Fertility Blood Test UK (2026): What to Test, NHS vs Private, Costs Explained
Important — information, not medical advice
Fertility decisions are personal, time-sensitive, and emotionally weighty. A blood test result on its own is not a fertility prognosis. If you are actively trying to conceive without success, or have a specific concern, see your GP and ask about NHS fertility investigation — the criteria are time-based (12 months under 36, 6 months at 36+) and the NHS workup is more comprehensive than any private blood panel. Full disclaimer.
Fertility testing is one of the highest-stakes private-health categories in the UK. The blood tests themselves are not complicated — AMH, FSH, oestradiol, thyroid, plus the male hormones where relevant — but the questions they are used to answer often are. Do I have time? Should I freeze eggs? Why aren't we conceiving? A £159 panel cannot answer any of those on its own, but it can give you informed inputs to the conversation with a clinician. This guide is the honest map: what to test, when, what it actually tells you, and where the NHS vs private decision really sits.
The 90-second answer
If you only read one box
- The single most important marker is AMH (ovarian reserve) — testable any day, age-banded reference ranges, £49–£89 standalone.
- A proper female fertility panel adds FSH, LH, oestradiol, prolactin (day 2–5), SHBG, testosterone, TSH. £89–£249 in the UK.
- NHS fertility workup is free after 12 months of trying (under 36) or 6 months (36+). It's more comprehensive than any private panel and includes ultrasound plus semen analysis. Wait times for funded IVF, however, have tightened.
- For men: semen analysis is the first-line test, not blood work. NHS semen analysis is free via GP. Private is £100–£250. Male fertility blood work (testosterone/LH/FSH/prolactin) is second-line when semen analysis is abnormal.
- AMH is not a fertility prognosis. Low AMH does not mean you can't conceive; normal AMH doesn't mean you will. AMH predicts IVF response and age at menopause, not month-to-month conception chances.
- Best private picks: Medichecks Advanced Female Fertility (~£159) for full female panel; LetsGetChecked Ovarian Reserve (~£129) for AMH-only; Medichecks Male Hormone Advanced (~£79) for male blood work plus separate semen analysis.
Who genuinely benefits from a private fertility blood test
Five scenarios where paying for private fertility testing makes solid sense:
- You are under 36, trying for under 12 months, and want a baseline. The NHS doesn't investigate at this point. Private AMH and basic hormone panel gives you data before the NHS clock starts. £89–£159.
- You are considering delaying childbearing and want informed information. AMH and basic hormone testing in your late 20s or early 30s gives you a baseline against which to track. Useful input for egg-freezing decisions, though not by itself sufficient to make those decisions.
- You have risk factors for reduced ovarian reserve. History of ovarian surgery, chemotherapy, autoimmune disease, or family history of premature ovarian insufficiency. Earlier testing is genuinely informative here.
- You have irregular cycles and suspect PCOS. Full female hormone panel (FSH, LH, AMH, testosterone, SHBG, free androgen index, TSH) is the standard PCOS workup and is genuinely valuable. NHS will do this when indicated, but private routes can be faster.
- You want to plan IVF and need pre-clinic baseline data. Most fertility clinics will retest with venous samples anyway, but having recent AMH and hormone results speeds the initial consultation and clarifies which clinics are realistic options.
When private testing is less useful
- You have been trying to conceive for over 12 months (or 6 if 36+) without success. Go to the NHS. A blood panel alone misses the dominant causes of infertility (anatomical issues, male factor, ovulation timing) that only a full investigation catches.
- You are under 30 with no concerns and no symptoms. The "biological clock" AMH testing market for this group is huge but the actionable information is small — most women in this demographic have AMH in the normal range and the result tells them nothing they didn't already know.
- You expect a number to tell you whether to have children. No fertility blood test does this. Decisions about timing of childbearing involve far more than ovarian reserve — partner status, finances, career, health, personal readiness. A private AMH at 29 cannot answer "should I have a baby now?" no matter what number it returns.
What to test: women
The core panel
- AMH (anti-Müllerian hormone) — ovarian reserve. Not cycle-dependent, test any day. Age-banded ranges: 25y typical 20–40 pmol/L; 30y 15–30; 35y 10–25; 40y 2–10; 45y often <2.
