Blood tests are an essential part of all fertility assessments. We test your blood for several different hormone levels that can help us determine if you, your partner, or both of you are struggling with infertility. Although blood tests are only one part of a fertility assessment, and additional testing is needed to paint a full picture.
Anti-Müllerian Hormone (AMH)
Anti-mullerian hormone (AMH) is primarily produced by the granulosa cells in the ovary. Granulosa cells help support the growth and development of eggs. Therefore AMH is used as an indirect measure of ovarian reserve or the number of eggs that exist in the ovaries.
However, there are some important components and misconceptions about AMH testing which are important to understand, which are outlined right here. First, hormonal contraception medications may lower AMH levels temporarily, but this does not indicate a truly decreased ovarian reserve. Second, AMH and other ovarian reserve tests do not predict time to menopause– AMH levels may be very low or even undetectable several years before the final menstrual cycle and thus AMH does not predict natural fertility. Third, AMH is best used to estimate ovarian response during an egg freezing or IVF cycle. Fourth, high AMH is a risk factor for ovarian hyperstimulation, which is an over-response during an egg freezing or IVF cycle that increases the risks, particularly during recovery. Fifth, rarely, a very high AMH level may indicate an AMH secreting granulosa cell tumor of the ovary. And finally, AMH can be tested at any point in the menstrual cycle.
Follicle stimulating hormone (FSH)
Follicle stimulating hormone (FSH) is a hormone produced by the pituitary gland, a small gland located at the base of the brain. FSH is important for eggs and sperm. It stimulates eggs growth before they are released by follicles in the ovary and it also stimulates sperm production in the testicles. As ovarian reserve declines with aging, the FSH level increases. For patients with regular recurring menstrual cycles, we measure FSH early in the menstrual cycle (typically cycle day 2-3). FSH can help assess pituitary and ovarian function in patients with menstrual cycle irregularity and pituitary and testicular function in patients with abnormal sperm production.
Luteinizing hormone (LH)
Luteinizing hormone (LH) is another hormone produced by the pituitary gland. LH supports the maturation and final ovulation of an egg in the ovary. LH also stimulates the production of testosterone and supports the production of sperm in the testicles. Similar to FSH, LH is measured on cycle days 2-3 in patients with regular menstrual cycles, and is interpreted in the context of estradiol levels. Also similar to FSH, LH can help assess pituitary and ovarian function in patients with irregular menstrual cycles as well as pituitary and testicular function in patients with abnormal sperm production. LH levels drastically rise (surge) immediately prior to ovulation and are often checked by multiple blood or urine tests to determine the optimal window for intercourse or insemination (IUI) to help conceive.
Estradiol is a hormone mostly produced by the granulosa cells in the ovary. Estradiol is also produced in smaller amounts by other organs, including the testicles, adrenal glands, and adipose (fat) cells. Estradiol concentration decreases FSH secretion from the pituitary gland and thus it is often tested at the same time as FSH to help interpret the FSH levels. Estradiol is a hormone that acts on the pituitary gland to decrease FSH production and allow for only a single egg to ovulate in a natural cycle. Estradiol also causes growth and development of the uterine lining to prepare for subsequent implantation of an embryo and pregnancy.
Progesterone is a hormone produced by the granulosa cells of the ovary after the egg has already ovulated. The main function of progesterone is to prepare the uterine lining for subsequent implantation of an embryo. Progesterone levels are tested after ovulation has occurred – to confirm that ovulation DID occur. This test is most commonly checked if your menstrual cycle is slightly or borderline irregular to determine if ovulation is actually occuring.
Thyroid stimulating hormone (TSH)
Thyroid stimulating hormone (TSH) is another hormone produced by the pituitary gland. This hormone acts on the thyroid gland to produce thyroid hormone. Thyroid testing is most important for patients who have clinical signs of low or high thyroid hormone. For patients with irregular menstrual cycles or abnormal sperm production this testing is typically done because thyroid abnormalities may be contributing to infertility. For patients with regular menstrual cycles and normal sperm production, TSH is often checked as a screening tool. There is some data to suggest that in select patients with borderline thyroid malfunction (subclinical hypothyroidism, or not producing enough thyroid hormone), thyroid supplements may slightly decrease the risk of subsequent miscarriages.
Prolactin is a hormone also produced by the pituitary gland that plays an important role in many reproductive systems including the breasts’ ability to produce milk for breastfeeding, the ovaries’ ability to ovulate eggs and produce hormones, the testicles’ ability to produce sperm and hormones, and the uterus’ ability to allow for implantation of an embryo. Hyperprolactinemia (high prolactin) can interfere with natural and assisted reproduction (IVF, IUI). Prolactin may be elevated for a number of reasons, including side effects from other medications or supplements. Hyperprolactinemia may present as irregular menstrual cycles or abnormal sperm production. Some patients may present with milky nipple discharge, unrelated to breastfeeding.
Androgens are a group of hormones. DHEA, Androstenedione, and Testosterone are all examples of hormones tested on an androgen panel. Androgens are primarily produced by the ovaries, testicles and adrenal glands. Abnormal androgens levels can lead to abnormal puberty development, abnormal growth of body and facial hair, acne, ambiguous genitalia, changes in sexual drive and function, irregular menstrual cycles, or abnormal sperm production. Polycystic ovarian syndrome is a very common syndrome that contributes to infertility and is strongly associated with elevated androgen levels. Low sperm production and low testosterone can impact fertility and general health and should be addressed regardless of fertility goals.