Fertility Testing: What to Expect and When to Get Checked
The American Society for Reproductive Medicine defines infertility as the failure to achieve pregnancy after 12 months of unprotected intercourse. For women 35 and older, that threshold drops to six months — and for women over 40, the CDC advises pursuing evaluation and treatment without a defined waiting period.
Those timelines are the standard clinical triggers for a fertility evaluation. They are not the only ones. Patients with irregular cycles, a history of PCOS, endometriosis, prior pelvic surgery, or two or more miscarriages warrant earlier evaluation, regardless of how long they have been trying.
Damien Fertility Partners has provided reproductive care across New Jersey since 1989, with offices in Shrewsbury (Monmouth County), Newark (Essex County), and Jersey City (Hudson County). All diagnostic evaluations — hormonal bloodwork, transvaginal ultrasound, structural imaging, and semen analysis — are performed in-house. The same ABOG board-certified reproductive endocrinologist who orders the tests reviews the results and develops the treatment plan.
Fertility Testing
Evaluation is recommended after 12 months of trying for women under 35, and after six months for women 35 and older. Earlier evaluation is appropriate in specific circumstances:
Cycle irregularity. Irregular or absent periods signal ovulatory dysfunction. This is a directly actionable finding, and waiting the full 12-month threshold before investigating it delays treatment unnecessarily.
Known reproductive diagnoses. Patients with confirmed PCOS, endometriosis, uterine fibroids, or a history of pelvic infections or surgeries should seek evaluation sooner. These conditions affect tubal patency, ovarian reserve, and uterine receptivity in ways that can be identified and, in many cases, corrected before treatment begins.
Recurrent pregnancy loss. Two or more miscarriages warrant structured evaluation for structural, hormonal, immunological, and genetic contributing factors. The ASRM addresses recurrent pregnancy loss as a distinct clinical category with its own diagnostic protocols.
LGBTQ+ patients and single individuals. For same-sex couples, single individuals, or anyone planning to use donor sperm, donor eggs, or a gestational carrier, fertility testing is the appropriate first clinical step before any treatment pathway begins.
Fertility Testing for Women
Hormonal Bloodwork
A complete hormonal panel typically includes FSH, LH, estradiol, AMH, thyroid function, and prolactin. Each marker answers a different clinical question.
FSH and estradiol. Follicle-stimulating hormone (FSH) and estradiol are drawn together on cycle day 2 or 3. Elevated FSH may indicate diminished ovarian reserve. An elevated day-3 estradiol can mask an abnormal FSH — which is why the two are always interpreted together, not in isolation.
LH. Luteinizing hormone informs ovulatory function. An elevated LH-to-FSH ratio can, in some cases, support a PCOS diagnosis alongside other clinical findings.
AMH. Anti-Müllerian hormone is one of the most reliable indicators of ovarian reserve. It can be drawn at any point in the menstrual cycle, which makes it logistically straightforward. A low AMH may reflect a smaller follicle pool; a high AMH can in some cases suggest PCOS. AMH is an important data point, but it does not predict pregnancy outcomes on its own. It is always interpreted alongside antral follicle count, age, FSH, and clinical history.
Thyroid function and prolactin. Both are measured routinely because they are correctable causes of ovulatory disruption that are frequently missed outside a specialist setting. Hypothyroidism and hyperprolactinemia can both interfere with ovulation without producing obvious symptoms.
Structural and Imaging Evaluation
Transvaginal ultrasound. A transvaginal ultrasound assesses uterine anatomy, ovarian morphology, and antral follicle count (AFC) — a direct measure of ovarian reserve that complements the AMH level. It can identify fibroids, polyps, ovarian cysts, and other structural findings that affect treatment planning.
3D ultrasound. When a uterine anomaly is suspected — a uterine septum, for example — a 3D ultrasound provides a coronal view of the uterine cavity that 2D imaging cannot reliably produce. This view is essential for distinguishing a septum from a bicornuate uterus before any surgical planning.
Hysterosalpingogram (HSG). An HSG uses contrast dye and imaging to assess the uterine cavity and evaluate whether the fallopian tubes are open. It is ordered when tubal factor infertility is suspected based on clinical history. In some cases, hysteroscopy — direct visualization of the uterine cavity with a thin camera — is performed instead of or alongside an HSG, and can serve as both a diagnostic and a surgical step when a structural finding is confirmed.
All imaging is performed in-house. There is no referral to an outside imaging center.
Fertility Testing for Men
Semen Analysis
Male factor infertility contributes to approximately 30–50% of all infertility cases, either alone or in combination with female factors. A semen analysis is a required component of every complete fertility workup — not an optional step.
The test measures sperm count, motility, morphology, and volume. It is noninvasive, straightforward to perform, and capable of identifying male factor contributions that would otherwise go undetected for months if evaluation focused solely on the female partner.
Semen parameters are inherently variable. Sperm count, motility, and morphology can fluctuate significantly between samples and between laboratories. A single abnormal result is not definitive. A single normal result is not a guarantee. When the initial analysis raises concern, a repeat test is typically recommended to confirm findings before the results change a treatment recommendation.
Moderate to severe male factor infertility — including very low sperm count (oligospermia), absent sperm (azoospermia), or severely impaired motility — generally points toward IVF with intracytoplasmic sperm injection (ICSI), where a single sperm is injected directly into each egg.
