Trying to Conceive? Here’s When to Consider a Fertility Evaluation

Clinically reviewed by Sara Mucowski, MD

Key Takeaways

• A fertility evaluation is the first step in understanding why pregnancy may not be happening.
• Testing may include hormone bloodwork, semen analysis, and imaging such as ultrasound or HSG.
• Evaluation is typically recommended after 12 months of trying under age 35, or six months if over 35.
• Results help guide clear, personalized treatment options.

What Is a Fertility Evaluation?

A fertility evaluation is a series of tests used to understand your reproductive health and identify possible reasons pregnancy has not occurred. It gives your care team a clearer picture of hormone levels, egg or sperm health, and how the reproductive organs are functioning.

In general, evaluation is recommended if:

• You are under 35 and have been trying to conceive for 12 months without success.
• You are 35 or older and have been trying for six months without success.
• If you are 40 or older and ready to conceive.

Earlier evaluation may be appropriate if you have irregular cycles, known reproductive conditions, prior pelvic infections or surgeries, or a history of miscarriage.

The goal is simple: gather accurate information so you can make informed decisions about next steps.

Why Do You Need a Fertility Evaluation?

Fertility challenges can stem from many factors. For women, ovulation issues are common. For men, sperm count, movement, or structure may be involved. Age, medical history, and lifestyle factors can also play a role.

Without testing, it’s difficult to know what’s contributing to delays in conception. A fertility evaluation helps identify patterns and potential barriers. Once those are clear, treatment options can be tailored to your specific situation.

Early evaluation can also expand your options. The sooner you understand what’s happening, the sooner you can decide how you want to move forward.

Who Should Get a Fertility Evaluation?

A fertility evaluation is appropriate for anyone experiencing difficulty conceiving. It may also be helpful if you:

• Are over 35 and planning to try soon
• Are considering freezing eggs or embryos to help preserve future fertility
• Have irregular or absent menstrual cycles
• Have experienced more than one miscarriage
• Have a history of endometriosis, PCOS, or pelvic infections
• Have had prior surgeries or treatments that could affect fertility

For men, evaluation is important if there is concern about low sperm count, prior testicular injury, or hormonal imbalance. Male factor infertility contributes to a significant portion of fertility challenges, so testing both partners is often recommended.

Even if you are not actively trying, some people choose fertility testing to better understand their reproductive timeline and options.

What Are the Different Types of Fertility Tests?

A fertility evaluation typically includes a combination of bloodwork, semen analysis, and imaging studies. Each test provides a different piece of information.

Hormone Testing

Hormone testing is done through bloodwork. These tests assess whether reproductive hormones are within expected ranges and whether ovulation is occurring as it should.

In women, commonly tested hormones include:

• Follicle-stimulating hormone (FSH)
• Luteinizing hormone (LH)
• Estradiol
• Progesterone
• Prolactin
• Anti-Müllerian hormone (AMH)
• Thyroid hormones

In men, testing may include:

• FSH
• LH
• Testosterone
• Estradiol
• Prolactin 
• Genetic testing 

Abnormal hormone levels can point to issues with ovulation, ovarian reserve, or sperm production.

Semen Analysis

A semen analysis evaluates both the quantity and quality of sperm.

Key factors include:

• Sperm count
• Motility (movement)
• Morphology (shape and structure)

Healthy sperm must move efficiently and have normal structure to fertilize an egg naturally. If results are outside typical ranges, additional testing or treatment may be recommended.

Ultrasound and Hysterosalpingogram (HSG)

Ultrasound imaging allows providers to examine the uterus and ovaries. A transvaginal ultrasound offers detailed images and can assess ovarian reserve by counting visible follicles.

A hysterosalpingogram (HSG) is an X-ray procedure used to evaluate whether the fallopian tubes are open. A contrast dye is placed into the uterus so blockages or structural concerns can be identified.

Together, these imaging studies help determine whether sperm and egg are able to meet and whether the uterus is structurally prepared for implantation.

What Happens After a Fertility Evaluation?

Once testing is complete, your fertility specialist will review the results with you and explain what they mean.

If a specific cause is identified, treatment can be directed toward that issue. In some cases, results are normal, and further testing may be recommended. Sometimes small adjustments in timing, lifestyle, or ovulation support are enough. In other cases, assisted reproductive treatments may be discussed.

The purpose of evaluation is not to rush you into treatment. It’s to provide clarity so you can make informed choices.

What This Means for You

If you’ve been trying to conceive without success, or if you want a clearer understanding of your reproductive health, a fertility evaluation is a practical first step.

At Utah Fertility Center, your evaluation includes a thorough review of your medical history, targeted testing, and a thoughtful conversation about your goals. From there, your care plan is built around what makes the most sense for you.

FAQs

When should I consider a fertility evaluation?

If you’ve been trying to conceive for 12 months under age 35, or six months over age 35. You should also consider evaluation sooner if you have irregular cycles, recurrent miscarriage, or known reproductive conditions.

Can I still conceive naturally after a fertility test?

Yes. Fertility testing does not affect your ability to conceive. It simply provides information about your reproductive health.

What if my results are normal but I still can’t conceive?

Additional testing, lifestyle adjustments, or assisted reproductive options may be discussed depending on your full clinical picture.

How much does a fertility evaluation cost?

Costs vary by location and the scope of testing. Basic evaluations may range from a few hundred dollars, while more comprehensive testing may be higher. Insurance coverage depends on your plan and state requirements.

What happens next?

Your provider will review your results with you and outline possible next steps based on your specific findings and family-building goals.