This article was last updated April 19, 2021.
There are many ways to prevent pregnancy, but what happens if you actually want to get pregnant?
While fertility isn't something that can be 100% accurately predicted, there are certain hormones that play a role in the big picture. With many people waiting later in life to start families (hello, careers!), fertility hormone testing can allow you to better plan for your future.
If you're interested in fertility hormone testing, you've got a choice about where you get it done: at your doctor's office or in your very own home. We're here to give you the lowdown on what you should know about each testing option so you can make the right decision for you.
Fertility testing at your OB-GYN
Most OB-GYNs (excluding those who specialize in fertility) don't routinely order proactive fertility-related lab work, and when they do, insurance coverage isn't guaranteed. An OB-GYN may order a blood test to measure specific hormone levels, but usually only if there's a reason to do so — for example, you have irregular periods or specific concerns about your menstrual cycle.
Comprehensive fertility testing and work-ups are not regularly performed or covered by insurance unless a couple hasn't conceived after 6-12 months of trying (six if you're 35+ and 12 if you're under 35) — which is the definition insurance providers often use for infertility. Even then, insurance coverage may not be guaranteed.
What can doctors test for?
There are several different tests doctors may perform to learn more about your fertility health. Your OB-GYN can conduct some in their office — for others, fertility specialists (aka reproductive endocrinologists or REIs) are required. These doctors are experts in the field of infertility and reproductive medicine.
Tests to check on fertility for people with ovaries:
- Fertility hormone testing: Your doctor may order blood panels to measure your reproductive hormone levels. Detecting any out-of-range hormone levels is important when diagnosing potential fertility issues.
- Ultrasounds: A fertility specialist might take a look at the actual structure of your uterus, ovaries, and fallopian tubes with a pelvic ultrasound to check for any blockages or abnormalities in your fallopian tubes that may prevent an egg from reaching your uterus.
- They may also look for signs of endometriosis, fibroids, or pelvic inflammatory disease (aka PID, which can be caused by untreated sexually transmitted infections).
- They can also count the number of follicles in your ovaries, called an antral follicle count (AFC), which helps them figure out the number of eggs you have — also known as your ovarian reserve.
- Physical exams: In addition to checking for PID, your doctor may perform a pelvic exam to check for any lumps, fibroids, ovarian tumors, ovarian cysts, and/or signs of endometriosis that could affect your fertility.
- X-rays: Your doctor might take a closer look at your reproductive organs using a hysterosalpingogram (HSG), which is the long name for an X-ray of your uterus and fallopian tubes. Similar to an ultrasound, it will show your doctor if any blockages are getting in the way of conception.
- Laparoscopy: This is a minor surgical procedure that an REI usually only performs if a specific issue has already been diagnosed, such as PID, fibroids, or some other kind of blockage. During a laparoscopy, your doctor will make a small incision in your lower abdomen, then insert a tube with a camera at the tip to more closely examine your fallopian tubes, uterus, and ovaries.
Tests to check on fertility for people with sperm:
- Semen analysis: To diagnose male infertility, an REI needs to take a really close look at your sperm quality using a fertility test called semen analysis. By examining ejaculate samples, your doctor can figure out how likely it is that your sperm can make the journey to reach an egg. This sperm test looks at sperm count (how many sperm are in 1 milliliter of ejaculate), volume (the amount of semen ejaculated), motility (the sperm’s ability to move), and morphology (the sperm’s shape).
- Fertility hormone testing: An REI might order blood panels to measure your fertility hormone levels.
Fertility testing at home through Modern Fertility
The Modern Fertility Hormone Test provides the same comprehensive blood test and fertility hormone panel you’ll find in an REI's office — but it allows you to measure your fertility hormone levels from the comfort of your home.
Here's how it works:
- You’ll collect a blood sample at home with a simple finger prick — all you have to do is send your sample to our lab for analysis with the prepaid return envelope.
- If you’re not comfortable performing the finger prick yourself, you can also head to a nearby lab for a blood draw.
- ~10 days after we receive your sample, you'll get your test results and physician-reviewed reports (more on these later) in your personalized online dashboard.
What can Modern Fertility test for?
Here are the fertility hormones Modern Fertility can measure with their at-home test:
- Anti-Mullerian hormone (AMH): This reproductive hormone is a proxy for your ovarian reserve, signifying how many eggs you have.
