The logical first step when you realise it's taking longer than you hoped to get pregnant is to go and see your GP.
But depending on who your GP is, and what kind of relationship you have with them, this may or may not be a useful step. If you go to a bulk billing clinic where you have approximately 7.5 minutes with your GP in a normal consultation, they're not going to be able to cover much in that time that's really going to help you.
But they may recommend you or your partner take a fertility test – or several of them. Some of the fertility tests your GP may request are really important and helpful. But some are, in my 20+ years of experience as an embryologist and fertility educator, a bit of a waste of time.
Read on to learn about five fertility tests that GPs commonly recommend, and how (and if!) they can help you on your quest for a successful pregnancy.
5 Common Fertility Tests Requested by GPs
Day 2 or Day 3 FSH Hormone Levels (Female Fertility Test)
Hormones play a big role in how easy or hard it is to get pregnant. Some of the key hormones involved in fertility are Lutenising Hormone (LH), Thyroid Stimulating Hormone (TSH), and Follicle Stimulating Hormone (FSH).
The FSH hormone levels test is done on Day 2 or Day 3 of your reproductive cycle. FSH is one of the hormones produced in your brain that tells your ovary to start growing follicles, the part of the ovary that releases eggs. These growing follicles then produce oestrogen which feeds back to the brain to tell it to stop making so much FSH.
If your FSH is elevated at Day 2 or 3 of your cycle, it's a sign that your body is having to work really hard to grow follicles. Higher FSH = harder to 'kick start' the ovaries to produce eggs.
As you get older, and your ovarian reserve decreases, your FSH level at this part of your cycle increases. Measuring FSH at this stage gives an indication of ovarian reserve.
This doesn't really tell you anything about 'fertility' per se. You could have a very low ovarian reserve, but still get pregnant next month, or a really high ovarian reserve and never get pregnant due to some other issue – like blocked fallopian tubes, for example.
What it does tell us, is how you are likely to respond to the drugs that you may need to take if you end up being referred to a fertility specialist and having a cycle of IVF, and what kind of dose may be required to stimulate your ovaries to produce a certain number of eggs.
If your cycles are irregular, it can also give some insight as to why that might be. For example, if oestrogen is elevated at this stage of your cycle, that means that follicles have already started to grow. This is more common in older women.
If the follicles start to grow too early in the cycle, it means that the endometrium (the lining of the uterus) doesn't have enough time to grow before ovulation. Which leads to a timing issue between egg growth and endometrium growth that can cause problems with implantation.
There is some suggestion that what your hormones are doing on Day 2 or 3 of your cycle can indicate a number of things about how you may respond to fertility treatment, or what your outcomes might be.
But this information isn't that helpful and really only adds to the anxiety. It's not going to stop you trying to conceive – it's only going to make you more anxious about whether it will ever happen.
Day 21 Progesterone Levels (Female Fertility Test)
This is a test that is generally done on Day 21 of your cycle and, in theory, tests the level of progesterone halfway between ovulation and Day 1 of the next cycle. The time from ovulation to Day 1 of your next period is called the Luteal Phase.
A rise in progesterone during the Luteal Phase indicates that ovulation has occurred.
The Luteal Phase is almost always 14 days (if it's shorter than 12 days, then this will make implantation tricky and is a topic for another blog post).
If you have a 28 Day cycle, then ovulation will occur on around Day 14, and Day 21 will be exactly halfway through the Luteal Phase, so testing progesterone on this day can confirm ovulation.
However, if you have a 30 day cycle, then ovulation will occur on Day 16 and the halfway point of your Luteal Phase will land on Day 23.
And if you have a 26 Day cycle, ovulation will occur on Day 12 and the halfway point of your Luteal Phase will land on Day 19. So testing on Day 21 won't be mid-Luteal Phase and will likely give you a weird kind of result that doesn't confirm ovulation.
There is no harm to doing this test, but here are two reasons why I think this test is a waste of time:
If you have a 28 Day cycle (or anything between 25-33 days), then pin-pointing that mid-Luteal day is easy – it's Day 21. But I can also tell you without a test that you're almost certainly ovulating. It is the process of ovulation that causes you to have your next period 14 days later ... meaning there's no need to measure progesterone mid-Luteal to check for ovulation.
If your cycle is longer than 33 days, then it's likely you are not ovulating, or ovulating only sporadically. So pinpointing that mid-Luteal day to test is going to be very difficult, and may waste valuable time whilst you wait.
