Fertility bloodwork: 7 hormones which are most important for fertility
This happens to me often: a woman writes to me and tells me all about her fertility journey and asks a ton of questions.
Then I say: all right, but could you please send me your recent bloodwork?
Then the woman sends me a ton of data: all the stimulation protocols she’s been through, her husband’s sperm values, all kinds of paperwork from the clinic …but nothing really relevant to conclude about her fertility.
So I figured I need a reference post where I would put all hormones which are relevant for estimating fertility. I will sort them from the most to least important, with the most important remarks to each of them, as well as range which you should expect to see on your bloodwork.
Let’s start with the most important one:
1. AMH (Anti-Müllerian Hormone)
AMH is the most important hormone to assess a woman’s ovarian reserve.
AMH values are stable and can be measured at any point of a woman’s menstrual cycle. In order to arrive at a reliable estimate of how many eggs are left, AMH levels are often measured along with follicle stimulating hormone (FSH) levels.
Here is AMH range you should expect (in ng/mL, please don’t confuse with pMol/L given by some laboratories):
< 33 Years <2.1 ng/mL
33-37 Years <1.7 ng/mL
38-40 Years <1.1 ng/mL
= 41+ Years <0.5 ng/mL
2. FSH (Follicle Stimulating Hormone)
FSH has to be measured on a specific day in the cycle (day 3 but if you miss it, anything from day 2 to 5 will work).
FSH range on day 3 and what to expect sorted by age:
< 33 Years < 7.0 mIU/mL
33-37 Years < 7.9 mIU/mL
38-40 Years < 8.4 mIU/mL
= 41+ Years < 8.5 mIU/mL
In general, FSH under 6 marks an excellent ovarian reserve, 6-9 is good, 9-10 still OK, 10-13 means a diminished reserve, 13+ is very hard to stimulate.
The last but very important thing to remember is that FSH often oscillates in women in advanced reproductive age. Meaning that having a FSH of 6 in one cycle does not mean your ovarian reserve is good, only that you need to check several cycles in a row. The number which counts in terms of predicting the number of eggs left is always the highest FHS value ever measured.
3. LH (Luteinizing Hormone)
Measure on day 3, because it will rise later and become very high just before the ovulation.
A normal LH level is similar to FSH. An LH that is much higher than FSH is one indication of PCOS (however, there is no need to panic as there are more diagnostic criteria for PCOS, such as androgens and their derivatives as well as the ultrasound).
LH range on day 3:
< 7 mIU/ml
The moment when LH becomes 20 mIU/ml or more is called the LH surge and it leads to ovulation within 48 hours. If you are trying to get pregnant naturally, you need to learn to recognize this moment. Either by using a charting method and following the signs which your body tells you, or by using ovulation strips.
4. E2 (Estradiol)
Also the estradiol (estrogen) should be measured at the beginning of the cycle (around day 3). Good values are considered about 25-75 pg/ml.
Levels on the lower end tend to be better for stimulating. Depending on how many follicles are being produced, E2 will rise, to at least 2-3X times the initial value. At the mature follicle size of 18mm, the levels will be about 200-600 pg/ml per follicle. The levels are sometimes lower in overweight women and women with egg quality issues.
Very high levels of estradiol (several hundred or more) may indicate existence of a functional cyst.
5. Thyroid Stimulating Hormone (TSH)
TSH should be measured at the beginning of the cycle.
The normal range for TSH levels is considered to be 0.3 to 3.0 mIU/L . Anything above 3.0 is considered hypothyroid. Some endocrinologists believe that a TSH level above 2.0 mIU/L may indicatea poor thyroid function and prefer to bring a woman to TSH levels of <2.0 mIU/L prior to stimulating with fertility drugs.
6. DHEA-S (DHEA-Sulfate)
There are many articles on DHEA on my blog. If you are over 35 and trying to get pregnant, it is likely that supplementing with DHEA over a course of several months could help you improve egg quality.
However, before doing so it is advisable to first check your basal DHEA-S values and then monitor them every two months or so because:
1) you want your DHEA-S to rise to the upper third or above of the range which is normal for 25-year old women (who are at the peak of their fertility), but at the same time
2) you don’t want your DHEA to become too high causing side-effects (which is very unlikely as DHEA levels decline as women age, but do keep monitoring every two months)
Testosterone is secreted from the adrenal gland and the ovaries. You may know it as a “male hormone”, but it is in fact very important for the follicular maturation and growth. There are several parameters which should be measured to arrive at a realistic picture of the testosterone milieu, the most important one being:
Day 3 Total Testosterone 6-86 ng/dl
Day 3 Free Testosterone 0.7-3.6 pg/ml
There are several more substances from the testosterone-related pathways, such as Androstenedione, Sex Hormone Binding Globulin (SHBG), and 17-Hydroxyprogesterone, but they are often relevant in diagnostic of PCOS or in clarifying various other disorders which interfere with fertility.
Want to know my advice on your fertility journey? Please send me an e-mail as described here and we’ll set up a Skype-consultation at a time that suits you!
Hope this short list helps! If you don’t have all of the values, it’s fine! However, if you send me just the two most important ones, these would be the first two ones: FSH and AMH.
Wish you all the best,