When should I get a fertility test?

If you've been trying to conceive for 12 months without success (or 6 months if you're over 35), it's worth speaking to a GP. You can also request investigations earlier if you have a known condition like PCOS, endometriosis, or irregular cycles, or if you have concerns about sperm health.

What does a fertility test involve?

For women, initial tests usually include a blood test to check hormone levels (including AMH, which indicates ovarian reserve), an ultrasound to look at the ovaries and uterus, and sometimes a test to check whether the fallopian tubes are open. For men, a semen analysis checks sperm count, movement, and shape.

What is IUI and how is it different from IVF?

IUI (intrauterine insemination) places prepared sperm directly into the uterus around the time of ovulation. It's less invasive than IVF and doesn't involve egg collection. It's typically recommended for mild fertility challenges or unexplained infertility, and success rates per cycle are lower than IVF.

What is egg freezing?

Egg freezing (oocyte cryopreservation) involves stimulating the ovaries, collecting eggs, and freezing them for future use. It's used by people who want to preserve their fertility before age-related decline, before medical treatment that may affect fertility, or simply because the time isn't right yet.

Can I get fertility treatment on the NHS?

NHS fertility treatment is available but varies significantly by area. Most Clinical Commissioning Groups (CCGs) offer some IVF funding, but eligibility criteria — including age, BMI, and whether either partner has children — differ widely. IUI is less commonly funded. A GP referral is the first step.

Understanding Your Fertility: Tests, Treatment and What to Do First

The worry you haven't said out loud yet

Fertility concerns rarely announce themselves. They tend to arrive quietly — a niggling feeling, a cycle that doesn't look quite right, a month that becomes six that becomes a year. Many people spend a long time living with that worry privately before they say it to anyone, including a doctor.

If that's where you are, you're in good company. And you don't need to have a diagnosis, or a plan, or even a clear question to read this. Sometimes the most useful thing is simply to understand what's happening in your body and what the options look like — so that when you're ready to take the next step, it doesn't feel like stepping into the unknown.

Asking questions about your fertility isn't giving up on things happening naturally. It's just information.

When is it worth seeking help?

The standard guidance — and it's a reasonable starting point — is to speak to a GP if you've been trying to conceive for 12 months without success. That timeline exists because conception often takes longer than people expect, and most people will conceive within a year without intervention.

But guidelines don't account for everything. There are circumstances where it's worth seeking help sooner, without waiting to tick a time-based box:

Irregular or absent periods

Cycles that are consistently very short, very long, or unpredictable — or periods that have stopped — can indicate an ovulation issue worth investigating. You don't need to have been trying to conceive to raise this with a doctor.

A known condition affecting fertility

PCOS, endometriosis, a history of pelvic inflammatory disease, or previous treatment for cancer are all reasons to have an early conversation with a specialist rather than waiting for a time threshold.

Concerns about sperm health

Sperm factors account for roughly half of all fertility challenges, and yet sperm health is often the last thing investigated. A semen analysis can be done without a GP referral through many private clinics and home testing services — and it's one of the simplest, most informative tests available.

Considering egg freezing

If you're thinking about preserving your fertility but the timing isn't right to try yet, understanding your current ovarian reserve gives you useful information for planning. It doesn't predict the future, but it can clarify whether egg freezing makes sense for you right now.

What fertility tests actually involve

Fertility investigations sound more daunting than they usually are. Most initial tests are straightforward — a blood test and an ultrasound scan will answer many of the most important questions. Here's what to expect.