Interpreting Results
No fertility test result is read in isolation. An AMH level reflects ovarian reserve but does not predict whether pregnancy is achievable. An elevated day-3 FSH may suggest diminished reserve, but its clinical significance depends on the estradiol level drawn the same day, the patient’s age, and the antral follicle count. A borderline semen analysis result requires a second sample before it changes a treatment recommendation.
The goal of a fertility evaluation is a complete diagnostic picture. Results are reviewed together — across both partners, across all markers — before any treatment recommendation is made. At our practice, the physician who ordered the tests reviews the results and explains them in full clinical context. There is no generic portal notification with a number and no follow-up instruction.
From Evaluation to Treatment
Once the evaluation is complete, your board-certified physician will recommend a treatment path based on your full diagnostic picture. For some patients, that means ovulation induction with oral medications. For others, IUI or IVF is the appropriate starting point.
Patients with structural findings — fibroids, polyps, or a uterine septum — may benefit from surgical correction before or alongside fertility treatment. Our in-house surgical team, including Dr. Nina Seigelstein, performs minimally invasive gynecologic procedures directly. Patients are not referred out.
For patients who proceed to IVF, our embryology lab holds accreditation from the College of American Pathologists (CAP), the FDA, and the NJ State Department of Health — all with zero deficiencies. The lab uses CHLOE by Fairtility, an AI-powered embryo monitoring system built into embryoscope time-lapse incubators, to support embryo selection with continuous, non-invasive developmental data. In 2023, we reported an 81.8% live-birth rate per new patient for women under 35, as submitted through SART. Clinic-to-clinic comparisons should be interpreted with caution due to differences in patient populations. Full outcomes data is available on the SART website and our success rates page.
The Physicians Conducting Your Evaluation
Dr. Miguel Damien founded the practice in 1989 — originally as East Coast IVF, establishing New Jersey’s first successful IVF program in Monmouth and Ocean County. He is a Dartmouth Medical School graduate who completed his OB/GYN residency and REI fellowships at Harvard Medical School and the University of Connecticut. Board-certified in REI by ABOG and fluent in Spanish, he has been named a Castle Connolly Top Doctor in the NY Metro Area six times (2005, 2007, 2008, 2010, 2017, 2018).
Dr. Barry Perlman is an ABOG board-certified REI specialist and Fellow of the American College of Obstetricians and Gynecologists (ACOG). A published researcher on endocrine disruptors and fertility, he has been named a Castle Connolly Top Doctor five times. He joined our practice in 2023 and offers both in-person and virtual consultations.
Frequently Asked Questions
1. How long should I try to conceive before seeking fertility testing?
The ASRM recommends evaluation after 12 months for women under 35, and after six months for women 35 and older. Earlier evaluation is appropriate with irregular cycles, a known reproductive condition such as PCOS or endometriosis, or a history of two or more miscarriages. The CDC advises that women over 40 seek evaluation without a defined waiting period.
2. Does my partner need to be tested too?
Yes. Male factor infertility contributes to approximately 30–50% of all infertility cases. A semen analysis is a required component of every complete evaluation. Identifying male factor contributions early allows for faster, more targeted treatment. See our IVF with ICSI page for how male factor findings shape treatment options.
3. What does AMH tell us about fertility?
AMH reflects ovarian reserve — the size of the remaining follicle pool. A low AMH may indicate a smaller egg supply; an elevated AMH can in some cases suggest PCOS. AMH is interpreted alongside antral follicle count, age, FSH, and estradiol. No single marker predicts pregnancy outcomes on its own, and our physicians review all findings together before making any treatment recommendation.
4. Can I get fertility testing if I’m not trying to conceive yet?
Yes. Baseline testing — AMH, antral follicle count, and a hormonal panel — provides a useful picture of your reproductive timeline. Patients considering egg freezing typically begin with this evaluation to determine whether preservation is time-sensitive. Dr. Perlman offers virtual consultations for patients who want to begin that conversation remotely.
5. Does Damien Fertility Partners provide care for LGBTQ+ patients and single individuals?
Yes. We provide fertility evaluations and treatment for individuals and couples of all backgrounds, including same-sex couples, single parents by choice, and those pursuing reciprocal IVF, donor sperm IUI, or gestational carrier arrangements. There are no BMI-based limitations. New Jersey’s 2024 fertility insurance mandate removed prior restrictions based on age, relationship status, and sexual orientation for eligible group plan members.
6. How soon will I get my results?
Most hormonal bloodwork results are available within a few days. Imaging findings are reviewed the same day. Because all evaluations are performed in-house and reviewed by the same physician managing your care, follow-up is prompt and results are discussed in full clinical context — not delivered as raw numbers through a portal.
Schedule a Fertility Evaluation with Dr. Damien or Dr. Perlman
A fertility evaluation is a defined, time-limited process. For most patients, the full workup — hormonal bloodwork, imaging, semen analysis, and physician review — can be completed within a few weeks of the initial consultation. Those results form the basis of every treatment decision that follows.
We see patients at our offices in Shrewsbury (Monmouth County), Newark (Essex County), and Jersey City (Hudson County). Dr. Perlman offers virtual consultations for patients who prefer to begin remotely. We provide care to individuals and couples of all backgrounds and family-building paths, with no BMI-based limitations and dedicated support for LGBTQ+ patients. Spanish-speaking providers are available at all three offices.
Visit damienfertilitypartners.com or call (732) 758-6511 to request a consultation with Dr. Damien or Dr. Perlman.