Fertility has become a very hot topic these days with the surge in both assisted reproductive technology (ART) and adoptions.
ART typically consists of medications, intrauterine insemination (IUI) or in vitro fertilization (IVF) with the sole purpose of becoming pregnant.
In general, experts tell women under 35 years old to try regularly to get pregnant at ovulation for 12 months before considering additional work-up. Women between 35 and 40 years old should try for six months.
Whether you are in your first month or your first year without success, here are five tests to talk about with your doctor.
1. Follicle Stimulating Hormone (FSH)
Follicle stimulating hormone is the means of communication between the pituitary in your brain and your ovary. As the name implies, it causes the ovary to recruit and stimulate follicles leading to a main follicle that releases an egg at ovulation.
The higher the FSH, the lower the potential for follicle growth and stimulation because of low ovarian reserve (decreased ability of the ovary to produce eggs) leading to infertility.
Typically done on day 3, 4 or 5 of the menstrual cycle (meaning the first few days of your period) an ideal number is 10 mIU/ml or less. Double digits are more concerning, as far as chances go. Interestingly, blood type O is found in research to have a diminished ovarian reserve, whereas type AB has the best protection.
2. Anti-Mullerian Hormone (AMH)
Besides the FSH, the anti-mullerian hormone is also important as it too is a marker of ovarian reserve quantity and quality. Low levels mean low follicle count. High levels could mean polycystic ovarian syndrome. This test is also drawn early in the menstrual cycle, typically on day 3 or 4.
Progesterone is critical for prepping the uterus for implantation and maintaining the pregnancy the first several weeks until the placenta takes over. On a typical 28-30 day cycle, progesterone should be drawn on day 19, 20 or 21 and should be 7ng/ml or higher.
Lower levels may indicate a lack of ovulation or weak ovulation and may require progesterone (not progestin) supplementation starting at a positive ovulation and stopping if your period starts (but continuing usage when you are pregnant).
4. Full Thyroid Panel
A full thyroid panel is critical for fertility. Most health care providers check thyroid stimulating hormone (TSH). When it comes to making babies, it's important to also look at the active hormones free T3 and total T3, as well as free T4 and total T4.
Don’t forget the thyroid antibodies as well, thyroid peroxidase antibody and thyroglobulin antibody. Even suboptimal levels can create problems with becoming pregnant.
5. Test for Polycystic Ovarian Syndrome
Evaluate for polycystic ovarian syndrome by checking your free testosterone levels and total testosterone levels, DHEA-S levels, coupled with a fasting insulin and glucose.
If you have irregular or absent periods, acne, hair growth in places you don’t want it (known as hirsuitism) or have had a recent pelvic ultrasound that showed several follicles on your ovaries, then you should get evaluated.
6. BONUS TEST! Prolactin
Here’s a 6th test to consider -- the prolactin test. Prolactin is the hormone of milk production in the breasts. Results that are elevated, even slightly, or are at the high end of normal, can cause the body to become confused and prevent pregnancy.
There are various reasons for a high prolactin, from high stress to a prolactinoma (usually benign tumor) in the brain. This is assuming you are not currently breastfeeding.
If you are having issues becoming pregnant, ask your health care provider about these tests and remember that the health of the father is half the equation. Therefore make sure he is getting the appropriate work-up as well.
1. Implications of Blood Type for Ovarian Reserve. Web. 22 July, 2012.
2. Anti-Mullerian Hormone (AMH) in Female Reproduction: Is Measurement of Circulating AMH a Useful Tool? Web. 22 July, 2012.
3. Endocrinology and Recurrent Early Pregnancy Loss. Web. 22 July, 2012.
4. Endocrine Society Issues Guidelines for Management of Hyperprolactinemia. Web. 22 July, 2012.
Reviewed July 23, 2012
by Michele Blacksberg RN
Edited by Jody Smith