The Most Common Fertility Blood Tests

Building a family isn’t as easy as you think. For individuals and families who struggle with loss and infertility, the road to becoming a parent is paved with pain, grief, needles and bloodwork after what seems like endless appointments. And for some, the end result is not always parenthood.

I’m sending my love and care to anyone out there reading this who has lived through this. With every fibre of my being, I wish I could change it for you.

That being said, it can be overwhelming to undergo so much testing and not be really sure of what specialists are looking for. It’s also really easy to be taken advantage of by unqualified practitioners, offering expensive tests that don’t have any bearing on your treatments.

I’m breaking down the most common tests done to assess fertility status and their role in guiding reproductive care! It’s important to check in with your primary care provider if you’re planning to undergo fertility treatment as they will know you, your health status and any other markers of benefit for you. This blog post does not constitute medical advice and should not be used in place of recommendations by your primary care provider.

1. FSH and LH. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are released by the pituitary gland in the brain, working to stimulate the ovaries to develop and mature follicles. The dominant follicle is released in ovulation, as an ovum. By testing these two hormones, your team can determine if the brain is producing enough in order to prepare for and stimulate ovulation, or if it is producing too much. From here, different treatments can be used to help increase production or treat the reason for excess. There are two fertility medications that act on these two hormones: Clomid (which acts on the pituitary gland to increase production of FSH and LH) and FSH itself to stimulate production.

2. AMH. Anti-Mullerian hormone (AMH) is a protein produced by granulosa cells in the follicles. It can act as a marker for ovarian reserve and determine the response to controlled stimulation of the ovary, which might give indication to how successful IVF treatments may be. A higher AMH level will likely have more success with fertility treatment, but as of right now, we don’t have any evidence-based ways to increase AMH. This might partially be due to the fact that babies with ovaries are born with all of their follicles for their lifetime, and at some point the follicles are unable to mature for ovulation or have been depleted; AMH may give an indicator to menopausal status.

3. Prolactin. This is a hormone that inhibits FSH and gonadotropin releasing hormone (GnRH), which prevents ovulation from occurring. Prolactin also assists in the production of milk for breastfeeding after pregnancy, and its suppressive side effect provides the short-term (but somewhat unreliable) birth control after having a baby. If prolactin is high, your team will want to find out why – conditions of the pituitary gland are usually the cause, but there may be others. By assessing this level, your team can add medications to treat the cause and promote ovulation for fertility.

4. Serum progesterone. Your body primarily produces progesterone after ovulation, so testing this level allows your team to see if you’ve ovulated, and if you’re making enough progesterone to stabilize the uterine lining. It’s important to test this level after confirmed ovulation, as testing it too early will make it appear low! Progesterone replacements or other medications that stimulate progesterone production are typically used to support a stable endometrium and allow for healthy implantation to occur.

5. Testosterone. This may be done for both the egg-carrying partner and the sperm-carrying partner. Levels that are high in egg-carriers may indicate conditions such as PCOS where androgens impact ovulatory status and frequency, and low testosterone in sperm-carriers may be to blame for poor libido, erectile dysfunction and low sperm quality. Medications to suppress testosterone may be used – it’s important to work closely with your healthcare team as some supplements, pellets and other products claiming to contain testosterone are commonly not regulated and may contain too much testosterone.

6. Estradiol (E2). This is one of the three main forms of estrogen, important in follicle maturation and development. If estrogen levels are too low, it’s important to address why – is energy intake too low, like in hypothalamic amenorrhea? Is there limited stimulation (identified with FSH and LH)? If estrogen levels are too high, some medications can be used to balance them – often this is through progestins or progesterone, similar to that of birth control.

You shouldn’t have to go through fertility care alone, and you deserve support at every stage. Be sure to ask your healthcare team for their recommendations for counselling, group therapy and providers who can hold space for the emotional and mental things, so you can show up for the physical stuff stronger.