The first visit, and the tests that follow it

Both of you, if you can manage it. Part of the answer is often on his side and his test is the simplest one there is; a first visit with both of you in the room saves a month. If he cannot come, come alone and bring his questions, and his test can still be arranged.

Bring every report you have, from anywhere, however old: scans, blood tests, a semen analysis, an operation note, a discharge summary from a pregnancy that ended. Nothing is repeated without a reason, and the old results often answer questions that would otherwise need a new test.

There is no wrong day of the cycle for the first visit. If you can choose, the first few days after a period starts are the most useful, because some blood tests are timed to those days and the scan reads the ovaries most clearly then.

The story first, and it takes a while. How long you have been trying and how; how your cycles run; previous pregnancies, for either of you, with anyone; illnesses, medicines, operations; smoking, alcohol, weight, shift work; what has already been tested and what it showed. Then his side: his health, any operations or injuries, any previous children, and whether he has been tested before.

Then an examination, and a scan of the uterus and ovaries. The scan shows the shape and lining of the uterus, whether there are fibroids, polyps or cysts, and the number of small follicles resting on each ovary, which is a picture of your egg reserve on the day. It takes a few minutes and it is not uncomfortable.

You leave with the list of tests, a reason for each, and the day of your cycle on which each is done. Not a diagnosis, because there is not one yet, and not a treatment plan, because a plan built before the tests is a guess.

Test	When	What it tells
Hormones that drive the cycle (FSH, LH, oestradiol)	Day 2 to day 4 of a period	How hard the body is working to grow an egg
AMH	Any day	The size of the egg reserve, read a second way alongside the scan
Thyroid and prolactin	Any day	Two things that quietly stop ovulation and are easily corrected
Progesterone	About seven days before the next period is due	Whether an egg was released this cycle
Sugar, and a general blood count	Any day, fasting for the sugar	Health that affects a pregnancy, and PCOS’s metabolic side
Infection screen, blood group	Any day	Routine before any treatment, and useful for a pregnancy
Semen analysis, for him	After two to five days without ejaculation	Count, movement and shape; his whole side in one test
A tube test, if it is needed	The week after a period ends	Whether the tubes are open

AMH is a hormone made by the small resting follicles, so its level rises and falls with how many of them there are. A low result means fewer eggs to work with, which changes the timing of the steps and the advice about how long to try. A high result, in a woman with irregular periods, often goes with PCOS. What AMH does not do is predict a pregnancy. A woman with a low AMH who ovulates regularly can conceive without help; a woman with a high AMH who does not ovulate cannot until that is treated. The number is read alongside the scan, your age and your cycle, and you are told what it means for you and what it does not.

The tubes carry the egg to meet the sperm, and a tube that is blocked cannot be seen on an ordinary scan. Where the story or the scan raises the question, a tube test is done: either an X-ray with a dye passed through the cervix, called an HSG, or a scan with a little saline passed the same way. The dye test is uncomfortable for a few minutes and is done at a radiology centre on a day soon after a period; the saline scan is gentler and is done in a scan room. Which one, and whether it is needed at all, depends on what the story and the scan have already shown. It is not done on the first visit and it is not done for everyone.

A semen analysis: one sample, produced after two to five days of abstinence, read by a laboratory that does this every day, with the result back in a day or two. It is one of the most useful tests in the work-up, and often the one that is skipped, usually because nobody asked him. If a result is abnormal it is repeated after a few weeks before anything is concluded, because one sample can be wrong. Everything else on his side is on the page for him.