If you've been trying for a year (or six months if you're 36 or over) and your GP is the next stop, knowing the fertility testing UK NHS pathway in advance turns a confusing appointment into a useful one. The NHS does test, it tests in a set order, and what you get depends partly on your age and partly on your postcode.
Here's what to expect, and what to ask for, before you walk in.
When the NHS Starts Fertility Testing
The standard trigger is 12 months of regular unprotected intercourse under age 36, or 6 months at 36 and over. [src] Earlier referral is offered if there's a known cause: irregular cycles, suspected PCOS or endometriosis, prior pelvic surgery, prior chemotherapy, or a partner with a known sperm or urological history.
This is the gateway to the fertility testing UK NHS pathway, and it starts at the GP. Both partners are assessed from day one. If you're not sure whether you've hit the threshold, our cornerstone on when to see a fertility specialist covers the decision in more detail.
Book the GP appointment as a couple where possible. The workup is for both of you, and a single visit saves a second one.
NHS Fertility Blood Tests, What They Actually Check
NHS fertility blood tests run in a predictable order. The GP can request most of them; a few are held back until you've been referred to secondary care.
Day 21 progesterone (or 7 days before your next expected period) confirms whether you ovulated that cycle. A level above roughly 30 nmol/L is the usual ovulatory threshold, though labs vary.
FSH, LH and oestradiol on day 2 to 5 of your cycle give a snapshot of pituitary signalling and early follicular drive. Some GP pathways skip these unless cycles are irregular.
TSH and prolactin screen the thyroid and pituitary, both of which disrupt ovulation when out of range.
Rubella immunity and chlamydia screening are pre-pregnancy basics. Rubella status changes whether you'll be advised to vaccinate before conception; chlamydia is a tubal-factor risk.
AMH (anti-Mullerian hormone) estimates ovarian reserve. It's the test patients ask about first, and it's the one most GPs won't run until you've been referred to secondary care for IVF assessment.
Patients often arrive asking for AMH on the first visit. NHS pathways generally hold this test until a referral is in motion. If you want it sooner, a private blood draw is an option, and most NHS clinics will accept the result.
Tests for Your Partner
Semen analysis is arranged through the GP via the local andrology lab. The sample is usually produced at home or on site after 2 to 7 days of abstinence, and results take 1 to 2 weeks. If the first is abnormal, NICE recommends a repeat after roughly three months, since sperm parameters fluctuate with illness, fever and stress. [src]
For more on what to expect and how to interpret the report, see our guide on when should your partner get a sperm analysis.
Imaging and the Tubal Check
A pelvic ultrasound is often the first imaging step and can be done at the GP-attached clinic or in secondary care. It checks the uterus, ovaries and antral follicle count.
The tubal check is either an HSG (X-ray with iodine dye) or a HyCoSy (ultrasound with saline-foam contrast). Both confirm whether the fallopian tubes are open. HyCoSy is increasingly the default in NHS units because it avoids radiation.
A laparoscopy comes later, usually only if endometriosis is suspected or earlier tests have not explained the picture.
NICE specifically does not recommend the post-coital test, routine endometrial biopsy, or routine prolactin without symptoms. If your GP suggests any of those, it's reasonable to ask why.
NICE Fertility Guidance and What's Changed
NICE fertility guidance was updated with NG257 in 2024, replacing CG156. The headline changes were a move toward prognosis-based decisions (rather than purely calendar-based "you've tried for X months"), tighter guidance on adjuncts in IVF, and revised age and BMI thresholds for funded treatment.
The principle hasn't changed: investigations should be done in parallel where possible, not in series, so a couple doesn't lose six months waiting for one test after another. If your initial workup comes back normal, our piece on next steps for unexplained infertility explains what reasonable second-line investigations look like.
NHS IVF Eligibility and the Postcode Lottery
NHS IVF eligibility is decided by your local Integrated Care Board (ICB) in England, by Health Boards in Scotland and Wales, and by HSC Trusts in Northern Ireland. NICE recommends up to 3 full cycles for women under 40 and 1 cycle for women aged 40 to 42 who meet criteria. [src] Most ICBs fund fewer.
Common ICB criteria include:
- BMI usually 19 to 30
- Non-smoker (often for 3 to 6 months)
- No living children in either partner's household
- Female age cap, typically 40 or 42 at start of treatment
- A minimum period of trying, often 2 years
Scotland funds up to 3 cycles for eligible couples under 40, the most generous offer in the UK. Wales funds 2. Northern Ireland funds 1. England varies ICB by ICB, which is the source of the postcode lottery.
So, how long is the NHS fertility waiting list in practice? From GP referral to first NHS-funded IVF cycle, expect 12 to 18 months in many regions, longer in some. Diagnostic workup itself often runs 3 to 6 months.
What to Do If You Don't Qualify for NHS IVF
The options when you fall outside the criteria are usually:
- A self-funded private investigation in parallel with the NHS workup
- A second opinion to confirm the diagnosis and plan
- Self-funded top-up cycles after a partial NHS course
- Cross-border treatment in a regulated EU clinic
Our breakdown of IVF cost in the UK, NHS vs private lays out the realistic numbers and the trade-offs.
FAQ
Can my GP refuse to refer me for fertility testing?+
A GP can decline to make a tertiary referral if you haven't met the trigger criteria (12 months under 36, 6 months at 36+, or a known cause). They cannot decline the basic GP-level workup if you're TTC. If you're hitting the threshold and feel stuck, request a different GP within the practice or a second opinion.
Will the NHS test my AMH?+
Not at the GP-level workup, in most pathways. AMH is usually requested by secondary care when IVF assessment is on the table. If you want it earlier, private testing is straightforward and the result will be accepted by NHS clinics.
Does same-sex couple eligibility differ?+
Yes. Most ICBs now fund some treatment for female same-sex couples, but criteria vary, and many require a number of self-funded donor IUI cycles before NHS IVF is offered. Check your local ICB policy directly.
How long does the full NHS fertility workup take?+
Realistically 3 to 6 months from first GP visit to a complete picture, depending on cycle timing for hormone tests and local waiting lists for HyCoSy or HSG.
Can I do private tests and bring the results to the NHS?+
Yes, in most cases. Hormone bloods, AMH and semen analysis from a UKAS-accredited lab are usually accepted by NHS clinics. Imaging is sometimes repeated for protocol reasons.
References
Citations referenced inline above link to their primary sources (NHS, NICE, CDC, ACOG, ASRM, peer-reviewed journals).
The fertility testing UK NHS pathway is structured and free at the point of use, but it moves at NHS pace. Knowing the right tests to expect at each stage means you ask the right questions and don't lose a year on tests that should have been parallel. If you'd like a private second opinion on your results, or a clearer view of where you sit on the NHS timeline, that's the conversation we have in a consult.
Ready for a personalised fertility plan?
Book a one-to-one consultation. We'll review your history and map the next concrete step.
