Fertility Testing: What You Need To Know

Fertility testing usually involves getting tested in a healthcare provider's office. However, this type of testing is available in other forms. For example, you can order an at-home test to measure your hormone levels. And one company, Kindbody, has even offered pop-up clinics on the streets of Manhattan.

Though fertility testing is more easily available than ever, does that mean all individuals of childbearing age should take advantage? Some healthcare providers say no—but if you do choose to be tested, they say there are some things to keep in mind.

Types of Fertility Tests

Blood Tests

When a person has questions about fertility, healthcare providers usually start with a blood test to determine levels of anti-Mullerian hormone (AMH). This hormone is released by the eggs and declines with age as the number of eggs shrinks.

An AMH test can provide a good idea of how many eggs someone has left, said Jennifer Eaton, MD, a fertility specialist and director of the Women & Infants Fertility Center in Providence, Rhode Island.

You can get your AMH levels tested in a healthcare provider's office or at a lab facility or order an at-home kit from a company like Modern Fertility, Let's Get Checked, or Everlywell. With any home test, the results take a few days to be analyzed.

Blood tests for fertility can also measure levels of follicle-stimulating hormone (FSH). This number goes up as a person's egg count goes down, so it can be another indication as to whether their "ovarian reserve," or the number of eggs they have left, is normal for their age.

Hysterosalpingographies

For couples who have been trying to get pregnant and haven't succeeded, a healthcare provider will likely recommend other blood and urine tests, along with hysterosalpingography (HSG).

HSG is an X-ray of the uterus and fallopian tubes to check for any abnormalities or blockages. A healthcare provider can perform the procedure in an ob-gyn office, a clinic, or a hospital. HSG should preferably be done in the first 14 days of a person's menstrual cycle to reduce any possibility that a person might be pregnant.

Other Fertility Tests

To further evaluate fertility, a healthcare provider might also consider additional tests such as:

• Genetic testing
• Hormone measurements
• Hysteroscopies
• Laparoscopies
  
• Saline sonohysterograms
• Semen analyses
• Testicle biopsies
• Transvaginal ultrasounds
  

Expenses for Fertility Testing

Many insurance companies won't cover fertility testing for people under 35 unless they've been trying to conceive for a full year. For those 35 and over, tests are generally covered after couples have been trying for six months.

To be sure about coverage, you may want to contact an insurance company to determine if they will cover the costs of fertility testing before having it completed.

Additionally, if you are simply looking to find out your AMH levels, you can ask a healthcare provider or insurance company whether this test would be covered. At-home kits fall in the $100 to $200 range, while costs in a healthcare provider's office or at a fertility clinic can vary.

The Reliability of AMH Tests

While the AMH test tends to be a go-to for providers, a 2017 study found that ovarian reserve numbers are not necessarily an indication of fertility.

Researchers gave blood and urine tests to 750 women who had been trying to get pregnant for three months or fewer, ages 30 to 44, and then followed them for the next six to 12 months. Almost 500 of those women conceived naturally during that time, and the women's levels of AMH and FSH had no significant association with who got pregnant and who didn't.

Lead study author Anne Z. Steiner, MD, professor of obstetrics and gynecology at the University of North Carolina, was surprised by the findings. "These tests have worked their way into generalists' offices and more mainstream uses, and we were really hoping to find that they are a good test for women who want more information about their fertility," Dr. Steiner told Health. "Ultimately, that's not what we found."

Dr. Steiner said these findings should discourage women in their 30s and 40s from reading too much into these tests if they haven't already been trying to get pregnant for several months. Dr. Eaton, who was not a part of the study, agreed and said she doesn't recommend them to women who are just curious about their numbers.

The test may be helpful, though, for women who are considering freezing their eggs or undergoing IVF. "These tests are really to test the quantity of the eggs, but the more important thing is the quality of eggs," said Dr. Eaton. "We don't have any good tests for egg quality, so we don't have any good test for somebody to know if they're truly fertile or not."

Another reason AMH may not be a good indicator of fertility is the lack of standards for the test.

One study reported that while AMH is the preferred method for determining ovarian reserve (the number of eggs someone has), there are no international standards, which makes comparing tests taken from different sites or with different brands difficult. The study authors also stated that very little is known about what actually affects AMH levels, which can limit proper interpretation of the results.

Lifestyle Factors Play a Role in Fertility Too

Even if a couple's fertility tests all come back normal, there can be other factors that could get in the way of a healthy conception and pregnancy. Those lifestyle factors that could affect fertility include:

• High physical activity
• Nutrition
  
• Smoking
• Increased stress
• Use of drugs or excessive alcohol

For example, a study published in 2018 suggested that stress can affect a woman's ability to become pregnant. The study authors stated that psychological interventions—like cognitive behavioral therapy (CBT), a form of talk therapy—can be beneficial for people with infertility. CBT can potentially decrease anxiety and depression "and may well lead to significantly higher pregnancy rates."

In a 2022 literature review, researchers compared physical activity levels in thousands of participants and found that for both men and women, low and moderate levels of physical activity reduced the risk of infertility, improving the chances of becoming pregnant. But high levels of physical activity tended to increase the risk of infertility, making becoming pregnant more difficult.

Why You Should Avoid Relying on Fertility Test Results Alone

Regardless of the results of fertility testing, you don't need to only consider the results by themselves.

"There is a misconception that if you have a normal AMH level, you're fine and you can delay trying to get pregnant," said Dr. Eaton. "And I wouldn't want anyone to hold off just because of these results." With "normal" AMH test results, plenty of couples may still struggle to get pregnant.

On the contrary, those who received results noting issues may end up conceiving just fine. "A lot of people also think that if you have a low AMH level, you're not going to be able to have a baby—and that's not true either," said Dr. Eaton.

Ultimately, fertility tests—especially those not done in a healthcare provider's office—should be considered only one piece of the puzzle, said Dr. Eaton. And they shouldn't take the place of advice from a healthcare provider or give couples preconceived notions about what is and isn't possible for them.

"The real bottom line is that the most important thing that affects your fertility is your age," said Dr. Eaton. And while you're likely to have fewer problems getting pregnant the younger you are, "I always tell my patients that the best time to start a family is when you're ready to start a family—not based on what a test tells you or what you feel pressured to do."

A Quick Review

To find out how fertile you are, you can have fertility tests completed either in a medical office or from home. However, there are a few things to consider about fertility testing, from the types of tests you may need to testing expenses to the reliability of certain tests.

Overall, fertility testing results shouldn't be the only thing that guides your decisions about pregnancy. Try to consider the whole picture of everything affecting your fertility level, including lifestyle factors such as nutrition and stress.