Fertility Workup 101: What to Expect at Your First Visit

You are not alone in seeking answers about your fertility. In the United States, about one in six couples faces challenges with conception, and referrals for fertility evaluations are on the rise as more people delay childbearing. It’s natural to feel anxious or uncertain about what your first fertility workup will involve, especially given the emotional and practical stakes.

Understanding what to expect can help ease your concerns. Most fertility investigations are straightforward and noninvasive, focusing on identifying common causes such as ovulation issues, sperm health, or fallopian tube problems. For many, the initial visit includes a detailed medical history, physical exam, and basic tests—steps designed to provide clarity and guide your next decisions.

It’s important to know that even with advanced treatments, natural human fertility is lower than many expect, with the chance of pregnancy per cycle peaking at about 33%. Managing expectations and receiving clear, compassionate guidance from your care team can empower you to make informed choices on your fertility journey.

Why book a fertility workup sooner rather than later?

Booking a fertility workup early can make a significant difference in your reproductive journey. Fertility naturally declines with age, and many underlying issues—such as low ovarian reserve or anatomical abnormalities—often go unnoticed until you seek evaluation. In a recent study, 58.5% of women who underwent a proactive fertility checkup discovered an anatomical issue, and 14% had a lower-than-expected ovarian reserve for their age. Early detection allows you to address these concerns before they become barriers to conception or limit your options .

You benefit from early assessment in several ways:

• You gain clarity about your reproductive health and future options.
• You can make informed decisions about family planning, career, and lifestyle.
• You have more time to consider fertility preservation, such as egg or sperm freezing, if needed.
• You reduce the risk of age-related fertility decline impacting your choices.

Health care providers should initiate the discussion on the possibility of infertility with patients during their reproductive years as early as possible, so as to allow for the widest array of options for fertility preservation. According to the Centers for Disease Control and Prevention, about 12% of women aged 15–44 in the U.S. have difficulty getting pregnant or carrying a pregnancy to term, underscoring the importance of timely evaluation. Early action empowers you to take control of your reproductive health and plan confidently for your future 1.

Curious about the lab values doctors watch most closely? Explore the ranges in Fertility Blood Tests: What Each Number Means.

How can you prepare before stepping into the clinic?

Preparing for your first fertility workup can help you feel more confident and make the process smoother. Start by gathering your complete medical history, including menstrual cycles, past pregnancies, surgeries, and any relevant health conditions. Bring a list of all medications and supplements you and your partner take. If possible, collect information about your family’s reproductive health, as this can guide your provider’s assessment.

Consider these steps before your visit:

• Track your menstrual cycles for several months, noting start dates, flow, and any irregularities.
• Write down questions or concerns you want to discuss.
• Ensure your partner is available for testing, as male factors contribute to infertility in about one-third of cases (Centers for Disease Control and Prevention, 2023).
• Check your insurance coverage for fertility testing and treatments

Bring or complete:

1. Prior labs, operative reports, and any imaging disks.
2. Cycle-tracking data from apps or paper charts.
3. Insurance cards, pre-authorizations, and a cost checklist—35 % of U.S. plans cover testing only.
4. A current medication and supplement list.
5. Partner paperwork; remind them to abstain 2–5 days before semen collection.

Emotional readiness is just as important. Research shows that women who feel prepared—emotionally, financially, and socially are more likely to continue and succeed with fertility treatment. Factors like higher education, supportive relationships, and open communication with your care team can boost your preparedness and reduce stress . As you prepare, remember: “Being able to detect and intervene [in readiness factors] will contribute to the fertility treatment success rate. If a couple starts well prepared, financial loss may be prevented, the treatment success may be improved, and discontinuation of treatment may decrease” 2.

Meeting online instead of in person? See the tips in Telehealth Tips: Nail Your First Online Fertility Consult.

Which female-focused tests happen first, and what do they reveal?

