What your fertility labs mean

If you’re struggling to conceive, you’re not alone. Infertility, or the inability to get pregnant after at least one year of unprotected sex, affects approximately 9% of men and 11% of women of reproductive age. As a result, up to 15% of couples are estimated to struggle with infertility, according to the National Institute of Child Health and Human Development. Women who have menstrual periods approximately every 28 days with prodromal symptoms of bloating, fatigue, breast tenderness are most likely ovulatory. 

While the causes of infertility are varied, your healthcare provider can help determine the root cause of the problem. Fertility labs are used to measure hormone levels, assess ovarian reserve, view number and motility of sperm, and evaluate the health of egg cells. Here’s a look at some of the most common hormone tests for infertility and what your results may mean.

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When should you start fertility testing?

Your healthcare provider may begin a fertility evaluation if you’ve been trying to conceive for at least one year without success. But if you’re older than 35, your healthcare provider may recommend a fertility evaluation after only six months of unprotected sex, says Shvetha Murthy Zarek, MD, a fertility specialist at Oma Fertility in St. Louis, Missouri. Having intercourse every other day is the optimal frequency to help sperm count stay high and increase the chance the sperm and egg will meet.

Types of fertility testing

Your healthcare provider will start by getting a complete medical history from both you and your partner, followed by a physical exam and tests.

Fertility test results can help determine if you have a hormone imbalance, poor ovarian reserve, low sperm count or disordered sperm motility, or another underlying cause of infertility.

Male fertility tests

For men, fertility testing starts with a medical history and physical exam to identify any inherited conditions, chronic conditions, surgeries, or injuries that could affect fertility. This can be paired with any combination of the following male fertility tests:

• Semen analysis (considered the cornerstone of male partner workup)
• Scrotal ultrasound
• Transrectal ultrasound
• Hormone testing
• Post-ejaculation urinalysis
• Genetic tests
• Testicular biopsy
• Specialized sperm function tests

The semen sample should be collected after two to seven days without ejaculation and submitted to the lab within one hour of collection.

Fertility tests for women

Fertility testing for women also begins with a thorough medical history and physical exam. This can be paired with the following tests:

• Ovulation testing
• Ovarian function tests (Day 3 FSH, Day 3 estradiol, ultrasound, and inhibin B)
• Luteal phase testing (progesterone levels, more hormone testing, and possibly an endometrial biopsy)
• Additional hormone testing

At-home fertility test kits

At-home fertility test kits can provide quick answers for couples who don’t want to wait for an appointment with a specialist. For women, typically the test kits involve collecting a small blood sample, and sending it to a lab that will test for a variety of hormones. For men, the test kits involve collecting a sperm sample for a lab. They can range from under $100 to $150, and usually you receive results within 10 days or less. These can be a good first step before meeting with a qualified healthcare provider. Be aware that infertility workups are often complex and that test kits may cause patients more confusion than provide answers. 

What blood tests are done to check fertility?

An infertility workup, also known as a fertility panel, is a series of tests that helps determine the cause of infertility. The fertility workup typically includes a blood test to measure hormone levels and an ultrasound to assess ovarian reserve.

“Fertility lab testing can be used to assess the health of egg and sperm cells—the foundation of a future baby,” explains Jaclyn Smeaton, ND, a naturopathic doctor, fertility specialist and founder of Hello Fertility. “Testing can also make sure hormones are in proper balance, that nutrition is optimized to support pregnancy, to rule out infections and other health issues that can negatively impact a future pregnancy, and more.” 

Here are some of the most common blood tests used to check fertility.

Follicle-stimulating hormone (FSH)

“FSH is a hormone made by the brain that communicates with the ovaries and tells them to mature an egg,” explains Dr. Smeaton. “In general, we want FSH to be at the low end of normal. Below 10 mIU/mL is considered good, and below 6 mIU/mL is optimal.”

When FSH levels fall outside of this range, it can be an indicator that the ovaries are not as responsive as they should be—which can happen for various reasons including aging or certain medical conditions, such as premature ovarian insufficiency (POI). When FSH is above the upper number in the normal range, this may be a sign of early menopause. 

Since FSH levels fluctuate throughout the menstrual cycle and typically peak just before ovulation, they should be tested on day three of the menstrual cycle where day one is the first day of full menstrual flow. 

Estradiol (E2)

“Estradiol is a critical hormone that is made by cells in the ovary as an egg matures,” Dr. Smeaton says. “There’s a surge right before ovulation that tells the brain that the egg is ready to be released from the ovary. The estrogen also helps thicken the lining of the uterus, called the endometrium.”

She adds that although the normal range of estradiol varies from 12.5 to 166 pg/mL, the optimal range is between 30 to 50 pg/mL. When levels are too low, it could be a sign that there isn’t enough estrogen to mature the egg or prepare the uterus for implantation. If levels are too high, it could mean the ovaries are less responsive than they should be.

Similar to FSH, estradiol should also be tested on day three of the menstrual cycle.

