Understanding fertility testing is a crucial yet often overlooked aspect of the conception journey. In our latest podcast episode, we dive into the world of fertility blood tests, examining what they are, when they should be performed, and how to interpret them correctly. This conversation aims to empower you with knowledge that many fertility clinics don’t adequately provide.
The timing of fertility testing represents a significant gap in conventional medical approaches. Most healthcare providers follow standard guidelines that recommend testing only after a year of trying for women under 35, or six months for those over 35. However, this reactive approach means many underlying issues remain unaddressed for too long. Taking a proactive stance can identify and address nutrient deficiencies, inflammation, and blood sugar issues before they become barriers to conception. While insurance coverage can be a limiting factor for early testing, understanding what’s happening in your body sooner rather than later provides invaluable insights for your fertility journey.
Standard fertility clinics typically run a basic panel of tests focused on cycle day 3 hormones:
- FSH (Follicle Stimulating Hormone)
- LH (Luteinizing Hormone)
- Estradiol
- Prolactin
These are usually supplemented with thyroid screening via TSH and sometimes include glucose, hemoglobin A1C, and vitamin D levels.
(You may be wondering why I didn’t include AMH, aka anti-mullein hormone, in this post…not to worry, we’ll devote an entire blog post and podcast episode to this hormone).
While these tests provide useful information, they’re often ordered through the lens of “how will someone respond to assisted reproductive technologies like IUI or IVF?” They rarely approach testing from a functional perspective that asks: “How can we optimize this person’s natural fertility? What underlying barriers might exist to conception?”
When in the cycle should fertility hormones be tested?
The timing of these tests is absolutely critical but frequently misunderstood.
FSH, LH and estradiol must be measured during cycle days 2-4 (ideally day 3) to provide meaningful information about how the pituitary gland communicates with the ovaries and how the ovaries are responding. Testing these hormones at other times in the cycle renders the results essentially useless for fertility assessment.
Another hormone that requires specific timing is progesterone, which should be measured 7 days after ovulation when this is when progesterone should be at its peak. You cannot arbitrarily test progesterone on cycle day 21, which assumes a 28-day cycle with ovulation on day 14. Since ovulation timing can vary quite a bit from person to person, timing progesterone testing to your actual ovulation date is essential for accurate results.
What about normal vs optimal values for fertility?
Perhaps the most significant gap in conventional fertility testing lies in the difference between reference ranges and optimal ranges for fertility. Take vitamin D as a prime example – lab reference ranges are typically 20-90 ng/mL, but research shows that fertility outcomes improve significantly when levels reach 30-50 ng/mL.
This distinction between “normal” and “optimal” exists for numerous markers, including thyroid function, inflammatory markers, and nutrient levels. Without understanding these optimal ranges, many people with “normal” test results continue to struggle with unexplained fertility challenges that could be addressed through targeted interventions.
Another critical consideration is how supplements and medications can interfere with test results. Biotin supplements, commonly found in hair/skin/nail formulas, can disrupt laboratory assays and lead to inaccurate results when taken in high doses. To ensure accurate testing, it’s advisable to discontinue biotin-containing supplements at least five days before blood work. Similarly, consistency in testing conditions – such as fasting status and timing of medication – is essential when comparing results over time to track progress.
You are more than a number…
The emotional impact of fertility testing shouldn’t be underestimated. Receiving test results can trigger fear, anxiety, or a sense of personal failure. It’s important to remember that laboratory values are not a reflection of your worth or character. They simply provide information that empowers you to take appropriate action. Developing tools to process these emotions, such as EFT tapping, can help transform the testing experience from one of dread to one of empowerment and hope.
Listen to episode 45 of the Brilliant Fertility Podcast to learn more about fertility lab testing:
- Listen on Apple Podcasts
- Listen on Spotify
- Watch on YouTube
Download my free fertility lab guide for a list of the blood tests I run in my female fertility patients. In this guide you’ll discover:
- The exact tests I request
- The time of the cycle they must be drawn
- What the marker is used to understand (ovarian reserve, inflammation, nutrient status, blood sugar regulation, etc)
- Optimal ranges for each marker