AMH (Anti-Müllerian Hormone)

A blood test that gives an indication of your ovarian reserve — roughly, how many eggs you have remaining. AMH declines with age, but it varies considerably between individuals. A low AMH doesn't mean you can't conceive, but it may affect how you respond to stimulation in IVF. It can be tested at any point in your cycle and is available privately without a GP referral.
Day 2–5 hormone panel

Blood tests taken at the start of your cycle check levels of FSH, LH, and oestradiol — hormones that regulate ovulation. High FSH can suggest the ovaries are working harder than they should to produce eggs, which may indicate reduced reserve. These tests give context that AMH alone doesn't.
Progesterone (Day 21 test)

A blood test taken around day 21 of a 28-day cycle (later if your cycle is longer) confirms whether ovulation has occurred. It's often one of the first tests a GP will request. A low result doesn't necessarily mean you don't ovulate — timing matters, and it may simply need repeating.
Pelvic ultrasound

An internal (transvaginal) ultrasound gives a picture of the ovaries and uterus. It can identify polycystic ovaries, fibroids, polyps, or signs of endometriosis, as well as counting your antral follicles — the small follicles visible at the start of a cycle, which give another indication of ovarian reserve.
Tubal patency test (HyCoSy or HSG)

A test to check whether the fallopian tubes are open — essential for natural conception and IUI, though bypassed entirely in IVF. HyCoSy uses ultrasound; HSG uses X-ray dye. Both are done as outpatient procedures and can cause cramping. Not everyone needs this test at the first stage of investigation.
Semen analysis

Assesses sperm count, motility (movement), and morphology (shape). A single result doesn't tell the full story — sperm quality fluctuates, and a follow-up test is often recommended if results are borderline. More detailed tests, including DNA fragmentation analysis, are available privately and can reveal issues a standard analysis misses.

A note on results

Fertility test results exist on a spectrum — there is rarely a hard line between "fertile" and "not fertile." A number outside the normal range is information, not a verdict. What matters is what that result means for your specific situation, discussed with a clinician who understands the full picture.

If you've received results that worried you and haven't had a chance to discuss them properly, it's worth asking for that conversation. You're entitled to understand what your results mean.

Treatment options — before IVF

IVF is the treatment most people have heard of, but it isn't always the first step. Depending on what investigations reveal, there are other routes that may be tried first — or that may be the right fit entirely, without IVF ever being needed.

Ovulation induction

Mild intervention

If investigations suggest you're not ovulating regularly — as is common with PCOS — medication (typically Clomid or letrozole tablets, sometimes injections) can stimulate the ovaries to produce and release an egg. This is often the first treatment tried when ovulation is the primary challenge, and it doesn't require egg collection or laboratory fertilisation.

You'll have monitoring scans to check how your body is responding, and intercourse or IUI is timed around when ovulation is expected.

Invasiveness Low

Who it's for Ovulation disorders, PCOS

NHS availability Often yes

IUI — Intrauterine Insemination

Low intervention

IUI places a prepared sample of sperm directly into the uterus at the time of ovulation — either natural or stimulated. It reduces the distance sperm need to travel and increases the number reaching the egg. The procedure itself takes only a few minutes and doesn't require sedation.

IUI is typically recommended for mild unexplained infertility, mild sperm issues, or for single people and same-sex couples using donor sperm. Success rates per cycle are lower than IVF, but the process is considerably less demanding physically and emotionally. Many people try two or three IUI cycles before considering whether to move to IVF.

Invasiveness Low

Success rate 10–20% per cycle

NHS availability Varies by area

Egg freezing

Fertility preservation

Egg freezing — medically known as oocyte cryopreservation — follows the same initial steps as IVF: hormone injections to stimulate the ovaries, monitoring scans, and an egg collection procedure. The difference is that the eggs are frozen rather than fertilised, and stored for future use.

People choose to freeze eggs for many reasons. Age is the most common — egg quality declines over time, and freezing eggs in your early-to-mid thirties preserves them at their current quality for use later. Others freeze before medical treatment that may affect fertility, such as chemotherapy. Some simply want to preserve options while life is still taking shape.

Frozen eggs don't guarantee a future pregnancy, but they do give you more time and more choices. The earlier you freeze, the better the egg quality — though the procedure is available and worthwhile at any age up to around 40.

Invasiveness Moderate

Who it's for Preservation, medical, elective

NHS availability Medical reasons only

IVF

Higher intervention

When other approaches haven't worked, or when investigations suggest IVF is the most appropriate route, it offers the highest success rates of any fertility treatment. The ovaries are stimulated to mature as many eggs as possible, those eggs are collected, fertilised in a laboratory, and the best resulting embryo is transferred to the uterus.