- FSH (follicle-stimulating hormone) — rises as ovarian reserve declines. Day 2–5 baseline. <10 IU/L typical premenopausal; 10–25 IU/L diminished reserve; >25 IU/L menopausal transition.
- LH (luteinising hormone) — paired with FSH. The LH:FSH ratio also helps flag PCOS pattern (LH>FSH, often 2:1 or higher).
- Oestradiol — day 2–5 baseline typically 100–300 pmol/L. Raised early-cycle oestradiol can mask a high FSH (the oestradiol suppresses FSH artificially).
- Prolactin — raised prolactin can cause anovulation and irregular cycles. Important to rule out a pituitary cause.
- TSH — fertility-targeted TSH is generally <2.5 mIU/L (lower than the standard population reference). Subclinical hypothyroidism reduces fertility and increases miscarriage risk.
Useful additions
- SHBG + total testosterone + calculated free androgen index — essential for PCOS workup. Low SHBG and high FAI is the biochemical PCOS pattern.
- Day 21 progesterone — confirms ovulation in regular cycles. Often included in a separate kit because of cycle timing.
- Thyroid antibodies (TPO, TgAb) — positive antibodies predict thyroid dysfunction in pregnancy even with currently normal TSH.
- Vitamin D, ferritin, B12, folate — nutritional optimisation matters for fertility and pregnancy. Often under-tested.
- HbA1c — insulin resistance is closely tied to PCOS and to early miscarriage risk. Worth including in PCOS workup.
Skip these unless specifically indicated
- "Comprehensive" 40-marker panels for women in their 20s with no concerns. High false-positive flag rate, low actionability.
- DHEA-S — only useful in specific suspected adrenal-androgen cases.
- Genetic carrier screening bundled into fertility panels. Different product, different decision; pay for it standalone if you want it.
What to test: men
The first line: semen analysis
Semen analysis measures sperm count, motility (movement quality) and morphology (shape) — together accounting for roughly 30–40% of UK couple infertility cases. This is far more important than any blood test for male fertility assessment. The NHS provides semen analysis free via GP referral; private costs £100–£250 through fertility clinics and some private labs.
WHO 2021 reference values: total motile count >9 million per ejaculate, total sperm count >39 million, concentration >15 million/ml, progressive motility >30%, normal morphology >4%. Below these thresholds warrants further investigation; well above doesn't guarantee conception but rules out gross male factor.
Male fertility blood work (second line)
Blood testing in male fertility is for situations where semen analysis is abnormal and you need to distinguish testicular failure from hormonal/pituitary causes:
- Total testosterone — low T can cause secondary infertility.
- LH and FSH — distinguishes primary testicular failure (high LH/FSH) from secondary causes (low or normal LH/FSH).
- SHBG and calculated free testosterone — refines testosterone assessment.
- Prolactin — raised prolactin suppresses gonadotropins and impairs fertility.
- Oestradiol — useful when sex-hormone-binding globulin profile or aromatase activity is in question.
- Thyroid (TSH) — thyroid disease affects male fertility too.
Specialist male fertility testing
- DNA fragmentation index (DFI) — measures sperm DNA damage. Available privately at £150–£300. Relevant in unexplained infertility, recurrent miscarriage, or failed IVF cycles. Not part of routine workup.
- Karyotype — chromosome analysis. Indicated in azoospermia (no sperm) and certain other patterns. NHS-funded through fertility clinics where indicated.
UK fertility test costs in 2026
| Test | Typical UK price | NHS-funded? |
|---|---|---|
| AMH only (female) | £49–£89 | Sometimes, in fertility workup |
| Basic female fertility panel | £89–£159 | Yes, when criteria met |
| Comprehensive female fertility panel | £159–£249 | Yes, when criteria met |
| Male hormone panel | £55–£149 | Yes, when criteria met |
| Semen analysis | £100–£250 | Yes, via GP referral |
| Sperm DNA fragmentation | £150–£300 | Rarely |
| Pelvic ultrasound (transvaginal) | £150–£300 | Yes, in fertility workup |
| HyCoSy / HSG (tube patency) | £300–£800 | Yes, in fertility workup |
| IVF cycle (one round) | £3,500–£8,000+ | Varies by ICB; many areas 0 cycles |
The labs and clinics worth considering
Medichecks — Medichecks Advanced Female Fertility at around £159 is the best-value full female panel covering AMH, FSH, LH, oestradiol, prolactin, SHBG, testosterone, free androgen index and TSH. Their Male Hormone Advanced at around £79 covers the equivalent for men. Fingerprick home kits, doctor's report included.
