Causes & Treatment

The A-Z of fertility tests for women

Eloise Edington  |  9 Feb 2023

Understand your fertility: causes of infertility, treatments and next steps

Across Europe millions of people are seeking treatment for fertility issues. There are many reasons why people may struggle to conceive, and the causes of infertility are myriad and can be male or female factor, or both. 

Infertility is generally defined as an inability to conceive (i.e having regular sex without contraception) within a twelve month period, which is something that, according to the World Health Organization (WHO), affects 15% of reproductive-age couples worldwide. This is striking because it shows that fertility issues are by no means uncommon. It’s no surprise, then, that so many people in the FHH community are asking: “how do I know whether or not I can have kids?”

Working closely with Spain-based fertility clinics Eugin (in Barcelona and Madrid), pioneers in the fertility space since 1998, we’ve created a comprehensive guide to the various fertility tests for women, and what you might discuss with your doctor when approaching a potential infertility diagnosis. 

While a third of infertility cases are due to the male partner only, today we’ll be focussing on the tests for identifying causes of infertility in women. You can find more information on testing and treating male infertility here. 

Have a read through our A-Z of science-backed fertility tests for women so you can get familiar with some of the terminology, plus we’ve added what to expect from each procedure and some tips on your next steps.


How to test for female infertility

Anti-Müllerian hormone (AMH) testing

AMH is produced in the ovarian follicles and can tell you a lot about your fertility. AMH levels peak in a woman at around 25 years old, and slowly decline over time, becoming undetectable at around 50 years old.

AMH expression reflects ovarian reserve – how many eggs are present for potential fertilisation. Low AMH levels means a reduced chance of conception. 

What to expect: AMH levels are measured with a simple blood test and require no preparation.

Your next steps: By no means does a low AMH reading mean you won’t be able to conceive, but it may mean your chances are lower than you thought. Your fertility specialist will give you other tests before drawing a conclusion and deciding next steps.

Endometrial biopsy

This test involves gently scraping a sample of tissue from the uterus lining – the endometrium – to screen for issues with ovulation and/or for identifying inflammation that needs treating.

What to expect: The test should take around 10-15 minutes. A thin flexible tube is inserted into the uterus to take the sample. Some patients may feel minimal cramping. If you experience discomfort, you may be prescribed mild pain medication.

Your next steps: This standard test is designed to gather more information about why you might be struggling with infertility, and the results (whatever they may be) are unlikely to be fully conclusive and mean the end of the road. You can discuss your results with your clinician and take any necessary steps.

Hysterosalpingography (HSG)

Blocked fallopian tubes or abnormalities in the uterine cavity may cause fertility issues. A HSG is an X-ray test that helps give an outline of the fallopian tubes and see if they are blocked, as well as identify any other issues that need treating.

What to expect: A thin tube is inserted into the vagina and cervix and a dye known as contrast material is injected into the uterus. A series of X-rays tracks the dye and can create an image to see if there are any issues. This is a minimally invasive procedure, although you can expect some discomfort during and some cramping afterwards.

Your next steps: Blocked fallopian tubes are a common cause of infertility in women. If you’re diagnosed with blocked tubes, this means it can be difficult for sperm and egg to meet. While natural conception is not impossible if your tubes are partially blocked, if they are fully blocked you will need to seek further treatment.



hysteroscopy is a minimally invasive examination of the uterine lining. The test is used to investigate a range of issues, and is particularly useful for identifying factors that may be contributing to infertility, such as causes of abnormal bleeding and miscarriages.

A hysteroscopy can also be used to remove scarring, polyps and fibroids which can cause fertility problems.

What to expect: Taking between five and 30 mins, a thin tube with a camera is inserted into the vagina and cervix. Images from the camera are then observed by the clinician. If you’re having a condition treated, you might receive a general anaesthetic but should still be able to return home the same day. Mild discomfort and cramping afterwards can be expected.

Your next steps: If a hysteroscopy identifies an issue, your clinician will advise on next steps. Whether an issue is observed or not, the process is not very invasive and you should be able to safely return to normal activities within the next two days.


Chromosome analysis – also called ‘karyotyping’ – can be used to identify certain disorders that could be causing infertility. Chromosomes are thread-like structures within our cells which contain our genetic blueprint. The karyotype process evaluates your chromosomes, assessing size, shape and number in order to identify abnormalities.

Regular cells contain a complete set of 46 chromosomes; normal egg and sperm cells contain a half set of 23. Some chromosomal disorders can mean a predisposition to infertility, such as defects preventing conception.

What to expect: Karyotyping requires a blood test and will be over in a matter of seconds.

Your next steps: If a karyotype test reveals abnormal chromosomes, you may want to consider looking into IVF options. Eugin’s team can offer expert guidance on your options, in this case.

Transvaginal ultrasound

This is actually one of the first tests you’ll likely undergo if you’re concerned about infertility. An ultrasound scan is used to create an image of the uterus and ovaries in order to identify any abnormalities within the pelvic floor area and to assess the ovarian reserve thanks to the identification of antral follicles in the ovaries. It can also help identify cysts, tumours, polyps and fibroids.

What to expect: A transvaginal ultrasound involves gently inserting a transducer (imaging device) into the vagina. This may cause some discomfort, but it should not be painful.

Your next steps: Following a transvaginal ultrasound, your medical professional will be able to address issues you may have (if any) and to determine your ovarian reserve by performing an antral follicle count (AFC), then he/she will be able to make a plan if necessary for next steps on your fertility journey.


Run your A-Z with an expert, pioneering team (and a free first visit)

For the Eugin team, A-Z fertility testing is just one of the principles of expert care which sets this clinic apart amongst thousands of options across Europe. We love that: 

  • your first Eugin visit is free of charge 
  • the team operate a no waiting list policy
  • they’ve pioneered fertility and egg donation treatment for 25 years

Get in touch to book your free initial consultation, and your first steps with the Eugin team.

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