If after 3-4 months of TTC you haven’t gotten your positive pregnancy test, we recommend, if finances allow, to go ahead and order yourself some normal fertility blood tests. This can help you proactively pinpoint possible fertility concerns early in the process and will be helpful info to bring to your doctor. Below is the full list of recommended tests, as well as when you should take them:
AMH
Estradiol
FSH
LH
Progesterone
TSH
Free T3
Free T4
Reverse T3
TPO
Vitamin D
Androgen
Free Testosterone
Total Testosterone
Magnesium
Iron
Ferritin
AMH is referred to as the “gold standard” in fertility blood tests. AMH is a hormone secreted in the ovary, and is active in the body until menopause. Testing AMH levels can help determine the number of follicles in the ovaries as studies have shown a correlation between low AMH and low egg reserve. Lower AMH levels also correlate to a lower egg yield during ovary stimulation, which can lead to a much lower success rate for those undergoing IVF. It is actually recommended that for those with low AMH to pursue a mini-IVF protocol, as traditional IVF can “fry” your eggs, leading to a poor quality egg that isn’t capable of being fertilized. The best time to test for AMH is around days 2-4 of your cycle, or specifically day 3.
The charts below show average AMH levels with age. Each chart shows the same levels but with different units of measurement (ng/mL and pmol/L).
data source: https://extendfertility.com/your-fertility/fertility-statistics-by-age/
IMPORTANT: There are two different units of measurement that are often seen for AMH. It’s very important to know whether you're reading your AMH levels in ng/mL or pmol/L. If you're reading information and communicating with others about AMH on fertility support message boards, you’re going to see both results so make sure you referencing the correct UNIT OF MEASUREMENT.
If you need to convert units, you can convert pmol/L to ng/mL by multiplying by 0.14 and from ng/mL to pmol/L by multiplying by 7.14.
IMPORTANT NOTE: A lack of vitamin D can falsely indicate low AMH levels. Make sure you check your vitamin D level as well and if it’s low, supplement for a few months then recheck your AMH.
IMPORTANT NOTE: Your AMH can change from month to month and will not necessarily be the same every time you test. There’s no way to increase your egg reserve, but there are things you can try that have been shown to improve egg quality. Even women with very low or nearly undetectable AMH can still have viable, genetically healthy eggs and be successful getting pregnant depending on what other issues they may or may not have. If you’re having regular periods then you’re probably still ovulating (separate from any other fertility issues). A low AMH simply means you’re likely closer to menopause and closer to the end of your fertile years.
FSH, or follicle-stimulating hormone, is a hormone released in the brain that controls the growth of ovarian follicles, which contain eggs, and also in turn helping to produce other hormones such as AMH, estrogen, and progesterone. It plays a key role in controlling the menstrual cycle. This is another hormone that is best to be tested on the third day of your menstrual cycle.
FSH is also important for men as it regulates the production of sperm. Testing for FSH can help determine sperm count.
A high FSH likely means your ovaries are having to be stimulated more and more to release eggs. A high FSH is correlated to fertility concerns. Because your FSH changes throughout the month, it’s critical to test your FSH levels on the correct day of your cycle, which in most cases is day 3.
Estradiol (E2) is one of four types of estrogen. It helps with the development of reproductive organs. Testing this hormone’s levels shows the ovaries’ overall ability to produce eggs and can help in determining the accuracy of FSH levels. Like FSH and AMH, it should also be done on day three of your menstrual cycle. Estradiol is also found in males, helping to control erectile function and libido.
High estrogen can be problematic, as it can throw off your hormonal balance. Symptoms of high estrogen include bloating, swelling/tenderness of breasts, decreased sex drive, irregular periods, mood swings, headaches, weight gain, hair loss, and more. High estrogen can develop on its own, or from taking certain medications.
Low estrogen can be a symptom of early menopause, even if you’re within the lab reports range. If you’re nearer the low range of the “normal” that can indicate, depending on your age, possible early menopause which can impact your ability to get pregnant and also be a symptom of endometriosis. We would recommend seeking out a fertility endocrinologist for more information and support in this scenario.