IVF is a significant undertaking — physically, emotionally, and often financially. But for many people it's also the most direct path to the outcome they're hoping for. Understanding it properly before you're in the middle of it makes a real difference.

Invasiveness Higher

Success rate Up to ~35% per transfer

NHS availability Varies — criteria apply

A word on male fertility

Fertility challenges affect male and female partners in roughly equal measure — and yet, in almost every conversation, the investigation starts with the person with ovaries. This is partly historical, partly because female investigations are more embedded in routine healthcare. But it means that significant issues are often found late, after months or years of focus elsewhere.

A semen analysis is quick, non-invasive, and can be done privately without a referral. If there's a male partner, this should be one of the first tests — not the last. More detailed analysis, including DNA fragmentation testing (which assesses damage to the genetic material inside sperm, a factor that standard semen analysis doesn't measure), is available and increasingly recommended where there have been repeated failed cycles or unexplained results.

Sperm health is half of the picture. Investigating it early is not pessimism — it's efficiency.

Questions worth asking

It depends on your circumstances. A GP can refer you for initial investigations before the 12-month mark if you have a known condition that affects fertility (such as PCOS, endometriosis, or irregular cycles), if you've had previous treatment that may have affected your fertility. It's always worth asking directly, rather than assuming the door is closed. If you're not getting far on the NHS, basic tests including AMH and semen analysis are available privately at relatively low cost.
PCOS (polycystic ovary syndrome) is one of the most common hormonal conditions affecting people with ovaries — estimates suggest around 1 in 10 have it. It involves an imbalance of reproductive hormones that can disrupt ovulation, meaning eggs may not be released regularly or at all. The good news is that PCOS is one of the most treatable causes of fertility challenges — ovulation induction is often effective, and many people with PCOS conceive with relatively straightforward intervention. Having PCOS does not mean IVF is inevitable.
The stimulation and egg collection process is identical. The difference is what happens next: in egg freezing, the eggs are vitrified (flash-frozen) and stored, rather than fertilised. When you're ready to use them, the eggs are thawed, fertilised with sperm, and a resulting embryo is transferred — which is essentially the second half of an IVF cycle. Egg freezing is sometimes described as "IVF in two parts." The storage process has improved significantly over the past decade — modern vitrification techniques mean survival rates of 80–90% on thaw are standard at good clinics.
It depends on your diagnosis. For mild unexplained infertility or mild sperm issues, IUI is a reasonable first step — it's less demanding and less expensive than IVF, and for some people it works. The evidence suggests it's most effective in the first three cycles; beyond that, if it hasn't worked, the conversation usually shifts to IVF. For people with blocked tubes, poor ovarian reserve, or significant sperm issues, IUI is unlikely to be recommended — IVF is the more direct route. Your consultant should be able to advise clearly on whether IUI makes sense for your specific situation.
"Unexplained infertility" is a diagnosis given when standard investigations return normal results but conception hasn't happened. It affects around a quarter of people seeking fertility treatment, and it is one of the most frustrating things to hear — because the absence of an answer doesn't make the experience less real. Unexplained infertility doesn't mean nothing is wrong; it means the current tests haven't identified what's wrong. Treatment — usually starting with IUI and progressing to IVF — is still effective. IVF in particular often provides new information, because watching how eggs fertilise and embryos develop can reveal things that blood tests and scans can't.
NHS eligibility for fertility treatment varies significantly depending on where you live — criteria around previous children, BMI, lifestyle factors, and number of funded cycles differ between Integrated Care Boards (ICBs). The clearest way to check your likely eligibility before speaking to a GP is to use the NHS IVF eligibility calculator at Seen Fertility — it's specific to your area and gives a realistic picture of what funding you may be entitled to. If you don't qualify, or if waiting times are long, private treatment in the UK or abroad may be worth exploring.