At your first fertility visit, several female-focused tests are typically performed to assess your reproductive health and identify possible barriers to conception. The initial tests often include:

Day-3 hormone panel

These measure hormones such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and anti-Müllerian hormone (AMH). AMH is especially important for estimating your ovarian reserve—the number of eggs remaining in your ovaries. While AMH gives a good sense of egg quantity, it does not predict egg quality or guarantee pregnancy, and results must be interpreted alongside your age and other health factors. Pair this with your AMH Levels Chart for a fuller picture.

Transvaginal ultrasound

A pelvic ultrasound may be performed to check the structure of your uterus and ovaries, and to count the number of developing follicles (antral follicle count), which also reflects ovarian reserve. Walk through the procedure step-by-step in First Transvaginal Ultrasound: Step-by-Step Overview.

Hysterosalpingogram (HSG)

An X-ray with contrast dye confirms whether fallopian tubes are open and sometimes “flushes” minor debris, nudging pregnancy rates up by 2–4 %. Details live in HSG Test: Can It Boost Pregnancy Odds?.

Luteal-phase progesterone

A level ≥ 5 ng/mL one week before your period proves ovulation; see the nuances in Day-21 Progesterone: Why It Matters.

These tests reveal important information about your egg supply, ovulation patterns, and reproductive anatomy, helping your care team tailor the next steps in your fertility plan. Remember, age remains the strongest factor influencing fertility outcomes, and no single test can fully predict your chances of conception

What male-factor evaluations should you expect, and why do they matter?

At your first fertility visit, expect a thorough evaluation of male reproductive health, as male factors contribute to about half of all infertility cases in couples.

Key male fertility factors:

• Lifestyle habits: smoking, alcohol use, poor diet, obesity, inadequate physical activity, and high stress levels
• Environmental exposures: air and water pollution, pesticides, heavy metals, endocrine-disrupting chemicals (like phthalates and bisphenols), and excessive heat (e.g., from hot tubs or laptops)
• Medical conditions: hormonal imbalances, genetic disorders, infections, and chronic diseases
• Use of certain medications or recreational drugs
• Genitourinary issues: varicocele, undescended testicles, or anatomical abnormalities
• Age and overall health status
• Exposure to electromagnetic fields and radiation

Why these factors matter:

• They can reduce sperm count, motility, and quality, directly impacting your chances of conception.
• Many are modifiable—improving your lifestyle or reducing harmful exposures can enhance fertility outcomes.
• Some factors, like environmental toxins, may cause long-term or even generational effects on reproductive health through genetic or epigenetic changes.
• Male fertility is closely linked to overall health; issues here may signal broader health risks, including metabolic, cardiovascular, or oncologic conditions.
• Early identification and intervention can improve both fertility and long-term health prospects.

The multifaceted nature of both the causative factors and the susceptibility background makes the resulting fertility disturbance highly individual and variable among different men exposed to the same conditions 3 .

What happens after the tests and how is your treatment roadmap built?

After your fertility tests, your care team reviews the results with you to explain what they mean for your reproductive health. Together, you discuss your goals, preferences, and any barriers identified. Your treatment roadmap is then built step by step, tailored to your unique situation.

Key steps in building your treatment plan:

• Diagnosis: Your provider explains the findings from your tests—such as ovulation status, ovarian reserve, sperm quality, or anatomical issues.
• Personalized options: You receive recommendations based on your diagnosis, age, and personal goals. Options may include lifestyle changes, medications to induce ovulation using Clomid vs. Letrozole, intrauterine insemination (IUI) outlined in IUI Roadmap: From Prep to Pregnancy Test, in vitro fertilization (IVF) as in IVF Made Easy., or fertility preservation (like egg or sperm freezing) if needed .
• Shared decision-making: You and your provider discuss the risks, benefits, and success rates of each option. Your values and preferences guide the plan .
• Support services: You may be referred to counseling, financial navigation, or support groups to help you manage emotional and practical challenges .
• Follow-up: Your plan includes regular check-ins to monitor progress and adjust treatment as needed.

This collaborative, stepwise approach ensures you understand your options and feel empowered throughout your fertility journey. As the American Society for Reproductive Medicine emphasizes, “Shared decision-making and clear, comprehensive information are essential to avoid misunderstanding and to support the best outcomes for each individual or couple”.