Low estrogen/early menopause can cause a host of other issues including: extremely low energy, lack of or waning sex drive, dry skin, premature aging, hot flashes, and even urinary issues as lack of estrogen affects muscular pressure around the uretha and lowers the strength of pelvic and bladder tissue, leading to a feeling of needing to pee more frequently.
In women, luteinizing hormone (LH) is a crucial hormone in regulating the testes in men and ovaries in women. In men, LH helps the testes produce testosterone, which is needed to support sperm production. On day 14 of a woman’s menstrual cycle, LH causes ovulation to occur. Afterwards, it helps produce progesterone, which is required to support a healthy pregnancy. Testing LH levels at the beginning of your cycle may help diagnose hormonal imbalances, like Polycystic Ovary Syndrome (PCOS). Testing LH levels around day 14 of your cycle will help in determining when you are ovulating. You’ll want to test your LH multiple days leading up to your likely ovulation date though as your peak day can change from month to month and happens earlier or later than day 14 for some women.
LH is what triggers ovulation. When your LH levels surge upwards that is your body gearing up for ovulation. But just because your LH levels have peaked doesn't mean you’re without-a-doubt ovulating. You can confirm this with a progesterone test, because progesterone is released right after ovulation occurs. You can continue to test LH after you get a peak reading to see if you have a second gear up. Typically your body will release the egg 24-36 hours after your LH rises. You want to time intercourse six days leading up to your egg being released as well as every other day starting six days before and one day after.
In most women, you’ll start your period 14 days after ovulation if fertilization and implantation hasn’t occurred.
Progesterone is a female hormone that stabilizes the uterine lining after ovulation, preparing it for pregnancy. High levels of progesterone are required for the embryo to attach to the womb and maintain its position. This hormone is crucial before and during pregnancy to help nurture and develop the fetus. Progesterone levels increase towards the end of a woman’s cycle, so it’s best to test for this hormone 7 days after ovulation, more most women that’s around day 21 but if you a longer or shorter cycle you need to make sure you’re testing at the correct time (7 days post ovulation) otherwise your results will not be accurate.
A low level of progesterone 7 days after ovulations can indicate you are not actually ovulating. In this case, you may require fertility assistance including the possibility of ovulation inducing drugs like clomid or letrozole. Increased levels of progesterone are critical for implantation and maintaining a pregnancy, so women who are ovulating but not achieving a pregnancy or having repeated early miscarriages can benefit from progesterone supplementation through Week 10 of your pregnancy. While over-the-counter progesterone supplements are available, we would highly recommend working with a fertility specialist on progesterone supplementation.
TSH is your thyroid stimulating hormone. Your thyroid helps regulate body functions such as regulating weight, muscle strength, and mood. When your thyroid is underperforming, your brain makes more TSH to attempt to improve thyroid performance. When your thyroid is overactive, less TSH is produced. There is an increased demand on your thyroid during early pregnancy.
Hypothyroidism, or thyroid deficiency, has been researched by Harvard on its relationship with pregnancy and is believed to be a possible cause of infertility. Even slightly low TSH levels could correlate to fertility issues in women. It’s important if you’re trying to get pregnant that your thyroid levels are monitored and treated as required. Many women who have struggled to get pregnant, that had no other fertility concerns, have found success once they’ve had their thyroid issues successfully managed. This may be as simple as taking a daily thyroid pill like Synthroid or Armour Thyroid.
Free Triiodothyronine (FT3) is a metabolite secreted by the thyroid stimulating hormone. Free T3 is the active form of the thyroid hormone. It’s important to understand the difference between regular T3 and Free T3, in that one is bound to a protein, and the latter is not attached, freely flowing through the bloodstream. A normal level of free T3 in the blood is 0.2 to 0.5 ng/dL. Low T3 levels will cause low levels of energy, and Free T3 levels are important to check, NOT just regular T3 because it can help determine if a problem is actually present in the thyroid. Low T3 is often seen in hypothyroidism, but may be normal in subclinical hypothyroidism.
