Female Fertility Testing

What are the signs of female infertility, and when should I get tested?

Female infertility is not always visible. While some women experience clear signals, such as irregular or absent periods, unusually painful menstruation, or a history of miscarriage, many causes of infertility produce no noticeable symptoms at all. A woman can feel entirely healthy and still face challenges conceiving due to factors that can only be detected through targeted testing.

Infertility is clinically defined as the inability to conceive after 12 months of regular, unprotected intercourse. For women over 35, that window narrows to 6 months, reflecting the more rapid changes in ovarian reserve and egg quality that occur with age. That said, you do not need to wait. Earlier evaluation is appropriate if you:

• Have irregular, infrequent, or absent menstrual cycles

• Have been diagnosed with PMOS (formerly PCOS) , endometriosis, or uterine fibroids

• Have a history of pelvic inflammatory disease or sexually transmitted infections

• Have experienced one or more miscarriages

• Have had prior pelvic or abdominal surgery

• Are considering egg freezing or proactive family planning

Testing is equally valuable for women who are not currently trying to conceive but want a clearer picture of their fertility before making major life or family decisions.

Possible Causes of Female Infertility

A comprehensive fertility evaluation can detect a wide range of conditions that may be contributing to difficulty conceiving, including:

• Polyendocrine Metabolic Ovarian Syndrome (PMOS): A hormonal condition affecting ovulation that is one of the most common, and most treatable, causes of female infertility.

• Endometriosis: A condition in which tissue similar to the uterine lining grows outside the uterus, potentially affecting the ovaries, fallopian tubes, and surrounding pelvic structures.

• Uterine fibroids or polyps: Benign growths within or near the uterine cavity that can interfere with implantation or early embryo development.

• Blocked fallopian tubes (tubal factor infertility): Scarring or obstruction that prevents sperm from reaching the egg, or the fertilized egg from reaching the uterus.

• Primary ovarian insufficiency (POI): A condition in which the ovaries stop functioning normally before age 40, resulting in irregular cycles and reduced egg supply.

• Hormonal imbalances: Disruptions in FSH, LH, estradiol, prolactin, or thyroid hormones that interfere with ovulation or uterine receptivity.

• Low ovarian reserve: A diminished egg supply relative to what is typical for a woman's age, which may reduce the chances of conception or response to treatment.

• Irregular or absent ovulation (anovulation): One of the most common and treatable causes of infertility, often addressed effectively with medication.

• Pelvic adhesions or scarring: Scar tissue from prior surgery or infection that can distort pelvic anatomy and impair reproductive organ function.

• Genetic or chromosomal conditions: Inherited factors that can affect egg quality, ovarian function, or the risk of passing certain conditions to a child.

• Recurrent pregnancy loss: Repeated miscarriages that may point to an underlying anatomical, hormonal, genetic, or immunological cause.

• Unexplained infertility: When standard testing does not reveal a clear cause, further evaluation or advanced treatment may be recommended.

What is AMH testing and why does it matter?

Anti-Müllerian Hormone (AMH) testing is one of the most important fertility evaluations available to women, and one of the first tests ordered at Aspire Houston. AMH is a hormone secreted directly by the small, developing follicles in the ovaries, making it one of the most accurate available indicators of ovarian reserve: the number of eggs a woman has remaining.

What makes AMH particularly useful is its flexibility – unlike many hormonal tests that must be timed to a specific day in the menstrual cycle, AMH can be measured from a blood draw taken on any day. Results are typically available within a few days and are interpreted alongside other clinical findings.

What your AMH level may mean:

• Higher AMH levels: Generally indicate a larger ovarian reserve, suggesting a stronger potential response to ovarian stimulation and a wider range of treatment options available.

• Lower AMH levels: Suggest a diminished ovarian reserve which may affect how quickly a patient should pursue treatment and how she may respond to IVF stimulation.

• Very high AMH levels: Can sometimes be associated with polycystic ovary syndrome (PCOS), where many small follicles are present but regular ovulation may not be occurring.

AMH naturally declines with age – most significantly after the mid-30s – but lower-than-expected levels can also appear in younger women due to genetic factors, prior ovarian surgery, or autoimmune conditions. A low AMH result is not a definitive statement about your ability to conceive, but it is an important signal about timing and treatment approach. Understanding your AMH level early gives you and your physician the information needed to make decisions that are realistic, timely, and tailored to your biology.

What other female fertility testing is part of an overall evaluation?

Depending on your age, symptoms, medical history, and initial results, your Aspire Houston physician will recommend one or more of the following additional evaluations as part of a complete fertility workup:

Medical History and Physical Examination

Every evaluation at Aspire Houston begins with a thorough review of your personal and family medical history, including menstrual patterns, prior pregnancies, surgical history, and any known health conditions. A physical examination helps identify anatomical concerns that may not surface through bloodwork alone. This foundational step ensures that all subsequent testing is targeted, efficient, and appropriate to your individual situation rather than generic.

