Fertility Tests for Women Explained: AMH, FSH, AFC, HSG & Ultrasound

You've booked your first fertility appointment — and come away with a list of unfamiliar abbreviations: AMH, FSH, LH, AFC, HSG. Which day of your cycle should each test be done? What is a "good" AMH? And what happens if a result comes back high or low? It's easy to feel overwhelmed, and a single number seen on its own can cause a lot of unnecessary worry.

In this guide, the fertility specialists at Myra IVF Centre in Kenya, led by Dr. Sarita Sukhija, explain every core female fertility test in plain language: what it measures, when in your cycle it is done, how to read the results, and — most importantly — what the results mean for your next steps. If you're still deciding whether it's time to get tested at all, start with when should you see a fertility specialist?

What Fertility Tests Are Looking For

For a natural pregnancy, several things need to work together: an egg must be released (ovulation), sperm must reach it through an open fallopian tube, fertilisation must take place, and the embryo must implant in a healthy uterus. Female fertility testing checks each step:

• Ovulation — are you releasing an egg each month? (progesterone, LH, prolactin, thyroid, follicle tracking)
• Ovarian reserve — how many eggs do you have left? (AMH, FSH, antral follicle count)
• The fallopian tubes — are they open and healthy? (HSG, HyCoSy or laparoscopy)
• The uterus — is the cavity a normal shape, free of fibroids, polyps or scarring? (ultrasound, HSG, hysteroscopy)

Alongside these, your partner's semen analysis checks the sperm side of the equation. Testing both of you at the same time gives the full picture and avoids months of treatment aimed at the wrong problem.

Your Fertility Testing Timeline: Which Test on Which Cycle Day?

Many fertility tests depend on the timing of your menstrual cycle. Day 1 is the first day of full menstrual bleeding (not spotting). If your periods are irregular, your doctor will adjust the timing for you.

AMH (Anti-Müllerian Hormone): Your Egg Reserve

AMH is a hormone made by the small, developing follicles in your ovaries. The more of these follicles you have, the higher your AMH — so it gives a good estimate of your ovarian reserve, the number of eggs remaining. Because AMH stays fairly stable throughout the cycle, it can be tested on any day.

AMH is reported in either ng/mL or pmol/L (1 ng/mL ≈ 7.14 pmol/L), so always check which unit your laboratory uses. As a general guide:

Reference ranges differ between laboratories, and AMH naturally falls with age — a value that is low for a 28-year-old may be typical at 40. Your specialist will interpret your result for your age.

What AMH can — and can't — tell you. AMH is excellent at predicting how many eggs you are likely to produce with IVF stimulation, which helps your doctor choose the right medication dose. It also helps with planning egg freezing and supports a diagnosis of PCOS. But AMH measures egg quantity, not egg quality — and quality depends mainly on age. A low AMH also does not mean you cannot conceive naturally: a large 2017 study published in JAMA found that among women aged 30–44 trying to conceive naturally, those with low AMH were not less likely to become pregnant within 6–12 months than women with normal AMH. If you ovulate, you need only one good egg each month.

Things that can affect your AMH result include hormonal contraception (the pill, injection or implant can temporarily lower it), previous ovarian surgery such as cyst removal, and PCOS (which raises it). If your AMH is low, read our detailed guide to low AMH and poor ovarian reserve — the key message is not to delay seeking treatment.

FSH, LH and Estradiol: The Day 2–5 Hormone Panel

These three hormones are measured together early in your cycle, when they are at their baseline levels:

• FSH (follicle-stimulating hormone) is released by the pituitary gland in the brain to make follicles grow. When fewer eggs remain, the brain has to "shout louder" — so a high FSH suggests reduced ovarian reserve.
• LH (luteinising hormone) works with FSH, and a surge of LH mid-cycle triggers ovulation. An early-cycle LH that is higher than FSH can be seen in some women with PCOS.
• Estradiol (E2) is the main estrogen produced by growing follicles. It is measured alongside FSH because a high estradiol can suppress FSH and make it look falsely normal.

FSH can vary from one cycle to the next, so a single borderline result is often repeated or read alongside AMH and AFC rather than relied on alone.

Progesterone: Confirming That You Ovulate

After an egg is released, the empty follicle becomes the corpus luteum, which produces progesterone to prepare the lining of the uterus. A raised progesterone in the second half of the cycle is therefore good evidence that ovulation has taken place.

