Blood Tests for Infertility Evaluation and Treatment

FSH is a very important lab test at the start of an infertility evaluation and prior to any treatment. The FSH level indirectly measures the store of follicles (ovarian reserve) and the eggs (oocytes) remaining in the ovary, and can warn of potential diminished egg quality. A high FSH level indicates a diminished quantity of oocytes and alerts us to likely reduced quality oocytes. To help understand your fertility, your doctor will measure your FSH levels by drawing blood on the second or third day of your menstrual cycle. The FSH test result will fall into one of three ranges: normal (12 microIU/L). A borderline result suggests poor ovarian reserve and the need for prompt, aggressive treatment. An abnormal FSH level suggests a very poor ovarian reserve and a markedly low chance for a healthy pregnancy using your own eggs. Please note that the FSH lab ranges may vary from institution to institution. Keep in mind that a normal FSH result must be interpreted with the age of the woman in mind. A 23 year-old, 33 year old and 43 year old will have very different chances for success even if they all have the same FSH level. One last note about FSH, if your level is elevated, retesting to try to get a lower result will not change your prognosis.

This is a test commonly recommended to gain more information about a woman’s ‘ovarian reserve’ or fertility. On cycle day 3, an Estradiol and FSH level will be drawn. The patient then takes 50mg of Clomid (Clomiphene Citrate) cycle days 5 through 9 in the evening, and another FSH level will be drawn on cycle day 10. In general, a dramatically higher FSH on day 10 is an abnormal result indicating a compromise in egg number.

LH is released by the pituitary gland when an ovarian follicle is mature and ready to ovulate. LH induces the final maturation of the egg and causes the ripe ovarian follicle(s) to burst and release the egg(s) within. This blood test may be recommended to determine if you are currently ovulating, but is more commonly done in the early part of the menstrual cycle. Some women with PCOS have elevated levels of LH all the time, and this can interfere with ovulation. Of note, because urine LH predictor tests or Ovulation Predictor Kits (OPKs) measure elevated LH, women with high basal LH levels often have confusing results.

Prolactin is the hormone produced by the pituitary gland to stimulate the production of breast milk. Elevated prolactin levels (>25 ng/ml) may interfere with fertility.

TSH levels are usually tested to check for thyroid disease, which is common among women. A suppressed level of TSH (5.0 microIU/ml) is consistent with hypothyroidism. Either condition may cause fertility problems by causing hormonal imbalances, leading to anovulation or other problems in a woman’s menstrual cycle. Importantly, studies have shown that a TSH level between 1.0 – 2.5 microIU/ml is best for fetal brain development.

AMH is secreted by cells in the ovary that support egg development. This hormone gradually decreases over time as ovarian function declines, and drops to undetectable levels after menopause. To help assess your fertility and potential response to gonadotropins, your doctor may order this test, which can be drawn any day during the menstrual cycle, and is not affected by birth control pills. A Normal result is 1.0 ng/mL or higher, a Low Normal result is 0.7 – 0.9 ng/ml, Low is 0.3-0.6 ng/ml, and Very Low is 0.3 ng/ml.

Some or all of these labs may be recommended by your physician, depending on your history and symptoms.

Human chorionic gonadotropin (hCG), to find out if you are pregnant.
Testosterone, an androgen. Androgens at high levels can block ovulation and cause acne, male-type hair growth on the face and body, and hair loss from the scalp.
Prolactin, which can play a part in a lack of menstrual cycles or infertility.
Cholesterol and triglycerides, which can be at unhealthy levels with PCOS.
A chemistry screen to check kidney and liver function and glucose levels.
Thyroid-stimulating hormone (TSH) to check for an overactive or underactive thyroid.
Adrenal gland hormones, such as DHEA-S or 17-hydroxyprogesterone. An adrenal problem can cause symptoms much like PCOS.
Glucose tolerance and insulin levels, which can show insulin resistance.

The presence of antisperm antibodies can prevent some women from getting pregnant. The immune system sees the sperm as an invader in the body and creates antibodies to kill it. Although relatively rare, this can be a cause of infertility.

Antibodies affect sperm in two ways. They can kill the sperm. The antibodies also affect the motion of the sperm. Rather than swimming, they clump and move in a circular motion. In most cases, they are unable to reach the egg.

The antisperm antibody test is used to diagnose this cause of infertility. If no other cause for infertility can be found or the results of the post coital test are not conclusive, your doctor may recommend this test. The test looks for antibodies in the blood that attack a man’s sperm.

Men can develop anti sperm antibodies as well. Men who have had vasectomy reversal, varicocele or testicular surgery or injury are at a higher risk of developing these antibodies. If antisperm antibodies are detected, there are a few treatment options.

Infertility procedures, such as Intrauterine Insemination (IUI) or In vitro Fertilization (IVF) can help couples conceive. These procedures allow the sperm to avoid contact with the cervical mucous and reach the egg. In most cases, IUI will be attempted first. If pregnancy is not achieved, IVF may be recommended. In severe cases, doctors may take an added step. Some will use a procedure known as intracytoplasmic sperm injection or ICSI. This technique involves injecting the sperm directly into the egg, giving it a much better chance of fertilizing the egg and achieving pregnancy. ICSI is done with in vitro fertilization procedures. For more information about ASAB, click here.

Estradiol is a type of estrogen. This hormone is produced by ovarian follicles and increases as the follicles develop in the first part of the menstrual cycle. An elevated E2 level on the third day of your menstrual cycle could indicate compromised ovarian reserve despite a normal FSH level. E2 is measured during treatment cycles to assess your ovarian response to medication. Your fertility medication dosing is adjusted by your doctor who will look at your E2 levels in conjunction with ultrasound measurements of your follicles and uterine lining.

Progesterone is a major hormone needed to prepare and sustain the uterus for pregnancy. It is produced by the corpus luteum cyst of ovulation and later, after an embryo develops, by the placenta. This blood test is performed to determine the proper functioning of the corpus luteum. Progesterone controls the development of the lining of the uterus and prepares it for embryo implantation. If progesterone production is inadequate, the endometrium may not be able to sustain the implantation of the embryo. Progesterone testing is usually performed about 7 to 9 days after suspected ovulation. A low level at this time indicates either that ovulation has not occurred, or that there is a luteal phase defect.

HCG or human chorionic gonadotropin tests for the hormone that we know is the most important to our patients. This level can tell you whether or not you are pregnant, and subsequent levels can warn us about potential miscarriage or ectopic pregnancy. Beta-HCG (your nurse may refer to this test as your ‘beta’) is produced by the early embryo to signal the corpus luteum to keep making progesterone which supports the endometrial lining and the placenta. We may ask you to have your blood drawn multiple times if there is any concern about the development of the embryo, or if we are concerned you may have an ectopic pregnancy.

Your blood type is important to know during pregnancy, so it is routinely done before treatment. If a woman has Rh negative blood type, she may need RhoGAM injections during pregnancy to prevent sensitization and hemolytic disease of the newborn.