Can lifestyle and evidence-based habits really boost conception during your workup?

Yes, adopting healthy lifestyle and evidence-based habits can meaningfully boost your chances of conception during your fertility workup. Research shows that modifiable factors such as maintaining a healthy weight, eating a balanced diet, exercising regularly, managing stress, and avoiding smoking, excessive alcohol, and recreational drugs can improve both male and female fertility by supporting hormone balance, egg and sperm quality, and overall reproductive function. For women, habits like reducing stress, achieving a healthy body mass index, and avoiding environmental toxins can help regulate ovulation and improve the uterine environment, while for men, similar changes can enhance sperm count, motility, and DNA integrity.

Obesity, poor nutrition, and sedentary lifestyles are linked to hormonal imbalances and metabolic issues that can disrupt fertility in both sexes, but positive changes such as weight loss and increased physical activity—have been shown to reverse some of these effects and improve outcomes, even in assisted reproductio. Environmental exposures, like pesticides and endocrine-disrupting chemicals, also play a role, so minimizing contact with these substances is recommended. While not every lifestyle change guarantees conception, evidence strongly supports that healthier habits can optimize your fertility potential and may even improve the success of medical treatments.

Tracking follicle response while you optimize habits? Read Follicle Scans 101: How Doctors Track Egg Growth.

What if standard tests come back “normal”—are there advanced options?

If standard fertility tests come back “normal” but you’re still struggling to conceive, there are advanced testing options that can provide deeper insights.

For men, advanced sperm function tests such as sperm DNA fragmentation assays, oxidative stress tests, acrosome reaction tests, and assessments of sperm mitochondrial function—can reveal subtle problems with sperm quality or function that routine semen analysis may miss. These tests help identify issues like DNA damage or poor sperm survival, which can impact fertilization and embryo development, and may also predict the likelihood of success with treatments like intrauterine insemination (IUI) or in vitro fertilization (IVF).

For women, if standard hormone and imaging tests are normal, further options might include more detailed assessments of egg quality, uterine receptivity, or genetic screening of embryos (preimplantation genetic testing) during IVF, especially for those of advanced maternal age or with recurrent pregnancy loss. While these advanced tests can offer valuable information, they are not always necessary for every couple, and their use should be guided by your specific history and needs. It’s important to note that no single advanced test can guarantee a diagnosis or successful pregnancy, but together, they can help tailor your treatment plan and improve your chances of conception.

How does the workup adapt for LGBTQ+, single parents, or fertility preservation?

Fertility workups are increasingly tailored to meet the unique needs of LGBTQ+ individuals, single parents by choice, and those seeking fertility preservation.

For LGBTQ+ and transgender people, the process often includes early, comprehensive counseling about how gender-affirming treatments or surgeries may impact future fertility, and offers options such as sperm or egg freezing, embryo cryopreservation, or ovarian/testicular tissue preservation before starting medical transition. These discussions are ideally multidisciplinary, involving reproductive specialists, mental health professionals, and gender-affirming care providers, and should be individualized to respect each person’s identity, goals, and timing preferences.

Single parents by choice receive workups focused on their reproductive health and are counseled on options like donor sperm or eggs, surrogacy, and fertility preservation, with support for both medical and emotional aspects of solo parenthood.

Fertility preservation is also offered to people facing medical treatments (like chemotherapy) that may threaten fertility, as well as to those who wish to delay parenthood for personal or professional reasons. Across all groups, access to clear information, supportive counseling, and respect for diverse family-building goals is essential, as inadequate counseling can lead to regret or distress later on. The evolving approach ensures that everyone—regardless of gender identity, relationship status, or future plans—can make informed, empowered choices about their reproductive futures.

Egg freezing? Start with Egg Freezing 101: Preserve Fertility for Later.

Your top questions, answered fast

Do they run tests at the first appointment?
Often, initial fertility appointments include a detailed medical history and may involve some basic tests, such as bloodwork or a semen analysis, but more specialized tests are usually scheduled for follow-up visits depending on your situation.