- Thyroid-stimulating hormone (TSH) (and sometimes free thyroxine or fT4): TSH is produced by the pituitary gland in the brain to signal to the thyroid gland to produce fT4. Both hormones are involved in thyroid health and function.
- Estrogen: There are three types of estrogen, but we’re talking about estradiol, also known as E2. Estrogen is a “female” sex hormone responsible for the development and maintenance of sex characteristics (breast growth, menstruation, pregnancy, etc.). E2, which is produced by your ovaries. As we get closer to ovulation (which is the only time it’s physically possible to get pregnant), estradiol levels increase.
- Follicle-stimulating hormone (FSH): Also produced by the pituitary gland, FSH helps your ovaries grow your ovarian follicles (the fluid-filled sacs that house and release eggs) into mature eggs that can be ovulated and fertilized by sperm.
- Luteinizing hormone (LH): Produced by the pituitary gland, luteinizing hormone (LH) preps the body for possible pregnancy and surges 24-48 hours before ovulation to let your maturing ovary follicle know it can release an egg. (Measuring LH levels with ovulation tests, like ours, allows you to predict ovulation and your most fertile days.)
- Prolactin: This hormone facilitates milk production during breastfeeding/chestfeeding and suppresses ovulation after birth.
(One important note! If you’re on hormonal birth control, you won't be able to test E2, FSH, LH, or prolactin levels since synthetic hormones will affect your test results. But you can still check your AMH and TSH levels!)
What are the benefits of home fertility testing versus testing with a doctor?
The perks you'll only find testing with Modern Fertility range from affordability to more avenues of support to digital tools personalized for your body and goals:
- More accessible costs: Testing your fertility hormones at a clinic can cost over $1,000 without insurance coverage. With the Modern Fertility Hormone Test, you can measure the same fertility hormones for a fraction of the cost ($199). And there are no surprise costs — you know exactly what you’re paying, up front. And, similar to a gyno visit, you can submit a receipt to your HSA or FSA account to cover the tab.
- Testing flexibility: For the most accurate testing, some hormones have to be tested on the third day of your period. If you can’t get to your OB-GYN's office that day or aren’t sure when day 3 will arrive, you may have trouble scheduling an appointment at the right time. Additionally, certain lab tests are most accurate first thing in the morning — before breakfast or exercise. An at-home finger prick may be the easiest way to avoid missing your testing window, and it means you don't have to bother getting out of your PJs.
- Detailed explainers on each hormone: The role of each hormone in your fertility is explained in detail, and your own results are shown on a scale so you can see exactly where your levels fall when compared to other people your age.
- Physician-reviewed reports: Physicians (and ones who work in the fertility field, no less) interpret your results in a patient-friendly way, making it easy to understand what everything means.
- Downloadable raw lab results: If you love your healthcare provider (and we hope you do!), you can use your results to start a conversation about your reproductive health and your plans for kids.
- A 1:1 with a fertility nurse: A 1:1 consult with a fertility nurse is also included in the cost, so you can check in with any questions.
- Digital tools: Another cool feature that Modern Fertility offers (that you likely won’t get at your gyno) is personalized digital tools to help you map out your timeline and track your fertility from phase to phase (preconception through the first trimester of pregnancy!).
- Our free online community: The Modern Community is your digital space to open up about fertility and get real-talk support from other people with ovaries in similar spots along their reproductive journeys. It's also where we host live Q&As with fertility experts.
Whether at the OB-GYN or at home, what do your test results actually mean?
Since our test is currently only available for people with ovaries, we’ll focus on what doctor’s office and home fertility hormone test results mean for ovary-havers.
- High AMH for your age may mean you have a higher number of eggs than is expected or than is average for other people your age. High AMH is also sometimes found in people with polycystic ovary syndrome (PCOS), although it is not an official part of the Rotterdam criteria for PCOS diagnosis.
- Low or slightly low AMH for your age may suggest lower ovarian reserve or fewer eggs than average.
- Very low or undetectable AMH before the age of 40 may suggest primary ovarian insufficiency (POI), which is really important to talk to your healthcare provider about because POI is known to have implications for cardiovascular and bone health. Your healthcare provider may recommend fertility treatment and/or using an egg donor.
(Check out our guide to AMH for more info about how we measure this hormone and how your levels can affect your fertility.)
