern. Similarly, lower reserve numbers do not mean you cannot get pregnant—they are one piece of information.
- Lab ranges can vary. Different labs use different reference ranges, and what is "normal" for one lab may differ from another. Your care team will interpret your results based on the specific lab and ranges used.
- Results can change. Hormone levels can vary from cycle to cycle, and one set of results does not always predict future outcomes. Your care team will consider trends over time, not just single measurements.
The goal is to understand your unique situation, not to fit you into a category based on numbers alone. Your care team will help you understand what your results mean in the context of your age, history, and goals.
When Should You Consider Fertility Testing?
How do you know if it is time to get tested?
You should consider fertility testing if you are under 35 and have been trying to conceive for one year without success, or if you are 35 or older and have been trying for six months. However, you may want to start testing sooner if you have symptoms like irregular cycles, previous surgery, or conditions known to affect fertility (such as PCOS or endometriosis).
Testing is not just about finding problems—it is about understanding your situation so you and your care team can make informed decisions. Even if you are not ready to pursue treatment, testing can provide valuable information about your fertility timeline and options.
If test results show abnormalities, your care team may recommend further evaluation, lifestyle changes, or treatment options such as medications for ovulation, surgical correction of structural issues, or assisted reproductive technologies like IUI or IVF. The right path depends on your unique situation, goals, and preferences.
Remember that testing is a tool for understanding, not a verdict. Your results are one piece of information that helps guide your journey, but they do not define your possibilities.
How Her Serenity Approaches Fertility Testing
What is Her Serenity's philosophy on testing and transparency?
At Her Serenity, we believe that transparency and education empower patients to take control of their health journey. That means:
- Breaking down complex fertility test results into clear, accessible information that you can understand and use to make informed decisions.
- Explaining what numbers mean and what they do not mean, so you can see test results as one piece of a larger picture, not the whole story.
- Helping you understand that test results are tools for understanding, not verdicts that define your possibilities.
- Making medical information understandable so you can ask informed questions and make decisions that feel right for you, without pressure or overwhelm.
We believe that "sometimes, transparency is all you need" and that "your health is finally back in your hands." By explaining fertility tests in plain language, we help you understand your results so you can work with your care team to make decisions that align with your goals and values.
Taking the Next Step
How can you make sense of your fertility test results?
If you have received fertility test results and feel confused or overwhelmed by the numbers, you are not alone. These tests can feel complex, and it is natural to have questions about what your results mean for your fertility journey.
You can schedule a consultation to review your test results, discuss what they mean in the context of your age and history, and ask every question on your mind. Together, we can help you understand your results so you can make informed decisions about next steps.
Your fertility journey is personal, and test results are one tool to help you understand your situation. With the right information and a compassionate team beside you, you can move forward feeling informed and empowered, knowing that test results are one piece of a larger picture, not the whole story.
Remember: transparency and education empower you to take control of your health journey. By understanding what the numbers mean and what they do not mean, you can work with your care team to make decisions that feel right for you, without pressure or overwhelm.