For women there are three standard levels of testing, which when completed will offer a picture of fertility health.

The three levels are:

  • Level one – hormone assessment
  • Level two – tubal and uterine assessment
  • Level three – immunological screening to assess the immune system as this can cause problems with the physical internal environment of the vagina and uterus.

Blood testing : A couple of simple blood tests can identify any hormonal imbalance throughout your menstrual cycle. There are two blood tests to investigate the two phases of
your cycle.

Phase one of your cycle : This is during the follicular phase, and this blood test is carried out on days 1-3 of your cycle, with day 1 being the first day of bleeding. The test looks at the
levels of: FSH (follicle stimulating hormone), Oestradiol (E2), LH (luteinising
hormone), Prolactin, Thyroid hormones and Androgens.

Lets look at these individually:

Follicle Stimulating Hormone (FSH) :
FSH is produced by the pituitary gland to stimulate the growth and development
of ovarian follicles. This test is used as a baseline measurement of your ovarian
reserve and egg quality.
A high FSH usually indicates a low oestrogen level, which affects the growth and
development of your eggs and endometrium (uterine lining).
High FSH levels can be reduced naturally

Estradiol (E2) : This test measures your oestrogen level, which is secreted by your ovarian
follicles. When balanced it will develop the growth of eggs and thicken the
endometrium. It also balances FSH levels and stops them from rising too high. If
you have a low level of E2, your eggs may not mature sufficiently or they will not
be able to implant due to the thin quality of the endometrium.
If there is too much E2, there will be a variety of symptoms and this is often
present if your BMI is too high or there is insulin resistance as in the case of

Luteinising Hormone (LH) :
LH is released by the pituitary gland and stimulates ovulation, the formation of
the corpus luteum (tissue from a follicle that has released an egg), and the
production of Progesterone, which is needed during the luteul phase. A surge of
LH around half way through your cycle, triggers ovulation and you release an
egg. High levels of LH may indicate PCOS (polycystic ovary syndrome).

Prolactin :
This hormone is involved in the production of breast milk after childbirth, and
Progesterone. Prolactin is tested if PCOS is suspected and levels would be higher
than normal in this situation. High levels may interfere with ovulation and
progesterone levels may also be affected causing problems with maintaining a

TSH is responsible for controlling thyroid function and is important for the
metabolic processes in your body, which affect all your body systems. TSH
should always be checked if there are delays in conception, as a low TSH will indicate an imbalance of the thyroid, which may cause fertility problems until
this is addressed.
Androgens : These are male hormones that are checked to further rule out PCOS. If androgen
levels are high, it may be due to the pituitary gland producing large amounts of
LH, which prevents ovulation and causes high levels of male hormones to be released.
AMH – Anti-Müllerian Hormone : Checking for this hormone may give some idea of ovarian reserves, which will
tell you if you have a low, medium or high level of eggs left to release. The higher
the level the better, as you will have more of a chance of natural conception. AMH
is also used to assess ovarian response in assisted conception such as IVF cycles.

Phase two of your cycle :
Phase two begins after you have ovulated and is referred to as the luteul phase.
Again a simple blood test will give the necessary answers to establish how high your Progesterone level is.

Progesterone :
When a follicle releases an egg, it becomesa corpus luteum and it releases
progesterone. A blood test carried out by many Doctors on day 21 of your cycle, will give a reading of your Progesterone level. As everyone’s cycle varies, day 21
is not correct for everybody. Your hormone level does not rise sufficiently until 7
days after ovulation, and this is the correct time to be tested for Progesterone.
Please ask for a test 7 days after you have ovulated.
Progesterone is responsible for preparing the endometrium for implantation and
if it is not high enough, this may not be viable for pregnancy. If it is low, it can be
adjusted by using natural methods that involve working on increasing your core
energy, which enables your body to produce sufficient amounts of Progesterone.


Once you have completed the blood tests you may want to check that there are
no blockages in your fallopian tubes that might interfere with the travelling of eggs  or sperm, or uterine issues that may prevent implantation. There are three main tests that your GP or consultant can advise you on these.

1. Hysterosalpingogram (HSG) :
This will identify a blockage in the fallopian tubes. Liquid dye is put into the
cervix and x‐ray is used to track the movement of the dye, which will show if
there is any blockage or scar tissue causing a problem.

2. Laparoscopy :
This is an invasive test that requires a general anaesthetic and short hospital
admission. A small incision is made near your navel, and a laparoscope (camera)
is inserted to inspect the abdominal cavity, uterus and fallopian tubes.

3. Hysteroscopy :
This may be done alongside a Laparoscopy and involves using a viewing
instrument called a hysteroscope. This process involves mild sedation or a local
anaesthetic. The hysteroscope is inserted into the uterine cavity via the cervix to
look for any irregularities such as adhesions.
This is often the preparation for mapping your uterus before an IVF treatment
cycle begins.

If you have unidentified fertility problems, or a history of recurrent miscarriage,
then it may be necessary to be screened to check your immune system. This is
carried out with two blood tests, which are usually six weeks apart, and your
consultant will advise you on this if they feel it is a necessity.

This type of screening looks for antibodies in your blood, which if present will
detect an imbalance in your immune system, or some inflammation. It will also
establish whether there is an imbalance of natural killer cells, which may cause
problems with implantation. If there are high levels of antibodies in your blood,
they may interfere with a fertilised embryo, which may result in your body
rejecting the embryo.

There are numerous studies that have shown a correlation between recurrent miscarriage and immune disorders.

Immunological testing can be expensive and lengthy, but it may be worth
considering it if you fall into one or more of the following categories:

  • You have had two or more miscarriages
  • You have been diagnosed with unexplained infertility
  • You have good and healthy embryos that have failed to implant during IVF cycles
    Your GP or consultant can also help you with this.

As for women there are three standard tests available for men. It’s best to start, with level one and wait for the results to come back. Once they arrive it will be easy to identify whether level two is necessary.

The three levels are:

  • Level one – physical examination and semen analysis
  • Level two – hormone assessment – a blood test
  • Level three – further testing – a selection of different tests including:
    scanning; biopsy; genetic testing and further physical examination.

Level one – physical examination and semen analysis

A physical examination will be carried out to check for any visible evidence of
physiological problems within the testicles. A semen assessment will then also
be carried out, which gives a good picture of the fertility health.
Sperm health can be affected by many internal and external factors and running
a simple analysis on it, may help to pinpoint an underlying issue. It’s also the
least invasive form of testing between couples, and so it makes sense to do this
before running any other tests.
A sample of semen is taken, ideally at the clinic, and then tested immediately for
optimum results.
Illness and medication can have an effect on sperm health, and
so it’s best to mention any illness or medication usage over the previous three
months. Once the results return, a decision can be made as to what the next step
is. If the quality of the sperm is poor, a hormone assessment should be carried
out to look deeper into what may be going on internally.

Sperm analysis available here

Level two – hormone assessment

This level of testing is not often necessary and it is carried out with a simple
blood test. The results will show the levels of key sex hormones (most are
discussed under women’s testing) such as FSH, LH, Prolactin and Testosterone
(necessary for the development of healthy sperm).
If level two does not identify the problem, then level three will be suggested.

Level three – further testing

In very rare cases further testing is required to check the health of the testes and
to rule out any genetic issues. Your consultant would advise the necessary tests
based on the results from levels one and two, but they include scanning, further
physical examination, genetic testing and blood test.

Vitamin D

It is very important to check the Vitamin D levels checked for both male and female. Vitamin D is very important for the production of fertility hormones