Fertility tests explained: AMH, semen analysis, HSG and scans
In brief
- A fertility evaluation checks ovulation, egg reserve, the tubes, the uterus and the male partner's semen.
- AMH and the antral follicle count estimate egg number, not egg quality.
- A semen analysis is simple, and should be done early. The WHO 2021 lower reference limit for concentration is 16 million per mL.
- An HSG shows if the fallopian tubes are open.
- Thyroid and prolactin tests find common, treatable causes.
- Test results are read together with your age and history, never alone.
Why testing comes before treatment
When conception takes time, it is natural to want a treatment. But treatment works best when it matches the cause. A test that finds a blocked tube, a low sperm count or an underactive thyroid changes what you should do next. That is why Dr. Swati Shree at EVE Women and Fertility Clinic in Bangalore begins with a full evaluation of both partners.
The tests, one by one
| Test | What it tells you | What it cannot tell you |
|---|---|---|
| AMH (blood) | Roughly how many small follicles remain | Egg quality, or whether you will conceive |
| Antral follicle count (scan) | Follicles seen early in the cycle | Whether the tubes are open |
| Pelvic ultrasound | Shape of uterus, fibroids, polyps, cysts | Egg quality, tube function |
| Thyroid (TSH) | Underactive or overactive thyroid | Other hormone issues |
| Prolactin | A hormone that can stop ovulation | |
| FSH, LH, estradiol | Ovarian and pituitary hormone balance | |
| HSG or contrast ultrasound | Whether the tubes are open | How well the tubes move the egg |
| Semen analysis | Count, movement and shape of sperm | How well sperm fertilise an egg |
| Mid-luteal progesterone or follicle tracking | Whether you ovulate |
AMH: what it is and is not
AMH is made by small follicles in the ovaries. A lower value suggests fewer eggs, and a higher value suggests more. It can be tested any day of the cycle. It is helpful to plan IVF stimulation and to decide how soon to act. It does not predict whether you will conceive naturally, because egg quality depends mainly on age. A low AMH in a young woman is not a reason to give up.
The semen analysis
The semen analysis checks volume, concentration, motility and shape of sperm. The WHO 2021 manual gives lower reference limits, such as 16 million per mL for concentration and 42 percent for total motility. These are limits seen in fertile men, not pass marks. For a good sample, abstain for 2 to 7 days, collect in the container supplied, and deliver it promptly. If the result is abnormal, repeat after about 2 to 3 months, because sperm production takes about three months.
HSG: checking the tubes
If both tubes are blocked, natural conception and IUI are unlikely to work. An HSG is a quick X-ray test, done after your period ends and before ovulation. It may cause cramps for a few minutes. It is not done if pregnancy is possible. See the HSG page for detail.
What happens if everything is normal?
About one in four to one in three couples have no cause found. This is unexplained infertility, and it is common. It does not mean nothing can be done. Timed attempts, IUI or IVF are options that depend on your age and time trying.
How to prepare
- Come together, with earlier reports
- Note the first day of your last three periods
- Do blood tests and scans on the cycle days advised
- Do not self-start medicines before the evaluation
FAQs
Which fertility test should I do first?
Usually a pelvic ultrasound with an antral follicle count, an AMH blood test, thyroid and prolactin tests, and a semen analysis for the male partner. The tubal check follows at the right cycle day. Dr. Swati orders what fits your history, so you do only tests that help.
Can I do an AMH test on any day?
Yes. AMH varies little through the cycle, so it can be tested on any day. Some other hormones, such as FSH and estradiol, are best on day 2 or 3. The scan for antral follicle count is also done early in the cycle.
Is a normal semen analysis enough to rule out male factor?
A normal result is reassuring, but sperm counts vary. If your partner's result is borderline or if fertility is still a problem, a repeat test is sensible. The test does not show how well sperm function in fertilisation.
Does a low AMH mean I cannot get pregnant?
No. AMH shows how many eggs remain, not how good they are. Many women with low AMH conceive. It does mean that time may be shorter and that fewer eggs may be collected in IVF. Dr. Swati advises on timing.
Do I need all these tests?
Not always. Dr. Swati chooses tests after hearing your history. Some couples need fewer, and some need more. If something is not helpful for you, she will tell you, and explain why.
Sources
- WHO laboratory manual for the examination and processing of human semen, 6th edition (2021)
- ASRM Practice Committee, Testing and interpreting measures of ovarian reserve (2015)
- NICE Guideline CG156
- ESHRE Guideline: Unexplained infertility (2023)