Blood Tests for Fertility: Female & Male Testing Guide
Trying to conceive? Blood tests play a central role in fertility assessment. Here's what gets tested, when timing matters, what results mean, and how to get fertility tests covered by Medicare in Australia.
Female Fertility Blood Tests
Female fertility testing evaluates ovarian reserve (how many eggs remain), ovulation (whether eggs are being released), and hormonal balance. Timing relative to the menstrual cycle is critical for accurate interpretation.
| Test | When to Test | Normal Range | What It Means | Low / High Result |
|---|---|---|---|---|
| FSH (Follicle-Stimulating Hormone) | Day 2–4 of cycle | 3–10 IU/L | Stimulates egg development. Reflects ovarian reserve (how many eggs remain). Tested early in the cycle for a baseline reading. | Low: Rarely a concern on its own High: >10 IU/L suggests diminished ovarian reserve. >25 IU/L suggests very low reserve or approaching menopause. |
| LH (Luteinising Hormone) | Day 2–4 of cycle | 2–15 IU/L (follicular) | Triggers ovulation mid-cycle. Baseline level assessed alongside FSH. LH:FSH ratio >2:1 suggests PCOS. | Low: May indicate hypothalamic dysfunction High: Elevated LH with normal/low FSH is a hallmark of PCOS. Mid-cycle surge (>25 IU/L) indicates ovulation. |
| Estradiol (E2) | Day 2–4 of cycle | 100–400 pmol/L (early follicular) | Main oestrogen produced by developing follicles. Early-cycle baseline should be low. An elevated baseline may mask a high FSH. | Low: Very low levels may indicate ovarian insufficiency High: >400 pmol/L on Day 3 may suppress FSH artificially, making FSH appear falsely normal. |
| AMH (Anti-Müllerian Hormone) | Any day (not cycle-dependent) | 1.0–3.5 µg/L (age-dependent) | Best single marker of ovarian reserve. Produced by small follicles. Not affected by cycle day, pill use, or pregnancy. Declines with age. | Low: <1.0 µg/L suggests low ovarian reserve. May still conceive but time is limited. High: >5.0 µg/L may indicate PCOS (many small follicles). Associated with higher risk of ovarian hyperstimulation in IVF. |
| Progesterone (Day 21) | Day 21 of 28-day cycle (7 days post-ovulation) | >30 nmol/L confirms ovulation | Produced by the corpus luteum after ovulation. Confirms whether ovulation occurred and supports early pregnancy. Timing is critical — if cycle is longer than 28 days, test 7 days before expected period. | Low: <16 nmol/L suggests anovulation (no egg released). Common in PCOS and hypothalamic amenorrhoea. High: Very high levels occur in pregnancy (not a concern). |
| Prolactin | Any day (fasting, morning preferred) | <500 mIU/L | High prolactin suppresses ovulation. Commonly elevated by stress, medications (antipsychotics, metoclopramide), or a pituitary adenoma. | Low: Not clinically significant High: >1000 mIU/L needs investigation (pituitary MRI). Mild elevations (500–1000) may be stress-related. |
| Thyroid Function (TSH) | Any day | 0.5–2.5 mIU/L for fertility | Thyroid function affects ovulation, implantation, and early pregnancy. Fertility specialists use a tighter TSH range (0.5–2.5) than the general population range (0.5–4.5). | Low: Hyperthyroidism can cause irregular periods High: TSH >2.5 in women trying to conceive may warrant treatment with levothyroxine. TSH >4.5 is frank hypothyroidism. |
Male Fertility Blood Tests
Male fertility assessment combines blood tests (hormonal) with a semen analysis (which is NOT a blood test). Blood tests evaluate the hormonal signals that drive sperm production. A semen analysis is ordered separately and performed at a pathology centre.
| Test | Normal Range | What It Means | Abnormal Result |
|---|---|---|---|
| Testosterone (Total) | 8–30 nmol/L | Primary male sex hormone. Essential for sperm production. Should be measured fasting, before 10am (levels are highest in the morning and fluctuate throughout the day). | Low testosterone (<8 nmol/L) can impair sperm production. Causes include obesity, medications (opioids, steroids), pituitary disorders, and Klinefelter syndrome. Exogenous testosterone (TRT) SUPPRESSES fertility — it does not improve it. |
| FSH | 1–10 IU/L | Stimulates sperm production in the testes (Sertoli cells). Elevated FSH in men indicates the testes are failing to produce sperm adequately and the pituitary is compensating. | High FSH (>10 IU/L) suggests testicular damage or primary testicular failure. Low FSH may indicate a pituitary problem (hypogonadotropic hypogonadism) — potentially treatable. |
| LH | 1–9 IU/L | Stimulates testosterone production in the testes (Leydig cells). Assessed alongside testosterone to determine if low T is from the testes (primary) or pituitary (secondary). | High LH + low testosterone = primary hypogonadism (testicular problem). Low LH + low testosterone = secondary hypogonadism (pituitary problem — more treatable). |
| Prolactin | <500 mIU/L | Elevated prolactin in men can suppress testosterone and impair sexual function and fertility. Less common in men than women. | >1000 mIU/L warrants pituitary MRI to exclude prolactinoma. Medications, hypothyroidism, and stress can also elevate prolactin. |
| Thyroid Function (TSH) | 0.5–4.5 mIU/L | Both hypo- and hyperthyroidism can affect sperm quality. Less commonly tested in men than women, but should be checked if other hormones are abnormal. | Hyperthyroidism can cause reduced sperm motility. Hypothyroidism can affect libido and erectile function. |
Why Timing Matters: When to Test
Fertility hormones fluctuate significantly throughout the menstrual cycle and time of day. Testing at the wrong time gives misleading results. Here's the correct timing for each test:
FSH, LH, Estradiol
These hormones fluctuate dramatically through the cycle. Baseline levels in the early follicular phase provide the most clinically useful information about ovarian function.