Ovulation Assessment

Regular, predictable ovulation is essential for natural conception. Aspire Houston evaluates ovulatory function through several methods, including cycle tracking and basal body temperature monitoring, mid-luteal phase progesterone blood tests to confirm that ovulation has occurred, and transvaginal ultrasounds to observe follicle growth and rupture in real time. Identifying ovulatory disorders, such as anovulation or luteal phase defects, is a critical step, as many of these conditions respond well to targeted medical treatment.

Hormonal Testing

Reproductive hormones govern the menstrual cycle, ovulation, and the uterine environment for implantation. Standard hormonal testing at Aspire Houston typically includes follicle-stimulating hormone (FSH) and estradiol drawn on cycle day 2 or 3 to assess pituitary signaling and early ovarian response; luteinizing hormone (LH), which triggers the release of a mature egg; prolactin, elevated levels of which can suppress ovulation and disrupt cycle regularity; and thyroid-stimulating hormone (TSH), since thyroid dysfunction is a common and often overlooked contributor to fertility challenges. Results are always interpreted in the context of your broader clinical picture.

Ovarian Reserve Testing

Ovarian reserve describes the quantity – and to some extent, the quality – of a woman's remaining egg supply. At Aspire Houston, reserve is assessed through a combination of AMH blood testing and a transvaginal ultrasound antral follicle count (AFC), which directly counts the number of small follicles visible in the ovaries at the beginning of a cycle. Together, AMH and AFC provide a comprehensive picture of reproductive potential that is essential for planning IVF, egg freezing, or other fertility treatments.

Hysterosalpingography (HSG)

A hysterosalpingogram (HSG) is an outpatient X-ray procedure used to evaluate the structure of the uterine cavity and confirm whether the fallopian tubes are open. During the procedure, contrast dye is gently introduced through the cervix, and X-ray imaging tracks the path of the dye through the uterus and tubes. Open tubes allow the dye to flow freely into the pelvis; a blockage is identified by where the flow stops. The HSG is typically scheduled in the first half of the menstrual cycle and is completed in about 15 to 30 minutes. Some patients experience mild cramping during the procedure.

Transvaginal Ultrasound Testing

Transvaginal ultrasound is a foundational tool in fertility evaluation and cycle monitoring. Using a small, smooth probe placed gently inside the vagina, this imaging technique provides a clear, real-time view of the uterus, ovarian structure, and follicle development. It is used at Aspire Houston to assess the uterine lining and cavity, perform the antral follicle count for ovarian reserve, identify structural abnormalities such as fibroids, polyps, or ovarian cysts, and monitor follicle growth during stimulation cycles. The procedure is minimally uncomfortable and requires no sedation.

Laparoscopy

Laparoscopy is a minimally invasive surgical procedure performed under general anesthesia that allows a physician to directly examine the pelvic organs using a small camera inserted through a tiny incision near the navel. It is the only way to definitively diagnose conditions such as endometriosis, pelvic adhesions, and ovarian cysts that may not be detectable through imaging alone. When an underlying pelvic cause is suspected based on symptoms or prior test results, laparoscopy provides direct visualization and often the opportunity to treat what is found during the same procedure.

Genetic Testing

Genetic testing may be recommended for women with a personal or family history of chromosomal conditions, recurrent pregnancy loss, premature ovarian insufficiency, or known single-gene disorders. Carrier screening identifies whether you carry a gene mutation that could be passed to a child, while chromosomal analysis – of both partners and sometimes pregnancy tissue – can help explain a pattern of miscarriage. Your Aspire Houston physician will recommend appropriate genetic evaluations based on your specific history, and genetic counseling is available to help you interpret and act on results.

Saline Infusion Sonogram (SIS)

A saline infusion sonogram (SIS), also called a sonohysterogram, is a minimally invasive in-office procedure in which a small amount of sterile saline is introduced into the uterine cavity to improve visualization of the uterine lining during ultrasound. This technique is particularly effective at identifying intrauterine abnormalities such as endometrial polyps, submucosal fibroids, or uterine adhesions that can interfere with embryo implantation. The SIS provides more detailed information about the uterine cavity than a standard ultrasound and does not require sedation or a hospital setting.

How much does female fertility testing cost?

The cost of female fertility testing at Aspire Houston Fertility depends on which evaluations are recommended based on your individual history and clinical presentation. Many standard diagnostic tests, including bloodwork and ultrasounds, may be partially or fully covered by insurance, particularly when ordered for a documented medical indication.

Texas does not have a state-mandated fertility insurance law, which means coverage levels vary widely depending on your employer and plan type. We encourage you to contact your insurance provider before your appointment to understand what is covered under your specific benefits. Aspire Houston’s financial team is available to help you review your coverage and plan accordingly before care begins.

For any costs not covered by insurance, Aspire Houston offers a range of flexible financial solutions, including payment plans, financing options, and financial assurance programs to help reduce barriers to the care you need.