• Timing matters — the test should be done about 7 days before your next expected period. That is day 21 in a 28-day cycle, but day 28 in a 35-day cycle. A "day 21" test in a long cycle can wrongly suggest you didn't ovulate.
• Reading the result — a level above about 3 ng/mL (around 10 nmol/L) suggests ovulation has probably occurred; many clinics look for 10 ng/mL (about 30 nmol/L) or more as a reassuring sign of good ovulation.
• If the result is low, the test may have been mistimed — or you may not be ovulating. Your doctor may repeat it or use follicle tracking scans to check.

Home ovulation predictor kits detect the LH surge and can help you time intercourse, but they show that ovulation is likely rather than confirming it. Women with PCOS can get misleading results, because their LH may be raised throughout the cycle.

Other Blood Tests Your Doctor May Order

In Kenya, where tuberculosis is common, your doctor may also test for genital TB if your history, scans or HSG suggest it, because it can silently damage the tubes and the lining of the womb.

Antral Follicle Count (AFC): Counting Follicles on Ultrasound

The antral follicle count is done with a transvaginal ultrasound on days 2–5 of your cycle. The sonographer counts the small, fluid-filled follicles measuring about 2–10 mm in both ovaries. Each one contains an immature egg, so the total gives a real-time picture of your ovarian reserve — and, like AMH, it predicts how you will respond to IVF stimulation.

AMH or AFC — which is better? They measure the same thing in different ways and usually agree. AMH is a simple blood test that can be taken on any day; AFC gives an instant result during your scan, and the same scan checks your uterus and ovaries at the same time. Most specialists use both, because together they are more reliable than either alone.

Pelvic Ultrasound: Checking the Uterus and Ovaries

A transvaginal ultrasound — a slim probe placed in the vagina — gives a much clearer view of the pelvic organs than a scan over the abdomen, and is done with an empty bladder. It is not usually painful; most women describe it as similar to a smear test. Alongside the follicle count, it can show:

• Fibroids — their size and position, especially whether they distort the uterine cavity (see fibroids and fertility)
• Endometrial polyps and the thickness and pattern of the uterine lining
• Adenomyosis — endometrial tissue growing into the muscle of the uterus
• The shape of the uterus — such as a septum dividing the cavity; a 3D ultrasound gives the clearest picture
• Ovarian cysts, including endometriomas ("chocolate cysts") caused by endometriosis
• Polycystic-appearing ovaries
• A hydrosalpinx — a swollen, fluid-filled fallopian tube

If a polyp or other problem inside the cavity is suspected, your doctor may suggest a saline infusion sonogram, in which a small amount of sterile fluid is passed into the uterus during the scan to outline the cavity more clearly.

Follicle tracking (folliculometry). A series of scans from around day 9–10 of the cycle can watch a dominant follicle grow (usually 1–2 mm a day) to about 18–24 mm and then release its egg. This confirms ovulation, helps time intercourse or IUI, and measures the lining of the uterus, which is usually 7–12 mm thick around ovulation.

HSG: Checking Whether Your Fallopian Tubes Are Open

An ordinary ultrasound cannot show whether your fallopian tubes are open. The most widely used test for this is the HSG (hysterosalpingogram):

• When — after your period finishes and before ovulation, usually days 6–11, so there is no chance of an early pregnancy. Your clinic may ask you to avoid unprotected sex from the start of your period until the test.
• How — a fine tube is placed in the cervix and a contrast dye is gently injected while X-ray images show the dye filling the uterus and flowing out through the tubes. The test itself takes about 10–15 minutes.
• What it shows — whether one or both tubes are blocked, whether a tube is swollen (hydrosalpinx), and the shape of the uterine cavity.
• Comfort — period-like cramping for a few minutes is common; a simple painkiller taken about an hour beforehand helps.

An alternative is HyCoSy, which uses ultrasound and a contrast fluid instead of X-rays. A blockage seen right where the tube joins the uterus is sometimes caused by temporary tubal spasm, so it may need confirming. For a full guide to tubal problems and treatment, see blocked fallopian tubes: causes, HSG test and treatment options.