Thyroxine (T4), like T3, is a metabolite that comes from TSH. The thyroid gland makes more T4, but most of it is converted to T3 outside of the thyroid gland because T3 is more potent. Like free T3, free T4 (FT4) is the free-flowing form of T4 that is found in the bloodstream and not attached to a protein. Testing for FT4 is more accurate than testing for protein-bound T4 because FT4 is what’s available for use by your body and tissues. A normal level of FT4 is between 0.8 to 2.8 ng/dL. You want your Free T4 to be in this range, since Free T4 levels outside this range could impact not just your fertility but your overall wellbeing and could be indicative of a thyroid problem. Abnormally high levels of FT4 correlate to an overactive thyroid while abnormally low levels correlate with an underactive thyroid. T4 in its synthetic form (Levothyroxine) is what is usually given to patients with hypothyroid due to T3 being absorbed from the intestine too rapidly.
Reverse triiodothyronine (rT3) is the inactive form of triiodothyronine (T3) that typically demonstrates no biological activity. Levels of rT3 are useful for testing to see if someone is experiencing non-thyroidal illness syndrome. If your body is having trouble converting T4 to T3, it will instead produce Reverse T3, which can indicate a problem with the thyroid gland. This could possibly be caused by stress or malnutrition.
Thyroid peroxidase (TPO) antibodies are present when someone is experiencing autoimmune thyroid disease, which is most commonly seen in women of child-birthing age. It occurs when the body makes antibodies that attack the thyroid by mistake, causing hypothyroidism (when the thyroid doesn’t make enough thyroid hormones). It’s important to test for TPO antibodies, as a positive result often indicates a thyroid problem that could lead to pregnancy and fertility complications
Vitamin D is a naturally occurring nutrient found through sunlight as well as certain foods. Vitamin D has been linked to provide benefits to those trying to conceive, with studies showing that higher Vitamin D levels are associated with higher pregnancy rates. Vitamin D has also been shown to improve egg quality through stimulating the AMH hormone, so we recommend those trying to conceive to supplement with Vitamin D at least three months prior to trying to get pregnant.
While typically seen in males, androgen plays an important part in women as well. Androgen is produced in the ovaries and is later converted into estrogen. Androgen is also involved in thickening of the endometrium and menstrual cycle regulation. Hormones that are included in androgen are testosterone and dehydroepiandrosterone-sulfate (DHEA-S).
Women only need a small amount of testosterone. Only 1-2% of testosterone in women is free testosterone, and is helpful for identifying androgen excess.
Too much or too little total testosterone could interfere with fertility, as testosterone helps to develop follicles in the ovaries that hold and release eggs during ovulation. It’s important to test for because polycystic ovarian syndrome (PCOS) has been linked to high testosterone levels in women.
A study comparing women with and without PCOS found that women with PCOS consumed less magnesium. Luckily many foods including nuts and leafy greens contain magnesium, as well as supplements. It’s important to test for in determining signs of PCOS.
Iron is an important nutrient required by babies during pregnancy, and a lack of it could lead to anemia in the baby. Iron deficiency is the most common deficiency in the world, and the implications could be bad for those trying to conceive, as it is possibly linked to infertility, thyroid dysfunction, and even miscarriages.
Ferritin is the protein in which iron is stored in the form of. It is the indicator for iron deficiency. Ferritin has been linked to thyroid function, often showing reduced ferritin levels in hypothyroid patients. This is important to look for in a blood test, as it could be another indicator of possible fertility/thyroid issues
Understanding your blood results can be a little bit complicated and we definitely recommend discussing it with your doctor. However, a quick Google search can better help you understand your blood results on your own. Your lab results will come with normal ranges displayed. You’ll want to take note of anything above or below the normal range.
Modern Fertility is an online company that will send you a kit to test your fertility hormones. There is a lot of overlap between the tests we recommended and the tests included in your Modern Fertility kit. We’ve given Modern Fertility a try and here’s our review of it (coming soon). Although you’re better off going to a local lab, the explanations given to you by Modern Fertility on your results are very in-depth and well-thought out.
Blood tests can be expensive, especially if your health insurance won’t cover it. You can typically find self-pay facilities that are less than half of what Quest or Labcorp charges. If you opt to take all of the tests above they will likely cost around $1,000-$2,000 if you go self pay at Quest or Labcorp. A self-pay, decreased cost facility will be closer to $450-$700 total. Prices will vary of course based on the number of tests you get done and where you go. We are providing these price ranges just as a guide. If it’s not financially possible to get all or some of these lab tests done, we understand. We’re simply providing some suggestions to help pinpoint possible fertility issues in advance.