Luteinizing hormone (LH)

Luteinizing hormone (LH) aids in proper functioning of the reproductive system by stimulating processes such as ovulation. LH is produced by the pituitary gland and works closely with FSH. 

Your LH value can help identify when you’ll ovulate, as LH levels increase shortly before ovulation. It can also help your healthcare provider diagnose the cause of infertility issues. 

High LH levels may indicate conditions such as polycystic ovary syndrome (PCOS) or Turner syndrome. Low LH levels might be an indicator that your pituitary gland isn’t functioning properly or that you are severely underweight. Maintaining a healthy BMI between 20 and 30 is best for fertility.

LH levels fluctuate throughout the month. For fertility, LH should be tested on day three of the menstrual cycle.

Anti-Müllerian Hormone (AMH)

The results from Anti-Müllerian Hormone (AMH) tests can be paired with estradiol and FSH results to tell you more about the ovarian reserve, or the capacity of the ovary to produce eggs that are capable of being fertilized. 

AMH levels will naturally decline as you get older, so the ideal level changes, based on age. The normal range for AMH is 1 to 4 ng/mL, but optimal levels vary within this range, depending on age, says Dr. Smeaton. AMH is undetectable at menopause. 

But if your levels are outside of the normal range, she advises not to worry too much, because AMH may not indicate fertility as accurately as other fertility tests, such as FSH and estradiol tests. AMH levels are fairly consistent, so they can be tested at any time during a woman’s cycle.

Inhibin B

Inhibin B is a hormone that has an inverse relationship with FSH. In other words, as FSH levels go up, inhibin B levels go down—and vice versa. Therefore, if inhibin B levels are too high, it can decrease FSH levels and negatively affect your ability to conceive. 

Inhibin B levels can also give your healthcare provider more information about your ovarian reserve—although these levels are not considered reliable in assessing ovarian reserve on their own.

While the normal inhibin B level is less than 139 pg/mL, the ideal range is 15 to 24 ng/mL, according to Dr. Smeaton. This is to be tested on day three of the menstrual cycle.

Serum progesterone

Progesterone is a hormone produced by the ovaries during ovulation. It helps thicken and prepare the lining of the uterus for implantation of the fertilized egg.

Serum progesterone tests are commonly used to help identify whether ovulation has occurred. Dr. Smeaton explains that normal range is reported as 1.8 to 24 ng/mL. However, she shares that women with progesterone levels 15 ng/mL or higher tend to have better outcomes when it comes to fertility than women with lower progesterone levels. 

Unlike other common fertility blood tests, progesterone is tested on cycle day 21 in an average 28-day menstrual cycle, or seven days after ovulation. 

Prolactin

Prolactin is a hormone responsible for lactation and milk production. However, it can also interfere with fertility and is often the reason why menstrual cycles stop while breastfeeding. 

Normal prolactin levels are below 25 ng/mL. High prolactin levels can inhibit the release of FSH, which is important for the development of healthy eggs. As a result, high levels of prolactin can cause poor egg quality and decreased fertility.

“A persistently elevated prolactin level can cause irregular menstrual cycles, as well as irregular ovulation and infertility,” Dr. Zarek explains. “But, normalizing prolactin levels can actually restore fertility.”

Prolactin can be tested at any point throughout the menstrual cycle. However, it’s generally highest three to four hours after waking, so this is generally considered the best time to test your levels.

Testosterone

If a man’s testosterone levels fall below 300 ng/dl, it could have an impact on fertility or sexual health. This male hormone is measured by a simple blood test. It should be taken first thing in the morning between 7 a.m. and 10 a.m. when levels are typically the highest. Additional testing may include a prolactin test. Semen analysis is the first test that should be done to work up a couple’s fertility issue.

What are normal results for fertility blood tests? 

Dr. Smeaton shares normal and some optimal ranges for fertility blood tests here. However, your healthcare provider will help determine the specific target ranges for your situation, based on your age, medical history, and more. 

What if my fertility lab results are abnormal?

Once you’ve received the results of your fertility tests, your healthcare provider will help you understand what your results mean and then work with you to determine what your most successful path to pregnancy might look like, explains Dr. Smeaton.

Optimize lifestyle changes: quit smoking, lose weight to maintain a healthy BMI, and manage stress. Have sex every other day. Other options may include fertility treatments, such as:

• Intrauterine insemination (IUI), a procedure in which sperm is ejaculated, washed, put in a syringe, and injected into the uterus
• In-vitro fertilization (IVF), a procedure in which eggs are fertilized with sperm outside of the body and gently placed inside the uterus. 
• Gamete intrafallopian transfer (GIFT), a procedure where the eggs and sperm are transferred into the woman’s fallopian tubes

RELATED: 47% who received fertility treatment successfully conceived, according to new survey

Although abnormal lab tests results can be concerning, Dr. Smeaton explains that it doesn’t necessarily mean you can’t get pregnant. In fact, many couples who receive abnormal test results go on to have healthy pregnancies, she adds. Work with your healthcare provider or fertility specialist to develop an individualized plan that’s right for you and your family.