Fertility Ultrasound: What a Pelvic Scan Checks When You Are Trying to Conceive

If you have been trying for a baby for a while, a scan can feel like the first solid piece of information on offer: something that shows what is going on rather than another month of waiting. A fertility ultrasound does show a great deal, but it is one part of a set of tests, and NHS guidance is careful about when to start them and in what order.

This guide explains what the NHS says about seeing a GP, which tests come first for women and men, what a pelvic ultrasound checks and cannot check, how the fallopian tubes are tested, and what a private fertility scan can realistically tell you. It covers fertility investigations only, not pregnancy scans, which are part of NHS maternity care.

When the NHS says to see a GP

The NHS says to see a GP if you have not conceived after a year of trying, which it describes as having regular unprotected sex every 2 to 3 days. It says to see a GP sooner if you are a woman aged 36 or over, or if you have other reasons to be concerned, such as previous cancer treatment or a possible sexually transmitted infection. It also says both partners should usually attend, because fertility problems can affect either or both.

The NHS adds some perspective that is easy to lose when you are counting months: more than 8 in 10 couples where the woman is under 40 conceive within a year, and about half of those who do not conceive in the first year do so in the second. If you are under 40 and have not been trying for long, it says you may be advised to keep trying a little longer before tests begin. NICE's fertility guideline (NG257, published in March 2026) sets out the assessment pathway.

The tests that come first

Imaging is not the first test. For women, the NHS says a GP will arrange hormone tests, checking progesterone to see whether you are ovulating or, if your periods are irregular, checking gonadotrophin hormones, and a chlamydia test. For men, the first test is semen analysis, which the NHS says checks for problems such as a low sperm count or sperm that do not move properly, plus a chlamydia test.

The ultrasound scan comes alongside or after these. The NHS describes it as a test that checks the ovaries, womb and fallopian tubes and can detect conditions such as fibroids or endometriosis. Our guide to seeing a GP before a scan explains why that order matters.

What a fertility ultrasound checks

The scan is usually transvaginal: the NHS describes a probe placed in the vagina, which gives a clearer view of the pelvic organs than scanning through the tummy. University Hospitals Birmingham's fertility service describes what is assessed: the shape, size and appearance of the womb, and the size, activity, appearance and position of the ovaries. The NHS ultrasound page says internal scans can be uncomfortable, that you can ask the person scanning you to stop at any time, and that you can ask for a chaperone.

Many fertility services also count the small resting follicles on each ovary, an antral follicle count. NICE says an antral follicle count, or the AMH hormone test, can be used to predict how the ovaries are likely to respond to assisted conception such as IVF, while age remains the starting point for predicting the overall chance of pregnancy. A fertility specialist interprets the count alongside your age and other results. See pelvic ultrasound and MRI for endometriosis.

What it cannot check: whether the tubes are open

A standard ultrasound cannot tell whether the fallopian tubes are open. The NHS describes two tests that can. Hysterosalpingo-contrast-ultrasonography (often shortened to HyCoSy) is a type of ultrasound in which fluid is injected into the womb through the cervix and the scan tracks it through the tubes to look for blockages. A hysterosalpingogram is an X-ray of the womb and tubes taken after a dye is injected. NICE's guideline describes the X-ray test as a reliable way of ruling out blocked tubes for people not known to have other pelvic problems, and the ultrasound version as an effective alternative where the expertise is available.

Because the X-ray version uses ionising radiation, it has to be requested by a registered referrer and justified under the Ionising Radiation (Medical Exposure) Regulations 2017, so it is a hospital or fertility clinic test rather than one you can arrange yourself. The NHS also describes laparoscopy, keyhole surgery to examine the womb, tubes and ovaries; it says this is usually only done when a problem is likely, for example after pelvic inflammatory disease or when a tube blockage is suspected.

Tests for men

Fertility investigation is a two-person process, and the NHS is clear that problems can lie with either partner or both. University Hospitals Birmingham says semen analysis assesses the shape, movement and quantity of sperm, that further hormone tests may follow if sperm are absent or very few, and that a clinician may also request a testicular ultrasound, an external scan with a probe placed on the scrotum. NICE says a physical examination of the scrotum and testes should be offered after 2 or more abnormal semen analyses. Any scan is arranged only when the results point to it.

What a private fertility scan can and cannot tell you

Private fertility scans are widely advertised, usually as a baseline pelvic ultrasound with a follicle count, and they can be a reasonable step if a GP or fertility clinic has suggested a scan and the wait is long. Ultrasound does not use ionising radiation, so many clinics accept self-referral, although every clinic asks what the scan is for and its sonographer or radiologist decides whether it is appropriate. Timing in your cycle matters for some measurements, so ask the clinic when it wants to scan you.

Be realistic about what the result means. A normal scan is reassuring about the womb and ovaries but says nothing about the tubes, about ovulation month to month, or about sperm, and no scan predicts whether or when you will conceive. The report is most useful in the hands of a GP or fertility specialist who can read it with your other results, so ask who will receive it. You can compare pelvic ultrasound clinics near you on FindScan and send an enquiry; the clinic contacts you to confirm whether it needs a referral and when in your cycle to scan.

FindScan is a directory of independent, regulated imaging clinics: you compare clinics and send an enquiry, and the clinic contacts you. We are not a healthcare provider, and nothing here replaces advice from a GP or fertility specialist. If you are or may be pregnant, pregnancy scans are part of NHS maternity care; if you have severe pelvic pain, heavy bleeding or a high temperature, contact your GP urgently or NHS 111, and call 999 if you are seriously unwell.