How long does a full fertility workup take?
A complete fertility workup typically takes several weeks to a couple of months, as it may involve multiple tests (bloodwork, ultrasounds, semen analysis, HSG, etc.) that are timed to specific points in the menstrual cycle or require follow-up appointments.

Is the HSG painful?
The hysterosalpingogram (HSG) can cause mild to moderate discomfort or cramping for some people, but the pain is usually brief and manageable; over-the-counter pain relief and relaxation techniques can help.

What if I’m over 40?
Fertility declines with age, especially after 40, due to reduced egg quality and quantity, but options like IVF, use of donor eggs, and tailored medical support can still offer a chance at pregnancy; early evaluation and prompt action are recommended.

Can lifestyle changes replace medical treatment?
While healthy lifestyle changes such as improving diet, maintaining a healthy weight, reducing stress, and avoiding smoking or excessive alcohol can significantly boost fertility and sometimes even restore it, they rarely replace the need for medical treatment if there are underlying medical or age-related issues; instead, they work best alongside medical care to optimize your chances of conception.

Final Thoughts

A fertility workup is a structured, stepwise process designed to identify the causes of infertility and guide personalized treatment. It typically begins with a thorough medical history, physical examination, and targeted tests for both partners, including assessments of ovulation, ovarian reserve, tubal patency, and semen analysis, since male factors contribute to 40–50% of cases . Imaging and additional tests are used as indicated to uncover structural or functional issues. For women over 35, or those with known risk factors, evaluation and treatment are expedited due to the impact of age on fertility. While concise workups are more common for efficiency, evidence suggests that more comprehensive evaluations may lead to higher pregnancy rates, as they can detect subtle or less obvious causes of infertility.

The workup process is evolving, with options like online consultations proving as effective as traditional in-person visits in terms of patient satisfaction and shared decision-making. Importantly, fertility assessments are now being offered to a broader range of individuals, including those not immediately planning pregnancy, LGBTQ+ couples, and single parents, to support informed family planning and fertility preservation. Challenges remain, especially for underserved populations, in completing all recommended tests, highlighting the need for improved access and support. Ultimately, a fertility workup is not just about diagnosis—it empowers individuals and couples with information, options, and a clear path forward, tailored to their unique needs and goals.

For extra confidence, grab our printable First Visit Checklist and keep exploring starting with Fertility Blood Tests: What Each Number Means.

References

1. Fertility Check Up: A concept of all-in-one ultrasound for the autonomous evaluation of female fertility potential. Analysis and evaluation of first two years of experience… Journal of gynecology obstetrics and human reproduction, 102461. https://doi.org/10.1016/j.jogoh.2022.102461

2. Cancer Therapy, Gonadal Function, and Fertility Preservation: Narrative Review. JCO Oncology Practice, 20, 1580 - 1587. https://doi.org/10.1200/OP.23.00468

3. The Impact of Obesity and Metabolic Health on Male Fertility: A Systematic Review… Fertility and sterility. https://doi.org/10.1016/j.fertnstert.2023.10.017

4. Lifestyle and Environmental Factors Affecting Male Fertility, Individual Predisposition, Prevention, and Intervention. International Journal of Molecular Sciences, 26. https://doi.org/10.3390/ijms26062797

5. Fertility Preservation in Patients With Cancer: ASCO Clinical Practice Guideline Update… Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 36 19, 1994-2001. https://doi.org/10.1200/JCO.2018.78.1914

6. The fertility preparedness and affecting factor in women that undergoing fertility treatment. Reproductive BioMedicine Online. https://doi.org/10.1016/j.rbmo.2023.103494

7. Environment, Lifestyle, and Female Infertility. Reproductive Sciences, 28, 617 - 638. https://doi.org/10.1007/s43032-020-00279-3

8. Lifestyle and fertility: the influence of stress and quality of life on male fertility. Reproductive Biology and Endocrinology : RB&E, 16. https://doi.org/10.1186/s12958-018-0436-9