Fertility hormone testing overview
- Fertility hormone testing usually involves analyzing a woman’s blood or urine samples to determine if hormonal issues may be preventing her from becoming pregnant.
- Hormonal imbalances are a leading cause of infertility in women.
- Hormone levels can also affect male fertility and hormone testing may be appropriate for men as well.
- Primary fertility hormone testing involves analysis of follicle-stimulating hormone (FSH), luteinizing hormone (LH) levels and progesterone.
What is fertility hormone testing?
Hormones and their interaction affect a woman’s fertility by ensuring proper ovulation, proper implantation of the embryo in the uterus, and the woman’s capability to carry a pregnancy to term. When any of these hormones are out of balance, infertility can result. Common hormonal abnormalities affecting fertility include low thyroid function, low progesterone and high male hormone levels.
Fertility hormone testing determines the various levels and presence of a variety of hormones central to reproduction. Laboratory analysis of these hormones, generally obtained via blood and urine samples, allows fertility physicians to determine potential causes of infertility and the appropriate treatment options.
Who should consider fertility hormone testing?
Hormone imbalances usually cause symptoms that are easy to detect. If a woman has the following symptoms and is having difficulty becoming pregnant, she may consider hormone testing:
- Irregular menstrual cycles or no cycles
- Pain or cramping in the pelvic and/or abdominal areas
- Excessive bleeding or very little bleeding during menstrual cycles
- Unexplained excessive weight gain or loss.
Men suspected of having a low sperm count may consider hormone testing for FSH. Men with low sex drive or signs of infertility may be tested for LH.
Types of fertility hormone testing
Considerable hormone activity occurs during the menstrual cycle, so testing for hormones, such as those listed below, should be done at a specific time during the cycle.
Medications, including birth control pills, can interfere with hormone test results. Women and men should tell their physician beforehand about their medications, and may need to cease certain medications before fertility hormone testing.
FSH, which is affected by interactions of several hormones, helps control egg production and menstrual cycles in women. The FSH test, run via a blood test on day 3 of the menstrual cycle, will evaluate a woman’s ovarian function and assess the quality of her eggs.
As a woman ages, the brain and pituitary gland increase levels of FSH to stimulate the ovary. In general, women with elevated levels of FSH in their blood on day 3 of their menstrual cycle have reduced chances of live birth compared with other women of the same age.
Estradiol is the most important hormone during a woman’s reproductive years and is essential for maintaining reproductive growth and function. In females, estradiol is the principal growth hormone for reproductive organs, ensuring proper development of the vagina, endometrium, fallopian tubes, cervical glands and the muscle layer of the womb. It also triggers a series of events that lead to ovulation and maintains the eggs in a woman’s ovaries.
Estradiol is tested on day 3 to 5 of a woman’s menstrual cycle in order to determine the ovarian function and quality of eggs. Although abnormal estradiol levels often correlate with decreased ovulation and lower IVF success, the results of these tests are not absolute indicators of infertility. Additionally, high levels of estradiol may suppress the FSH, thus indicating false values.
LH, produced by the pituitary gland, stimulates the release of eggs from the ovaries and starts the production of the progesterone hormone, which will allow the uterus to receive a fertilized egg. LH shows up in urine prior to ovulation and may help women to predict when ovulation will occur.
A doctor may also evaluate LH levels from a blood test to help determine if a woman is ovulating. LH testing can reveal an imbalance in female hormones that may indicate polycystic ovary syndrome (PCOS). LH testing for a male can determine if he has problems with testicle function or certain genetic abnormalities.
Over-the-counter tests are available to measure LH in the urine.
A woman’s ovaries produce the progesterone hormone just after ovulation, so measuring its presence can indicate that ovulation has occurred. Approximately 12 to 16 days after the beginning of the menstrual cycle, progesterone prepares the uterus for a fertilized egg.
Progesterone is measured via blood tests to detect the level of the hormone, which typically peaks about one week after ovulation. Once a baseline of progesterone is established, the physician will test again around day 20 of the menstrual cycle. This is called a mid-luteal serum progesterone test.
Other hormone tests
Anti-Müllerian hormone (AMH) is produced in a woman’s ovarian follicles — the portion of the ovary in which an egg matures — and can be an indicator of ovarian function.
Women who have higher levels of AMH often have a better response to ovarian stimulation and tend to produce more retrievable eggs than women with low levels of AMH. Tests can be done at any stage of the menstrual cycle.
Thyroid stimulating hormone (TSH)
Normal thyroid function is necessary for fertility. Because TSH has an autoimmune function, healthy levels are important for fertilization, implantation and fetal development. TSH also has an effect on regular menstrual cycles.
Women with a family history of thyroid disease (hypothyroidism or hyperthyroidism), irregular menstrual cycles, or recurrent miscarriages should consider a thyroid analysis.
Inhibin B is a hormone that is produced to inhibit the production of FSH. Because inhibin B is produced directly from the ovarian follicles, which is where a woman’s eggs mature, levels of the hormone in a woman’s blood stream correlate to the number of eggs in her ovaries. As a result, inhibin B levels decrease as a woman ages and can be a test for ovarian reserve. Testing occurs on day 3 of the menstrual cycle.
Although typically thought of as male hormones, androgens can have an effect on female fertility. In women, nearly all androgens are immediately converted into estrogen, which aids in thickening the endometrium (the uterus lining), regulating the menstrual cycle and controlling sex drive. Excess androgen production in women can lead to anovulation (failure to ovulate). It may also indicate that a woman has PCOS, which is a common cause of infertility in women.
Androgen levels stay stable during the menstrual cycle and may be checked at any time.