By Gabrielle Gleeson-Solomon, CEO of Tota
Scientific Review by Dr Nick Parkinson, PhD
On what fertility tests are worth considering before trying to conceive.
Thinking about trying for a baby is exciting, but it also comes with a lot of questions.
A quick search online brings up an overwhelming list of fertility tests. AMH, hormone panels, ovarian reserve scans, sperm analysis, DNA fragmentation and more. The challenge is that every test measures something different, making it difficult to know which ones are actually worth considering.
In this article, we'll break down some of the most common preconception health tests, explain what each one can and can't tell you, and explore why the vaginal microbiome is becoming an increasingly important part of the fertility conversation.
What fertility tests are worth considering before trying to conceive?
There isn't a single fertility readiness test that can tell you whether you'll become pregnant.
For pregnancy to happen, ovulation needs to occur, sperm need to reach and fertilise the egg, and a healthy embryo then needs to implant successfully. Every stage relies on different biological processes working as they should.
That's why reproductive health is best thought of as a puzzle rather than a single result. Different tests provide different pieces of information, helping you build a better understanding of where you're starting from.
AMH: Understanding your ovarian reserve
AMH, (Anti-Müllerian Hormone) is one of the most talked-about fertility tests, and it's often one of the first tests people hear about when they start looking into fertility.
AMH measures ovarian reserve which is an estimate of how many eggs remain in the ovaries. It's particularly useful in fertility assessment and for people considering IVF, where it can help predict how the ovaries are likely to respond to treatment.
However, it doesn't measure egg quality or tell you how long it will take to conceive or whether you’ll be able to conceive naturally. Many women with lower AMH levels go on to have healthy pregnancies without fertility treatment, while a higher AMH level doesn't guarantee that someone won't experience fertility difficulties.
It can be an important piece of information, but it's only one piece.
Other hormone tests
There are several other hormone tests that measure different aspects of reproductive health and can help provide more information around a person’s fertility.
These might include:
- FSH and LH, which help assess communication between the brain and ovaries.
- Oestradiol, which provides further information about ovarian function.
- Progesterone, often measured after ovulation to confirm that ovulation has taken place.
- Thyroid function tests, as both an underactive and overactive thyroid can affect fertility and pregnancy.
Not everyone will need all of these tests. Which ones are appropriate depends on individual circumstances and the information you're looking to understand.
One of the biggest misconceptions about fertility testing is that there's a test for egg quality. While tests such as AMH can estimate ovarian reserve, there isn't currently a test that can directly measure egg quality. Instead, it's largely inferred from factors such as age and, during IVF, embryo development. That's why it's important to look at the whole picture when trying to understand fertility.
Don't forget - fertility tests for men
When people think about fertility, the focus often falls on women, when in reality, male factors contribute to around half of all fertility difficulties.
A semen analysis typically assesses several aspects of sperm health, including:
- sperm count
- sperm movement (motility)
- sperm shape (morphology)
It can also highlight issues that may benefit from further investigation or treatment.
If you're planning a pregnancy as a couple, it's worth remembering that understanding both partners' reproductive health often provides a much clearer picture than focusing on one person alone.
The fertility factor you may not have heard about - the vaginal microbiome
Alongside hormone testing and sperm health, another area of fertility research has been gaining increasing attention over the past decade: the vaginal microbiome.
The vagina is the first environment sperm encounter on their journey towards the egg, which is one reason researchers are investigating whether the vaginal microbiome may influence conception and early pregnancy.
Advances in DNA sequencing have transformed our understanding of these bacteria, revealing that the vaginal microbiome may play a much bigger role in women's health than previously thought. Researchers are now investigating how it influences fertility and pregnancy outcomes.
What does the research say?
Research into the vaginal microbiome and fertility is still relatively limited, in part because women's health has historically received less research funding and investment than many other areas of medicine. That said, the strongest evidence so far comes from IVF research.
A large review of the evidence found that women with vaginal dysbiosis had around an 18% lower chance of achieving a clinical pregnancy following IVF than women with healthier vaginal microbiomes. Researchers have also observed associations between vaginal microbiome dysbiosis (imbalance) and poorer reproductive outcomes, including recurrent implantation failure, miscarriage and unexplained infertility.
While researchers are still uncovering exactly how the vaginal microbiome influences fertility, the evidence already suggests it's an important part of reproductive health that's often overlooked. A vaginal microbiome test can show whether your microbiome is balanced to support sperm, implantation and early pregnancy.
Fertility investigations and treatment can be time-consuming, emotionally demanding and, for many people, expensive. A vaginal microbiome test isn't a replacement for conventional fertility testing, but it can provide additional information about an aspect of reproductive health that isn't routinely assessed. If a microbiome imbalance is identified, it may be something you can address before moving on to more complex investigations or treatment.
Should you test your vaginal microbiome before trying to conceive?
Although it isn't yet part of routine preconception care, the vaginal microbiome is becoming an increasingly important part of the fertility conversation, with more researchers, clinicians and fertility specialists recognising the role it could play in fertility.
A vaginal microbiome test won't tell you whether you'll become pregnant, but it can provide valuable information about an aspect of reproductive health that isn't routinely assessed during traditional fertility investigations. It can help you build a clearer picture of your reproductive health before you start trying to conceive.
While more research is still needed to understand exactly how the vaginal microbiome influences fertility, the good news is that it's relatively straightforward to assess. If an imbalance is identified, there are often practical steps you can take to support a healthier vaginal microbiome.
Understanding your fertility
There isn't one fertility test that's right for everyone. A fertility health check for women isn’t about ticking off every possible test. The best approach is to understand the areas of reproductive health that are most relevant to you.
For some people, that might mean hormone testing. For others, it could be a semen analysis or other investigations recommended by a healthcare professional. And as research continues to grow, the vaginal microbiome is becoming another important part of that picture.
Unlike many aspects of fertility, the vaginal microbiome is relatively simple to assess, and if an imbalance is identified, there are often practical steps you can take to improve it. That makes it a sensible test to consider before trying to conceive, helping you build the clearest possible picture of your reproductive health from the very beginning.
A clearer picture, wherever you are on your fertility journey
Whether you’re thinking about trying, already trying to conceive or preparing for fertility treatment, understanding your vaginal microbiome can add another valuable piece to your overall health picture.
Sources
- Komesu YM, Dinwiddie DL, Richter HE, et al. Defining the relationship between vaginal and urinary microbiomes. Am J Obstet Gynecol. 2020;222(2):154.e1-154.e10. PubMed: 31421123
- Haley E, Luke N, Mathur M, et al. Comparison shows that multiplex polymerase chain reaction identifies infection-associated urinary biomarker-positive urinary tract infections that are missed by standard urine culture. Eur Urol Open Sci. 2023;58:73-81. PubMed: 38152485
- Broache M, Cammarata CL, Stonebraker E, et al. Performance of a vaginal panel assay compared with the clinical diagnosis of vaginitis. Obstet Gynecol. 2021;138(6):853-859. PubMed: 34736269
This article is for general information and does not replace medical advice. If you're experiencing new, severe, persistent or worsening symptoms, please speak to a GP or another qualified healthcare professional.
0 comments