Fertility Assessment for Women:
What Tests Are Available?
A private fertility assessment provides a comprehensive picture of ovarian reserve, ovulation, and pelvic anatomy — identifying treatable causes of subfertility and guiding next steps.
In brief: A comprehensive fertility assessment at Victoria Medical includes AMH, FSH, LH, oestradiol, progesterone, thyroid function, prolactin, and a pelvic ultrasound with antral follicle count — all at a single appointment. NICE CG156 recommends assessment after 12 months of trying to conceive (6 months if over 35).[6]
Fertility Tests: What Each One Shows
| Test | Timing | Purpose |
|---|---|---|
| AMH (Anti-Müllerian Hormone) | Any time in cycle | Ovarian reserve — reflects the remaining egg supply. Low AMH suggests reduced reserve. |
| FSH (Follicle-Stimulating Hormone) | Day 2–5 of cycle | Elevated FSH suggests reduced ovarian reserve or premature ovarian insufficiency. |
| LH (Luteinising Hormone) | Day 2–5 of cycle | Elevated LH:FSH ratio suggests PCOS. LH surge triggers ovulation. |
| Oestradiol (E2) | Day 2–5 of cycle | Baseline oestradiol — elevated levels may indicate reduced ovarian reserve. |
| Progesterone | Day 21 of cycle (28-day cycle) | Confirms ovulation has occurred. Low progesterone suggests anovulatory cycle. |
| Thyroid function (TSH) | Any time | Thyroid dysfunction is a common and treatable cause of irregular periods and subfertility. |
| Prolactin | Fasting, morning | Elevated prolactin (hyperprolactinaemia) causes anovulation and amenorrhoea. |
| Antral follicle count (AFC) | Day 2–5 of cycle | Pelvic ultrasound count of small follicles — reflects ovarian reserve alongside AMH. |
From Our Practice — Dr George Xynopoulos
"Fertility assessment is one of the most emotionally charged consultations I conduct. Patients often come in with a mixture of hope and anxiety, and it is important to approach the conversation with both clinical rigour and genuine empathy. The most important thing I tell patients is that a fertility assessment is a starting point — not a verdict. Many of the conditions we identify, from thyroid disease to PCOS to hyperprolactinaemia, are highly treatable. Getting the right diagnosis early gives patients the best possible chance."
Frequently Asked Questions
When should I consider a fertility assessment?
NICE CG156 recommends that women under 35 who have not conceived after 12 months of regular unprotected intercourse should seek assessment. Women over 35 should seek assessment after 6 months. Women with known risk factors (irregular periods, previous pelvic surgery, endometriosis, PCOS) should seek earlier assessment.
What is AMH and what does it tell me?
Anti-Müllerian Hormone (AMH) is produced by small follicles in the ovaries and reflects the remaining egg supply (ovarian reserve). A low AMH suggests reduced ovarian reserve — but it does not predict whether you can conceive naturally. AMH can be measured at any point in the menstrual cycle.
Do I need a GP referral for a private fertility assessment?
No. At Victoria Medical you can self-refer for a private fertility assessment without a GP referral. We can arrange all necessary blood tests and pelvic ultrasound at a single appointment.
Can a fertility assessment tell me if I can get pregnant?
A fertility assessment provides important information about ovarian reserve, ovulation, and pelvic anatomy — but it cannot definitively predict whether you will conceive. It identifies treatable causes of subfertility and guides the next steps in your care.
What happens after a fertility assessment?
Depending on the results, next steps may include lifestyle advice, treatment for an underlying condition (thyroid disease, PCOS, hyperprolactinaemia), referral for ovulation induction, or referral to a fertility clinic for IVF assessment. At Victoria Medical, we will discuss all options at your results consultation.
References
- [1]Broer SL, Mol BW, Hendriks D, Broekmans FJ. The role of antimüllerian hormone in prediction of outcome after IVF: comparison with the antral follicle count. Fertil Steril. 2009;91(3):705–714. https://doi.org/10.1016/j.fertnstert.2007.12.013
- [2]Neven A, Laven J, Teede HJ, Boyle JA. A Summary on Polycystic Ovary Syndrome. Semin Reprod Med. 2018;36(1):5–12. https://doi.org/10.1055/s-0038-1667351
- [3]Chaker L, Cooper DS, Walsh JP, Peeters RP. Hypothyroidism. Lancet. 2022;398(10308):1382–1396. https://doi.org/10.1016/S0140-6736(21)01628-6
- [4]Guerriero S, Condous G, van den Bosch T, et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis. Ultrasound Obstet Gynecol. 2016;48(3):318–332. https://doi.org/10.1002/uog.15955
- [5]Fahs D, Abou-Abbas L, Hamdan Z, Salameh P. Polycystic Ovary Syndrome: Pathophysiology and Controversies in Diagnosis. Diagnostics. 2023;13(7):1252. https://doi.org/10.3390/diagnostics13071252
- [6]NICE. Fertility problems: assessment and treatment. NICE guideline CG156. 2013 (updated 2023). https://www.nice.org.uk/guidance/cg156
Dr George Xynopoulos
Consultant Physician & Cardiologist | GMC Registered | MRCP (UK)
Dr Xynopoulos is a Consultant Physician and Cardiologist at Victoria Medical, 170 Vauxhall Bridge Road, London.
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Comprehensive fertility assessment at Victoria Medical. Blood tests and pelvic ultrasound at one appointment.
020 3146 9508