Infertility is defined as the inability to conceive after 1 year despite carefully timed, unprotected intercourse. This is thought to affect over 200,000 people per year. At STAT Wellness, we take a preventative approach to fertility assessing fertility health, hormone balance, and key nutrients needed for a healthy pregnancy prior to even trying to conceive. While there are many factors that can impact fertility, blood tests can be an effective way to assess certain indicators and provide valuable insight into a person’s reproductive health. In this article, we’ll take a closer look at some of the blood tests that can be helpful for evaluating fertility health.
Follicle-Stimulating Hormone (FSH)
Follicle-stimulating hormone (FSH) is a hormone produced by the pituitary gland that is responsible for stimulating the growth and development of ovarian follicles in women and spermatogenesis in men. In women, FSH levels can provide insight into ovarian reserve – the number and quality of eggs remaining in the ovaries. Higher levels of FSH are typically associated with reduced ovarian reserve, while lower levels are typically associated with better ovarian reserve.
In women, FSH is typically tested on the third day of the menstrual cycle, as this is when levels are most indicative of ovarian reserve. For men, FSH levels can be tested at any time. Normal FSH levels can vary depending on the individual and the testing laboratory, but in general, levels above 11-15 mIU/mL in women and 10 mIU/mL in men may suggest reduced fertility. However, it is important to note that there is no perfect test and you must look at the whole picture.
Luteinizing Hormone (LH)
Luteinizing hormone (LH) is another hormone produced by the pituitary gland that plays a key role in regulating the menstrual cycle and ovulation in women, and testosterone production in men. In women, LH levels typically surge right before ovulation, which triggers the release of an egg from the ovary. In men, LH stimulates the production of testosterone in the testes.
Like FSH, LH levels can be indicative of ovarian reserve in women, as well as overall reproductive health in men. In women, LH is typically tested alongside FSH on the third day of the menstrual cycle. LH is ideally in a 1:1 ratio with FSH. If LH is twice as high as FSH, it may be indicative of PCOS. If LH and FSH are both high (15 or more), it may be indicative of perimenopause. If these levels are too low it may indicate lack of ovulation or a problem with the pituitary gland. In men, elevated LH levels may suggest testicular failure or certain other conditions.
Estradiol
Estradiol is a form of estrogen that is primarily produced by the ovaries in women. It plays a key role in regulating the menstrual cycle, promoting the growth and development of the endometrial lining, and preparing the body for pregnancy. In men, estradiol is produced in small amounts by the testes, and plays a role in regulating testosterone production.
At STAT Wellness, we check estradiol at a couple different points. We can check it day 3 of cycle to evaluate fertility OR in the mid luteal phase of cycle (about a week before your menstrual cycle starts) to evaluate the balance of estrogen and progesterone.
Progesterone
Progesterone is a hormone produced by the ovaries in women that plays a key role in preparing the uterus for pregnancy. It is typically produced after ovulation, and helps to thicken the endometrial lining in preparation for a fertilized egg to implant. In men, progesterone is produced in small amounts by the testes, and plays a role in the production of testosterone.
Progesterone levels can be helpful in evaluating a number of different fertility issues in women. Low levels of progesterone may suggest a problem with ovulation, the corpus luteum, estrogen dominance, or high cortisol (stress hormone). We commonly check this in the mid luteal phase of your cycle (about a week before your menstrual cycle should start) and we want this > 10.
AMH
This stands for anti-mullerian hormone and is a marker of ovarian reserve. We want this between 1-4 when trying to conceive; however some sources would argue 2-4 is optimal. A low AMH may indicate poor ovarian reserve, where a high AMH may indicate PCOS or excess follicles.
Thyroid Hormones
You have thyroid receptors in almost every cell of your body. Healthy thyroid levels help with temperature regulation, metabolism, digestion, hair/skin, menstrual cycle regulation, and ovulation. At STAT Wellness, we examine a minimum of TSH, T4 free, and T3 free on every one of our patients, especially those wanting to conceive. While the range for TSH is between 0.45 to 4.5, we like a tight window especially with fertility. Our optimal is to have a TSH between 1-2. If your thyroid comes back suboptimal, we will want to further explore the root cause of thyroid issues which can be iodine deficiencies, autoimmune disease, or stress.
In addition to the blood tests mentioned above, there are other tests and evaluations that may be recommended depending on individual circumstances. For example, a semen analysis is a common test to evaluate male fertility, with modern day technology this can be performed at home and sent to the lab for analysis. A couple of our favorite brands include: Legacy and Fellow. Remember it takes two to tango- 50% of infertility is rooted in male abnormalities.
We also suggest starting a good quality prenatal – for both men and women when thinking about conceiving. Our perfect time to start is 6 months before trying to conceive.
Here are a few of our favorite methylated prenatals:
At the end of the day, it is important to keep in mind that fertility testing is not a one-size-fits-all approach. Each person’s fertility journey is unique, and the testing and treatment options may vary depending on individual circumstances. However, having a basic understanding of the key blood indicators and markers of reproductive health can be a helpful starting point for discussions with your healthcare provider.
It’s also important to note that while blood tests can provide valuable information about fertility and reproductive health, they are just one piece of the puzzle. Other factors, such as lifestyle factors, medical history, and age, also play a key role in fertility. Making healthy lifestyle choices, such as maintaining a healthy weight, exercising regularly, and avoiding smoking and excessive alcohol consumption, can help improve overall reproductive health.
In conclusion, blood tests can be a valuable tool in evaluating fertility and reproductive health. Understanding the key hormones and markers of reproductive health can help individuals and healthcare providers make informed decisions about fertility testing and treatment. If you are experiencing difficulty getting pregnant or have concerns about your overall reproductive health, talking with your healthcare provider (or coming to STAT Wellness) and undergoing fertility testing can be a helpful step in the process.
Call or text 404-254-5905 to get on the schedule for an appointment today.
In good health,
Kristin Oja, DNP, FNP-C, IFMCP
