A fertility test maps the hormones that drive your cycle and your ovulation. Think of AMH for your ovarian reserve, FSH, LH and oestradiol for your cycle baseline, progesterone for ovulation, and TSH and prolactin that play a part around them. About 1 in 6 people face reduced fertility at some point (WHO, 2023). You can test these values without a referral.
This is the overview article in our fertility series. My take: a fertility test is not a panic step, but a way to stop guessing. The more you know about your hormones, the more focused your conversation with your GP or gynaecologist becomes. Below you will read what the test involves, which hormones go with it, when to test and when testing makes sense.
What is a fertility test?
A fertility test is a blood test that measures a set of hormones which together say something about your cycle, your ovulation and your ovarian reserve. It is not a pregnancy guarantee and not a diagnosis. It gives a snapshot that helps you understand your situation better.
Important to know: no single hormone tells the whole story on its own. AMH says something about how many follicles you still have in reserve, but nothing about the quality of an egg. Progesterone shows whether ovulation happened, but does not predict pregnancy. Only the pattern of several values together gives direction.
The route to such a test used to run through the GP only. That is still possible, and with complaints it is often the best starting point. But these days you can also test the relevant hormones yourself, if you simply want to know where you stand before taking a next step.
Which hormones are tested for fertility?
A fertility test usually looks at a fixed set of hormones. Each one lights up a different piece of your cycle. The table below links what you want to know to the hormone that says the most about it, and to the best time to test.
| What you want to know | Hormone | What it shows | Best time in your cycle |
|---|---|---|---|
| How many follicles you still have in reserve | AMH | An impression of your ovarian reserve | Any time in your cycle |
| How your ovaries start the cycle | FSH + oestradiol | The baseline on which a follicle matures | Day 2 to 5 of your cycle |
| Whether ovulation has taken place | Progesterone | A rise fits with ovulation | Around day 21, or 7 days before your period |
| An irregular cycle or PCOS pattern | LH | The LH/FSH ratio can reveal a pattern | Day 2 to 5 of your cycle |
| Whether a raised prolactin disrupts your cycle | Prolactin | A high value can disturb ovulation | Any time, ideally calm and rested |
| Whether your thyroid plays a part | TSH | A slow or fast thyroid affects your cycle | Any time in your cycle |
This table is an aid, not a prescription. Which combination is useful for you depends on your age, your cycle and your question. Want the whole pattern at once? The Fertility Assessment measures AMH, FSH and LH among others in one draw.
When in your cycle do you test fertility?
The timing matters, because your hormones move through the cycle. For your cycle baseline (FSH and oestradiol) you test best in the first days, day 2 to 5. To confirm ovulation you test progesterone in the second half instead, around day 21 in a 28-day cycle.
AMH, prolactin and TSH are less sensitive to the cycle day. You can test those at any moment in principle. That is handy if you have an irregular or absent period, because then there is no fixed cycle to anchor to.
Do you have a longer or shorter cycle than 28 days? Then ovulation shifts with it. A useful rule of thumb is to test progesterone about 7 days before your expected period. In our article on confirming ovulation you read exactly how to find that moment.
When does a fertility test make sense?
There is no fixed answer, and I think it is important to say that honestly. Some women want insight before they start trying, others only when it does not work after a while. Both are legitimate. Age does play a role in how you read the result.
Female fertility declines gradually from around age 32, and faster after 37 (ASRM, Committee Opinion 589, 2014). That is no reason to panic, but it explains why many women want to know where they stand around their mid-thirties. Read more in our article on getting pregnant after 35.
Has it not worked for a while? Then a test can help bring possible factors into view. When that moment is depends on your age and your situation. We worked this out in when to test your fertility. Always discuss lasting doubts with your GP.
What I most want to pass on: a test is not a verdict on your body. It is information. A normal result does not mean everything will happen on its own, and an abnormal value does not mean pregnancy is impossible. The numbers are a starting point, not an endpoint, and they belong in a conversation with someone who knows your situation.
Fertility testing with PCOS, thyroid or an irregular cycle
An irregular cycle is one of the most common reasons to have your hormones looked at. The cause does not always lie in the ovaries themselves. A thyroid problem or a raised prolactin can disrupt your cycle just as easily.
PCOS often goes with a raised LH/FSH ratio and sometimes a high AMH. That high AMH means something different in PCOS than in women without it: it points to many small follicles, not automatically to better fertility. We explain this in the overview of PCOS.