The best way to test for ovulation is to learn about the signs of ovulation and to keep a look out for them. (If you want some help with this, check out my course Fertility 101: Why aren't we pregnant yet?)
AMH Test (Female Fertility Test)
Anti-Mullerian Hormone (AMH) is a hormone secreted by the cells surrounding the tiny follicles in your ovaries that hold tiny eggs. These may one day grow up to be big follicles holding bigger eggs, which may then be ovulated and fertilised and become a baby.
An AMH blood test is a type of ovarian reserve testing that measures the levels of AMH in your blood, which is an indicator of how many eggs you have left. If you'd like to dive deep into this, see my full blog post about AMH testing, how it works, and what the results mean.
But in a nutshell: AMH testing gives an indication of what your ovarian reserve is, but tells you nothing about your ability to conceive. This test is not going to help you fall pregnant, but may indicate that you might need to seek help sooner.
Semen Analysis (Male Fertility Test)
A semen analysis (sometimes called a sperm test) is the most fundamental type of male fertility assessment, and it's super important. There are obviously 2 essential ingredients for making a baby – eggs and sperm. If you don't have these 2 ingredients, it's not going to work.
It's really simple to do a semen analysis and a crucial early step if things are taking longer than expected. An ejaculate contains all sorts of things – but only 5% is actually sperm! So it's important to have an andrologist assess the semen sample and determine how many sperm there are, how quickly they are moving, and what kinds of shapes they are.
It's quite normal for only 5% of the sperm in an ejaculate to be 'normally shaped' – but if that number is lower (like just 1% or 2%), then that may make falling pregnant trickier.
In some cases, we discover that there are very low numbers of sperm, or that the movement of the sperm is restricted. If there are not enough sperm, or there are not enough of them swimming in nice straight lines, that can make it more difficult to conceive naturally. It might happen eventually, but it may take longer.
So this information is really important to have when deciding what steps you want to take next. To learn more about this topic, check out my separate blog post on semen analysis.
One essential point to keep in mind if your GP requests a semen analysis: Make sure they request it from an andrology lab, and not a pathology lab!
Why does this matter? A pathologist is a doctor who analyses all types of body tissues, while an andrologist specialises in matters to do with male reproductive health, including male infertility issues. So an andrologist is the best qualified to conduct a semen analysis.
3 Other Tests to Take Before Getting Pregnant
Apart from recommending fertility blood tests for you and semen analysis for your male partner, your GP may request you take other tests before going any further on your fertility journey.
These tests will make any difference to how quickly you might get pregnant – but they're still incredibly important to take before your pregnancy starts. If they reveal any issues, you can have those investigated beforehand without any risk of complications arising during pregnancy.
Pre-pregnancy Screening
A pre-pregnancy screening is a simple blood test that screens for diseases, immunities, and other factors that are crucial to know about. It covers things like:
Whether you're immune to diseases like Rubella (German Measles) and Varicella (Chicken Pox)
Whether you have Hepatitis, HIV, Syphilis or Chlamydia
What your blood type is
If you're not immune to rubella for example, then you can have that vaccination before you get pregnant, which will make your pregnancy safer (you don't want to get a disease like Rubella while you're pregnant!).
Another example: Sometimes (but quite rarely!) your blood type can be incompatible with your baby's blood type, which can cause complications with your baby's development. Your doctor or fertility specialist should know what your blood type is from the get-go, so if your baby's turns out to be incompatible, they'll be able to administer the right treatment to ensure healthy development.
Genetic Carrier Screening Test
Genetic carrier testing is a blood or saliva test that looks at whether you carry a gene for genetic conditions like Cystic Fibrosis, Spinal Muscular Atrophy, and Tay-Sachs Disease, among others.
You may unknowingly carry such a gene, even if you don't have symptoms of a genetic disorder yourself. Genetic testing is particularly important for autosomal recessive conditions – this means that both parents must be carriers for their child to be at risk of inheriting the disorder.
Cervical Screening Test and Breast Check
These are standard tests that you should be getting done on a regular basis. But they're especially important to check off before conceiving. In case there are any issues, you definitely want to know before and not after you're pregnant!
If you would like more help decoding why you're not pregnant yet, head over to my masterclass Fertility 101: Why aren't we pregnant yet?
About the Author: Lucy Lines is an independent embryologist and fertility educator with more than 20 years of experience in the fertility field. Read full bio here.
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