Forth — Forth Female Fertility at around £144 covers AMH plus core female hormones with their characteristic app-based trend tracking. Good for the "I want to test annually" use case.
LetsGetChecked — LetsGetChecked Ovarian Reserve at around £129 is AMH-focused. Cheapest "I just want my AMH" option from a known brand. UK catalogue has shrunk over 2025–2026; verify current availability.
Specialist fertility clinics (Create, CRGH, The Lister, Bourn Hall, regional private fertility units) — offer comprehensive workups combining blood tests, scans and semen analysis with consultant interpretation. £350–£800 for full female + male initial workup. The right route once you are seriously considering IVF.
How to read your results
A few patterns and what they typically mean:
- AMH age-appropriate + normal FSH + regular cycles — reassuring picture for someone in the relevant age group. Doesn't guarantee easy conception but rules out obvious ovarian reserve concerns.
- Low AMH for age (e.g. AMH <5 pmol/L under 35) — diminished ovarian reserve. Take seriously. Consider GP discussion about fertility planning and, if relevant, egg-freezing or earlier attempts at conception. Does not mean infertility — many women with low AMH conceive naturally — but means the "I have time" assumption is less safe.
- Raised FSH + low AMH + irregular cycles + classic perimenopausal symptoms in 30s — possible premature ovarian insufficiency. Repeat FSH 4–6 weeks later. See GP — this is a clinical diagnosis with broader health implications.
- Raised LH (LH:FSH >2) + raised free androgen index + irregular cycles + acne or hirsutism — classic PCOS biochemical pattern. Confirm with clinical assessment and ultrasound. Management has direct fertility implications.
- Raised prolactin — investigate cause (pituitary, medications, stress before sample). Treatable; reversing prolactin often restores ovulation.
- Raised TSH — start treatment to bring TSH <2.5 mIU/L before active attempts at conception. Improves fertility and reduces miscarriage risk.
- Low testosterone + low LH/FSH in men — secondary hypogonadism. Pituitary cause should be investigated.
- Raised LH/FSH + low testosterone in men — primary testicular failure. Refer to urology/fertility specialist.
NHS fertility pathway in detail
The NHS-funded fertility workup is genuinely thorough. If you meet criteria, use it. The pathway:
- GP appointment. Initial assessment of cycles, medical history, partner details. Referral if criteria met.
- Initial investigations. Female: day 2–5 hormone panel including AMH where available, day 21 progesterone, TSH, chlamydia screen. Male: semen analysis. Both: BMI assessment.
- Referral to fertility clinic / gynaecology. Pelvic ultrasound, hysterosalpingogram (HSG) or HyCoSy to check tubal patency, repeat hormones if needed.
- Diagnosis. Causes are split roughly: female factor 35%, male factor 30%, combined 20%, unexplained 15%.
- Treatment. Lifestyle and ovulation induction first-line. IVF where indicated, subject to local NHS funding criteria.
NHS IVF funding criteria have tightened substantially over the past five years. Many areas now fund zero or one cycle. Age limits typically 39 or 40 for the woman. BMI, smoking status, pre-existing children (for either partner) all affect eligibility. Check your local Integrated Care Board policy before assuming funded IVF is available.
Related guides
- Private blood tests UK — pillar guide — the complete UK private testing playbook.
- Private cortisol test UK — stress and cortisol can suppress fertility hormones.
- Liver health blood test UK — liver markers worth checking pre-conception.
- AMH and fertility hormone test guide — the science of AMH in detail.
- Female hormone test guide — the broader hormone panel deep-dive.
- Menopause blood test UK — for women in the perimenopause transition.
- Best women's health blood test UK — umbrella guide across life stages.
- Best men's health blood test UK — for the male partner.
- Thyroid blood test guide — the most-missed fertility-relevant test.
- Private blood test vs NHS — the wider decision frame.