You're getting a fertility workup
You're at the start of testing. It helps to know what a complete evaluation looks like before it begins, so you can ask for anything that isn't on the list.
A basic evaluation answers three questions: are you ovulating, are the uterus and tubes open and normal, is the semen normal? Add ovarian reserve and that's the standard workup.
Most happens within one menstrual cycle: blood tests on specific days, an ultrasound, a tubal imaging test, and a semen analysis.
Some tests are commonly ordered but not routinely recommended — prolactin without symptoms, thrombophilia panels, laparoscopy for unexplained infertility. It's fine to ask why.
- Keep trying while you test. Testing doesn't mean pausing. Keep covering your fertile window.
- Make sure your partner is tested at the same time. Guidelines recommend evaluating both partners together, not one after the other.
- Start the habits that take months to show. Eggs and sperm both take two to three months to develop. What's worth your effort.
- Limited or mixed Ask about vitamin D if you're at risk of being low. For example if you get little sun, have darker skin, or eat a vegetarian diet.
Ovulation
Confirmed by regular cycles, a mid-luteal progesterone level, or ultrasound tracking.Ovarian reserve
AMH, antral follicle count, day 2–4 FSH and estradiol. Useful for planning treatment; not a prediction of whether you can conceive.Uterine cavity
Transvaginal ultrasound first; a saline sonogram is more sensitive for polyps and fibroids.Tubal patency
An HSG (X-ray with contrast) or a contrast ultrasound (HyCoSy) shows whether the tubes are open.Semen analysis
Volume, concentration, motility, and morphology. Often needs to be repeated once if abnormal.Thyroid (TSH)
Commonly included. Ask if it's part of your panel.
- Which of these has been done, and which haven't: ovulation, ovarian reserve, uterine cavity, tubal patency, semen analysis, thyroid?Ask for the list out loud. A complete workup should cover all of these.
- Has my partner had a semen analysis? If not, can we order one now?Male factors contribute in roughly 40–50% of cases, and the test is simple. It's the most commonly skipped part of an evaluation.
- What does each of my results mean, in plain language, and which ones change what we do next?
- Is there any test you'd consider for me based on my history that isn't on the standard list?For example, after a pregnancy loss, or with a history of pelvic infection or endometriosis, additional tests may be reasonable.
Plus 4 more on your appointment checklist.
The results that usually decide what comes next: ovulation status, tubal patency, ovarian reserve range, and semen parameters.
If a clear cause is found (for example, blocked tubes, no ovulation, a significant sperm issue), the next conversation is about the treatment that fits it. Move to I'm considering treatment.
If everything is normal, the label is 'unexplained infertility.' Guidelines recommend a defined plan for it, usually starting with ovulation medication plus IUI for a few cycles before IVF. That's a next step, not a shrug.
Consider another opinion if your partner hasn't been tested; if a tubal test wasn't done before treatment was recommended; if 'everything is normal' ended the conversation without a plan; or if your questions aren't being answered. Bring every result with you. See I want a second opinion.