When Further Tests Are Needed: Hysteroscopy and Laparoscopy

If the first-line tests show — or strongly suggest — a problem, your specialist may recommend a procedure that can both diagnose and treat it:

• Hysteroscopy — a thin camera is passed through the cervix to look directly inside the uterus. Polyps, fibroids inside the cavity, a uterine septum or scar tissue (adhesions) can often be removed in the same procedure.
• Laparoscopy — keyhole surgery under general anaesthesia to look at the outside of the uterus, the tubes and the ovaries. It is the gold standard for diagnosing endometriosis and pelvic adhesions, and a dye test during laparoscopy gives the most accurate check of the tubes.

Not every woman needs these. They are recommended when the history, scans or HSG point to a problem that could affect treatment.

Don't Forget Your Partner: The Semen Analysis

Female tests are only half of the picture. A semen analysis is a simple, non-invasive test that should be done at the same time as your own tests. The sample is produced after 2–7 days without ejaculation. The World Health Organization's 2021 reference values give the lower limits seen in fertile men:

• Volume: 1.4 mL or more
• Sperm concentration: 16 million per mL or more (39 million or more in total)
• Total motility (movement): 42% or more, with progressive motility of 30% or more
• Normal forms (morphology): 4% or more

An abnormal result is usually repeated after about three months, because sperm counts vary. For more, see male infertility: causes and treatment options.

Putting It All Together: What Common Result Patterns Mean

No fertility test should be read on its own. Your specialist looks at all your results together — with your age and how long you've been trying — to decide on the next step. Here are some common patterns:

What Fertility Tests Can't Tell You

Fertility tests are powerful, but it is important to keep them in perspective:

• No test measures egg quality directly. Your age remains the best guide to egg quality — which is why a 32-year-old with low AMH often does better than a 42-year-old with normal AMH (see fertility after 35 and 40).
• Normal results don't guarantee pregnancy, and abnormal results rarely mean pregnancy is impossible.
• One result is a snapshot. Hormone levels vary, and a single borderline value is often repeated.
• Online "normal ranges" can mislead. They vary between laboratories and don't account for your age or history — always discuss your results with your specialist.

How to Prepare for Your Fertility Tests

• Track your cycle — note day 1 (the first day of full bleeding) so tests can be booked on the right days.
• Tell your doctor about contraception — hormonal methods affect AMH, FSH and LH results. Ask whether to stop them before testing.
• Fasting is not usually needed for fertility hormone tests, unless blood sugar or insulin is also being checked.
• For prolactin, a morning test while relaxed is best, as stress can raise it.
• For the HSG, take a simple painkiller beforehand if your doctor advises it, and arrange to rest for the remainder of the day if you can.
• Bring previous results — scans, blood tests and operation notes help avoid unnecessary repeats.
• Book your partner's semen analysis for the same weeks.

Fertility Testing at Myra IVF Centre, Kenya

At Myra IVF Centre, fertility testing is organised as one coordinated work-up for both partners, so you get answers quickly and a clear plan:

• Hormone and ovarian reserve testing — AMH, FSH, LH, estradiol, progesterone, prolactin, thyroid and pre-treatment screening.
• Transvaginal ultrasound — antral follicle count, assessment of the uterus and ovaries, and follicle tracking.
• Tubal and uterine assessment — HSG, plus hysteroscopy and laparoscopy when needed.
• Male fertility testing — semen analysis and further male assessment where required.
• Treatment built on your results — from ovulation induction and IUI to IVF, ICSI, egg freezing and PCOS care, in our ISO 9001 certified laboratory.
• Three convenient locations — Nairobi, Mombasa and Kisumu.

With over 15 years of experience and a 79% overall IVF success rate, our team led by Dr. Sarita Sukhija will walk you through every result and what it means for you.

Conclusion

Female fertility testing comes down to four questions: are you ovulating, how many eggs do you have, are your tubes open, and is your uterus healthy? A handful of well-timed tests — AMH, the day 2–5 hormone panel, an antral follicle count and pelvic ultrasound, a progesterone check and an HSG — can answer them within a single cycle, especially when your partner's semen analysis is done at the same time.

Remember that no single number defines your fertility. The real value of testing lies in how the results fit together — and in the clear, personalised plan that follows. Speak with our fertility specialists at Myra IVF Centre to arrange your tests and understand your results.

Book a consultation today. Contact us at +254 786656236 or drsarita2007@gmail.com.