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Start with a GP appointment
If you have been trying to conceive for 12 months, or for 6 months if you are over 36, the first step is usually to book a GP appointment. In the UK, your GP can begin an initial fertility assessment and arrange the first tests.
It is often best to ask for both partners to be involved from the start. Fertility problems are not only due to female factors, and a basic evaluation should consider sperm, ovulation, and general health.
The first tests to ask about
The most important early test for a man is a semen analysis. This checks sperm count, movement, and shape, and it is usually one of the quickest ways to identify a possible cause of infertility.
For a woman, a common first blood test is for ovulation and hormone levels. This may include progesterone, FSH, LH, oestradiol, prolactin, and thyroid function tests, depending on your symptoms and cycle pattern.
Your GP may also suggest a pregnancy test and a review of your menstrual history. If periods are irregular or absent, this can help point towards conditions such as polycystic ovary syndrome or thyroid problems.
Tests that look at overall reproductive health
Another useful early test is an ultrasound scan of the pelvis. This can check the ovaries and womb for issues such as fibroids, cysts, or signs of endometriosis.
Your GP may also ask for blood tests to check general health. These can include a full blood count, diabetes screening, and tests for infections or immunity, depending on your history and any previous pregnancies.
When to ask for specialist tests
If the initial tests do not explain the problem, you can ask about referral to a fertility specialist. At that stage, you may be offered further investigations such as an HSG scan to check whether the fallopian tubes are open.
If your partner’s semen analysis is abnormal, repeat testing or referral to a urologist may be needed. In some cases, further hormone tests or genetic tests are also recommended.
Questions to raise at your appointment
It helps to ask, “What should we test first for both of us?” This keeps the assessment focused and ensures that male and female factors are considered together.
You can also ask how soon the tests can be arranged and what results would mean. If you have been trying for a long time, have irregular periods, a history of pelvic infection, endometriosis, miscarriage, or previous surgery, make sure you mention it early.
Practical next steps
Before your appointment, note how long you have been trying, the dates of your periods, and any medications you take. Bring details of any previous pregnancies, miscarriages, or STIs as these can be important.
The first fertility tests should be simple, targeted, and done early. A semen analysis, hormone testing, and a basic pelvic assessment are usually the best starting point in an initial UK fertility evaluation.
Frequently Asked Questions
A common initial workup includes a detailed history, physical exam, ovulation assessment, semen analysis for the partner, and basic blood tests such as TSH and prolactin. Depending on age and history, ovarian reserve testing and uterine/tubal evaluation may also be recommended.
Basic blood tests often include thyroid-stimulating hormone (TSH), prolactin, and sometimes day-3 follicle-stimulating hormone (FSH), estradiol, and anti-Müllerian hormone (AMH). These help look for hormonal or ovarian function issues that can affect conception.
A semen analysis is important because male factor infertility is common and can contribute to difficulty conceiving. It evaluates sperm count, movement, shape, and volume, which helps guide next steps.
Ovulation can be assessed with a mid-luteal progesterone blood test, ovulation predictor kits, menstrual cycle tracking, or ultrasound monitoring in selected cases. These tests help determine whether eggs are being released regularly.
Ovarian reserve testing often includes AMH blood testing, day-3 FSH and estradiol, and sometimes an antral follicle count by transvaginal ultrasound. These tests estimate how many eggs may remain and can help with treatment planning.
A transvaginal pelvic ultrasound is commonly used to look at the ovaries and uterus. It can identify fibroids, polyps, ovarian cysts, or signs of conditions such as polycystic ovary syndrome.
A hysterosalpingogram, or HSG, is a common test to check whether the fallopian tubes are open and whether the uterine cavity has abnormalities. Some clinics may use a similar contrast ultrasound study instead.
Hormone testing is usually requested early in the evaluation, especially if periods are irregular, ovulation is uncertain, or there are symptoms of thyroid disease or high prolactin. Timing may depend on the specific hormone being measured.
Anyone who has been trying to conceive without success should ask a primary care doctor, OB-GYN, or fertility specialist about an initial evaluation. The partner should also be included, because infertility can involve either or both partners.
In general, evaluation is recommended after 12 months of trying if the person is under 35 and after 6 months if they are 35 or older. Earlier testing is often advised for irregular periods, known reproductive issues, or prior pelvic surgery.
Genetic tests are not always part of the first step, but they may be considered if there is a history of recurrent pregnancy loss, known chromosomal issues, or severe sperm abnormalities. A clinician can decide whether karyotyping or carrier screening is appropriate.
Infection testing is not universal, but screening for sexually transmitted infections may be done if there is risk for tubal damage or other reproductive complications. This can help identify treatable causes that affect fertility.
Yes, even with regular cycles, testing may still be useful because ovulation is not the only factor involved in conception. Semen analysis and tubal or uterine assessment may still uncover a cause.
Yes, irregular periods are a strong reason to request evaluation because they may signal ovulation problems or hormonal conditions. Testing often focuses on ovulation, thyroid function, prolactin, and ovarian reserve.
Uterine evaluation may include transvaginal ultrasound, saline infusion sonography, or hysteroscopy if abnormalities are suspected. These tests look for polyps, fibroids, scar tissue, or structural issues that could interfere with conception or implantation.
It is helpful to share information about smoking, alcohol, medications, body weight changes, exercise patterns, and exposure to heat or toxins. These factors can influence fertility and may change which tests are recommended.
They should ask which findings are normal, which are abnormal, what the likely cause is, and what the next recommended step will be. It is also useful to ask whether more testing is needed or whether treatment can begin right away.
Yes, the evaluation is often tailored to each partner. Women may need hormone, ovulation, ovarian reserve, and uterine/tubal tests, while men usually start with a semen analysis and may need hormone or genetic testing if abnormalities are found.
If there is significant pelvic pain, painful periods, or suspicion of endometriosis, earlier imaging and specialist evaluation may be important. A doctor may also consider tubal testing and further assessment depending on symptoms and history.
Preparation depends on the test, but it may include scheduling bloodwork on specific cycle days, avoiding ejaculation for a short period before semen analysis, and following instructions for imaging studies. The clinic should provide exact preparation steps for each test.
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