Could your thyroid be playing a part? A slow or fast thyroid can affect your period and ovulation. In our piece on thyroid symptoms in women you read which values go with it. A hormone panel for women takes many of these values along at once.
Fertility testing before you want to get pregnant
Many women only think about testing when it does not work. Yet a test can give peace of mind exactly beforehand. A preconception test brings your nutritional status into view alongside your hormones, such as iron and vitamin D, so you start well prepared.
A well-known example is folic acid. The RIVM advises women with a wish to conceive to start folic acid before pregnancy, because it can lower the risk of spina bifida in the baby. That is dietary advice, not a test, but it shows that preparation begins before conception.
Want to know what you can check before a pregnancy? Read our article on optimizing prenatal health, or look at the Prenatal Essentials. Unsure which test fits? In which blood test when trying to conceive we line up the options, and in fertility testing: what you need to know you read how to begin.
Lifestyle and your fertility: what plays a part?
Hormones do not stand apart from the rest of your life. Sleep, stress, weight and food move along with your cycle. That does not mean you control everything, but a few habits seem able to make a difference according to research (ASRM, 2022).
Points that come up often:
- A regular sleep rhythm, because sleep helps steer your hormone balance
- Moving in a way that suits you, without exhausting yourself
- Food that keeps your blood sugar steadier, with attention to iron and vitamin D
- Less smoking and alcohol, which research links to lower fertility
These are general points, not treatment. What suits you is best discussed with your GP or midwife. A test can give you something to hold on to here: if you see a low iron or a low vitamin D, you know where to give attention. The value itself is not a diagnosis, but a starting point for a conversation.
Want to try in a focused way? Then it helps to know your fertile days. They lie around ovulation, usually in the middle of your cycle. An erratic cycle makes that harder to predict, and that is exactly when a look at your hormones can be clarifying.
I notice this reassures many women. Not because a test solves anything, but because it clears the fog. You know better where you stand, and that makes the choices afterwards calmer.
Testing your fertility yourself through Lunara
You do not need a GP referral for a hormone test. You order online, book a slot at a draw location near you (there are over 750 in the Netherlands) and have blood taken in the morning. You receive your result digitally, usually within a few working days.
Every result gets context from a BIG-registered doctor, per value. So you know not only what your AMH or FSH is, but what it can mean in your situation and whether a next step makes sense. You then discuss an abnormal result with your GP or gynaecologist. Want to first understand your menstrual cycle and hormones? That is a good starting point.
Frequently asked questions
Can a blood test tell whether I am fertile?
Not directly. A blood test shows how your hormones are doing and whether ovulation has happened. It does not predict pregnancy and does not rule out problems. The values give direction for a conversation with a doctor.
What does an AMH value say about my chance of getting pregnant?
AMH gives an impression of your ovarian reserve, so of the number of follicles. It says little about the quality of an egg and predicts no specific chance. You read more in our article on the AMH value by age.
Do I need to fast for a fertility test?
For most hormones that is not needed. But you test some values best at a fixed moment in your cycle. A morning draw, calm and rested, gives a more reliable picture for prolactin.
Is a fertility test the same as going to the gynaecologist?
No. A blood test is one part, but a gynaecologist can do more, such as an ultrasound or a test on your partner. Testing yourself can be a good starting point, not a replacement for care.
Do I also need a test on my partner?
When pregnancy does not happen, the cause lies with the man about as often as with the woman. A test on your partner can therefore be just as useful. A GP or gynaecologist can discuss that with the two of you together.
How often can you test your fertility?
There is no fixed answer. Some women choose to test periodically, for example when their situation or their cycle changes. What makes sense for you depends on your age and your question, and is best discussed with a doctor.
References
- American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and Practice Committee. Female age-related fertility decline. Committee Opinion No. 589. Fertil Steril. 2014;101(3):633-634. PMID: 24559617.
- Practice Committee of the American Society for Reproductive Medicine. Fertility evaluation of infertile women: a committee opinion. Fertil Steril. 2021;116(5):1255-1265. PMID: 34607703.
- Practice Committee of the American Society for Reproductive Medicine. Optimizing natural fertility: a committee opinion. ASRM, 2022.
- NHG and Thuisarts.nl. It is not working to get pregnant (subfertility). Dutch College of General Practitioners. Available via thuisarts.nl.
- RIVM. Folic acid and pregnancy. National Institute for Public Health and the Environment. Available via rivm.nl.
- World Health Organization. Infertility prevalence estimates, 1990-2021. WHO, 2023.
Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
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