AMH
AMH is produced by small antral follicles and remains relatively constant throughout the cycle. It can be tested at any time, including while on the oral contraceptive pill.
Progesterone
Progesterone peaks 7 days after ovulation. If your cycle is 35 days, test on Day 28 (not Day 21). If irregular, your GP may test multiple times or use ovulation prediction kits to time the test.
Prolactin
Prolactin is elevated by food, stress, exercise, and breast stimulation. For an accurate baseline, test fasting in the morning after a calm night’s sleep. Avoid exercise before the test.
Testosterone (male)
Male testosterone peaks in the early morning and can drop by 30–40% by afternoon. An afternoon result may falsely suggest low testosterone. Always test fasting before 10am.
Pre-Conception Screening Tests
Beyond fertility-specific hormones, a pre-conception blood screen checks immunity, nutritional status, and infections that could affect pregnancy. All of these are bulk billed under Medicare with a GP referral.
| Test | Who Needs It | Why | Medicare? |
|---|---|---|---|
| Rubella IgG antibodies | All women planning pregnancy | Rubella infection during pregnancy causes severe birth defects (congenital rubella syndrome). Vaccination cannot be given during pregnancy, so immunity must be confirmed before conceiving. If non-immune, vaccinate and wait 1 month. | Yes |
| Varicella (Chickenpox) IgG | Women unsure of chickenpox history | Varicella during pregnancy carries serious risks including congenital varicella syndrome and neonatal varicella. If non-immune, vaccinate and wait 1 month before conceiving. | Yes |
| Blood group and antibodies | All women planning pregnancy | Identifies Rh-negative women who will need Anti-D injections during pregnancy to prevent haemolytic disease of the newborn. Also identifies irregular antibodies that may complicate transfusion. | Yes |
| Iron studies and ferritin | All women planning pregnancy | Iron requirements increase significantly during pregnancy. Starting with low iron stores leads to pregnancy anaemia, which is associated with premature birth and low birth weight. Aim for ferritin >30 µg/L before conceiving. | Yes |
| Vitamin D | All women, especially dark-skinned or low sun exposure | Vitamin D deficiency in pregnancy is linked to gestational diabetes, pre-eclampsia, and poor foetal bone development. Supplement to achieve >50 nmol/L before conception. | Yes (with clinical indication) |
| Full blood count | All women planning pregnancy | Screens for anaemia, low platelets, and white cell abnormalities before pregnancy. Identifies thalassaemia carriers (common in Mediterranean, Asian, and Middle Eastern backgrounds). | Yes |
| STI screening | All women (and partners) | Chlamydia, syphilis, HIV, and hepatitis B are routinely screened. Untreated STIs can affect fertility (chlamydia causes tubal damage), pregnancy outcomes, and transmission to the baby. | Yes |
| HbA1c or fasting glucose | Women with BMI >30, PCOS, or family history of diabetes | Undiagnosed diabetes or pre-diabetes significantly increases the risk of birth defects and pregnancy complications. Optimising blood sugar before conception reduces these risks. | Yes |
Medicare Coverage & When to See a Specialist
Medicare covers initial fertility investigations
Your GP can order FSH, LH, estradiol, progesterone, AMH, prolactin, thyroid, and testosterone under Medicare with a clinical indication of infertility or subfertility. Pre-conception screening tests are also bulk billed. The pathology is free — you only pay the GP consultation fee (if not bulk billed).
AMH may have a gap fee
AMH testing is covered under MBS item 66695 when investigating infertility. However, some pathology providers charge a small gap fee ($10–30) for AMH. Check with your pathology centre before testing.
When to see a fertility specialist
Australian guidelines recommend referral after 12 months of regular unprotected intercourse without conception (6 months if the woman is over 35). However, if initial blood tests reveal clear abnormalities (e.g., high FSH, very low AMH, anovulation, male hormone problems), earlier referral is appropriate.
IVF monitoring is covered differently
Once you are under a fertility specialist, monitoring blood tests during IVF cycles (frequent estradiol, LH, progesterone) are bulk billed under specific MBS items. Out-of-pocket costs for IVF relate to the procedure itself, not the blood tests.
Semen analysis is NOT a blood test
A semen analysis is a separate pathology test. It is bulk billed under Medicare (MBS item 73528) when ordered by a GP or specialist. It requires 2–7 days of abstinence before collection. Two analyses, at least 3 months apart, are recommended before diagnosing male factor infertility.
Related Reading
Have Your Fertility Blood Test Results?
Upload your fertility blood tests to SmarterBlood for free AI-powered analysis. We'll explain every hormone marker in plain language and help you understand what your numbers mean for fertility.
Information sourced from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), Fertility Society of Australia and New Zealand (FSANZ), and the RCPA. Reference ranges are approximate and vary between laboratories. SmarterBlood provides health information and AI-powered blood test analysis. It is not a substitute for professional medical advice, diagnosis, or treatment.