Whether you are actively trying to concieve and unable to get pregnant after 12 months or you are planning for an egg freeze cycle and would like to assess your ovarian reserve, blood tests are a standard part of the fertility work up done by the fertility doctor to assess hormonal causes of infertility. Below are common blood tests ordered by the fertility doctor.
Follicle-stimulating hormone (FSH) – a reproductive hormone that controls the development of the eggs and the menstrual cycle in women and sperm in men. In men, FSH levels are used to help determine the cause for low sperm count. High FSH levels may suggest testicular dysfunction and low FSH levels may suggest dysfunction of the pituitary gland. In women, a Day 3 FSH test can be used to assess the woman’s ovarian reserve (the quality and the quantity of eggs). A Day 3 FSH value less than 10 mIU/mL is suggestive of adequate ovarian reserve. A high FSH level of 10 mIU/mL to 20 mIU/mL is associated with infertility.
Anti-mullerian hormone (AMH) – a hormone secreted by the cells in the ovary to support the eggs and is used to determine the size of the egg pool. AMH levels are correlated with the number of eggs retrieved after stimulation and is the best biomarker for predicting poor or excessive ovarian response. AMH can be measured anytime during the menstrual cycle.
- AMH <0.5 ng/mL predicts reduced ovarian reserve with less than three follicles in an IVF cycle
- AMH <1.0 ng/mL predicts baseline ovarian reserve with a likelihood of limited eggs at retrieval
- AMH >1.0 ng/mL but <3.5 ng/mL suggests a good response to stimulation
- AMH >3.5 ng/mL predicts an excessive response to ovarian stimulation and caution should be exercised in order to avoid ovarian hyperstimulation syndrome (OHSS)
Estradiol (E2) – a derivative of estrogen and the main sex hormone in women. Estradiol helps to maintain a healthy pregnancy. A Day 3 estradiol level with FSH can be used to assess the ovarian reserve. A high estradiol level (greater than 60 to 80 pg/mL) in conjunction with a normal FSH level has been associated with lower pregnancy rates.
Progesterone – a hormone that has multiple functions in the body including preparing a woman’s body for pregnancy and maintaining the pregnancy. Progesterone levels are commonly used to assess ovulation in women and to monitor the success of induced ovulation. A progesterone level greater than 3 ng/mL is evidence of recent ovulation. Progesterone levels are typically obtained on Day 21 in a regular 28-day cycle. If the woman has irregular cycles, the test is typically started 7 days before the presumed onset of menses and repeated weekly thereafter until the next menstrual cycle starts.
Luteinizing Hormone (LH) – a reproductive hormone that stimulates the releasing of the egg from the ovary in women and stimulates the production of testosterone in men. In both men and women, LH is often used in conjunction with other tests (i.e. FSH, testosterone, estradiol, and progesterone). In women, LH levels can be used to evaluate the function of the ovaries and determine a LH surge (ovulation).
Prolactin – a hormone commonly known to help women produce milk after birth and plays an important role in reproduction. Prolactin levels are used along with other hormone tests to help diagnose the cause of infertility and erectile dysfunction in men and the cause of menstrual irregularities and/or infertility in women.
Testosterone – the main sex hormone in men. This test may be done when male infertility is suspected or when a man has a decreased sex drive or erectile dysfunction.
Lindsay TJ, Vitrikas KR. Evaluation and treatment of infertility. Am Fam Physician. 2015;91(5):308-14.