Your Fertility Workup
Learn about the basic blood work and diagnostic testing that should be conducted to assess one's fertility health whether you are trying to conceive or freezing your eggs. Some of these can be run by your OB/GYN, who would refer you to a specialist when needed.
Still confused? We also decode fertility acronyms for you.
Basic Blood Work
You will be asked to come in for blood work ranging from Day 2 to 5 of your menstrual cycle, depending on the clinic. If you are already undergoing Assisted Reproductive Technology (ART), you will be asked to repeat several of these tests through ovulation. Otherwise, it is a one-time test to get a baseline.
This section lists what the clinician will test for and describes the purpose for each. Hover to learn more.
AMH
Most accurate predictor of a woman’s egg supply. This test can be more accurate than FSH because there is no fluctuation from month to month and the test is not dependent on a woman’s menstrual cycle, which means women can have the test at any point.
The test helps determine the quality and quantity of eggs available for ovulation.
Levels <1.0ng/ml tend to indicate low ovarian reserve while >3.5ng/nl may be a sign PCOS.
AMH
(anti-Müllerian Hormone)
Estradiol
Main female reproductive hormone secreted from the ovary
E2
(Estradiol)
FSH
Releases from the brain and stimulates the ovary to mature an egg.
High FSH levels can indicate to your physician that the hypothalamus and pituitary glands are working harder than normal due to a decrease in ovarian reserve (egg supply).
FSH levels can vary from cycle to cycle.
FSH
(Follicle Stimulating Hormone)
LH
LH
(Luteinizing Hormone)
Integral to the final maturation and release of a mature follicle.
This is the hormone that surges just before ovulation and what at-home "fertile window" predictor kits test for.
Progesterone
A hormone produced after ovulation, which can also document that you're ovulating.
Typically, this test is done 21 days into your menstrual cycle.
Learn about the critical role of progesterone in this podcast episode.
Progesterone
Thyroid
The pituitary gland in your brain creates thyroid-stimulating hormone (TSH) triggering the production of T3 and T4.
When T3 & T4 production is high or low, it can cause fertility issues, increased rate of pregnancy loss, ovulatory disorders, irregular periods, & preterm birth.
Learn why measuring your TSH level may not be enough.
Your Thyroid
When should I have tests done?
The definition of infertility is being under 35 and having tried actively to conceive for 12 months or more without success. If you are over 35, this time is 6 months or more.
If you fall in either category, get tested, but you will likely need more than hormone testing.
Additional Diagnostic Tools/Procedures
Ultrasound of the ovaries first done between days 2 through 4 of your cycle. This test determines the antral follicle count (AFC), which represents the number of eggs available for pregnancy that month.
These follicles can be stimulated so that multiple can mature, rather than the typical one women ovulate monthly.
Internal Ultrasound
This internal ultrasound is inserted into the vagina.
An x-ray of the uterus and fallopian tubes to see if a patient’s fallopian tubes are open, to assess whether the uterus has normal shape, and to ensure that the cavity is not affected by fibroids, polyps, or scar tissue.
X-ray contrast is injected into the uterus and an X-ray is taken to detect abnormalities in the uterine cavity. The test also determines whether the fluid passes out of the uterus and spills out of your fallopian tubes.
If abnormalities are found, you'll likely need further evaluation. In a few women, the test itself can improve fertility, possibly by flushing out and opening the fallopian tubes.
HSG (Hystersalpingogram)
HSG
Looks for uterine or fallopian tube disease. Sometimes a hysterosonography(his-tur-o-suh-NOG-ruh-fee) is used to see details inside the uterus that can't be seen on a regular ultrasound.
Pelvic Ultrasound
Pelvic Ultrasound
This minimally invasive surgery involves making a small incision beneath your navel and inserting a thin viewing device to examine your fallopian tubes, ovaries and uterus. A laparoscopy may identify endometriosis, scarring, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus.
Laparoscopy
Laparoscopic Surgery
Decoding Fertility Acronyms
Now that you have learned about the basics of hormones and testing, how does it all fit together? We've tied it all together for you.
Sources: ASRM, ACOG, Fertility & Sterility, MayoClinic, American Thyroid Association