- Low TSH and high fT4 could indicate a thyroid condition like hyperthyroidism. If your thyroid isn’t producing enough thyroid hormone, TSH levels rise to kick the thyroid into gear.
- High TSH and low fT4 could also indicate a thyroid condition like hypothyroidism. If your thyroid is producing too much thyroid hormone, TSH levels drop to balance things out.
- High E2 may suppress FSH production and disrupt ovulation.
- Low E2 may mean your uterine lining isn't able to get thick enough to support implantation and pregnancy — and might suggest you’re experiencing POI, or earlier menopause.
- High FSH could mean you have diminished ovarian reserve (DOR) and fewer eggs than average for your age because your body has to produce more FSH to mature your follicles.
- Slightly high FSH could mean you have slightly diminished ovarian reserve and fewer eggs than average for your age.
- Low FSH likely means you have a normal number of eggs for your age because your body doesn’t have to produce extra FSH to mature your follicles.
- Consistently high LH may suggest low ovarian reserve and could mean a higher risk for POI. (LH should be considered in combination with AMH and FSH because they're better indicators of ovarian reserve than LH alone.)
- Consistently low LH may suggest an issue with the hypothalamus or pituitary gland — the organs in the brain that work together to create LH. The pituitary gland may not be able to produce and release the LH needed for the LH surge that triggers ovulation.
- High prolactin may mean your body isn't getting the “go ahead” to ovulate normally or that your uterine lining may not be as well prepared as it could be for an embryo to successfully implant.
- Low prolactin could indicate weaknesses in the immune system and potentially trouble breastfeeding/chestfeeding, but low prolactin shouldn’t affect the ability to get pregnant.
What kind of infertility treatments are there?
Whether you're testing at home or with a doctor, if your results suggest any "red flags" that might make conception more challenging, your doctor can help you gain deeper insight into your hormone levels and provide recommendations for next steps. And while you may have thought it was necessary for that 6-12 month window of trying to pass before seeing a doctor about your fertility, it's never too early to talk to an OB-GYN or primary care provider about your Modern Fertility Hormone Test results and plans for kids.
Depending on your diagnosis, age, and other factors, your healthcare provider may either connect you with an REI (remember, that’s a fertility specialist) or work with you directly to help you navigate possible steps and treatments for achieving your fertility goals. If you're conceiving on your own or with a partner who has ovaries, you'll likely start with intrauterine insemination (IUI). (You can learn more about all of the various fertility treatments in our 101 guide.)
After completing blood work (which you can get ahead of with Modern Fertility) and possibly an ultrasound, your healthcare provider might start you on a gradual journey with more basic treatments at first:
- Fertility drugs: Your doctor might prescribe oral or injectable medications that alter your hormone levels to trigger ovulation.
- Intrauterine insemination (IUI): To make it easier for sperm to reach your egg, the doctor might recommend intrauterine insemination (IUI), which is when sperm is injected directly into your uterus.
Based on how your body responds to these treatments, your healthcare provider might next recommend assisted reproductive therapy (ART) (which will need to be done at a fertility clinic). Your doctor may suggest ART from the beginning due to some of the other factors outlined above:
- In-vitro fertilization (IVF), a procedure in which a fertility specialist recreates the steps of fertilization with an egg and sperm (either yours or a donor’s) outside of your body and inside a laboratory. The REI then transfers the most viable embryos into your uterus.
- Intracytoplasmic sperm injection (ICSI) can accompany IVF treatment, especially if you’re experiencing male factor infertility. During ICSI, the doctor will inject a single sperm into the egg to create an embryo. (We’ve focused mostly on treating female infertility in this article, but you can learn more about treating male infertility here.)
- Egg freezing can help you preserve eggs today so you're able to use them in the future. And because frozen eggs don’t age, they’ll have the same egg quality as the day they were frozen.
The bottom line: Modern Fertility is a cost-effective way to better understand your body
While fertility hormone testing at your OB-GYN’s office or through Modern Fertility will give you the same results, Modern Fertility's home test is often more cost-effective and always more convenient since you don’t even have to leave your house. The added support of physician-reviewed reports, fertility nurse consults, and the Modern Fertility online community is just a bonus (but a pretty great one, if you ask us).
So, if you’re considering proactive fertility lab work, whether you’re a planner or you’re just plain curious, Modern Fertility can deliver results and tools in a way that makes planning for kids feel a little easier.