Blood tests are an important diagnostic tool in determining what reproductive and health problems might be hindering your chances of conception. They are also important in determining causes of infertility in both males and females through an assessment of certain hormone levels.
Female Hormone Testing
For women, hormone testing involves a series of blood tests taken at different times in order to verify if there is a normal hormone production or not.
Typically on these days of the menstrual cycle, blood tests are conducted in order to assess the levels of the hormones listed below:
Day 2 or 3 – FSH/LH and Prolactin:
– Follicle Stimulating Hormone (FSH): FSH triggers the follicles within your ovaries to begin preparing for the release of an egg. High levels of FSH are generally an indicator that egg reserves are running low, although they also signal an overall imbalance of hormones.
– Luteinizing hormone (LH): This hormone controls egg development. During ovulation, levels of LH surge in order to trigger the release of the egg. Consistently high levels of this hormone in your body can prevent this increase and might also be an indicator of Polycystic Ovary Syndrome, which is a common cause of infertility.
– Prolactin: Prolactin is a stress hormone that is released by the pituitary gland. High levels of Prolactin can prevent the release of FSH and LH. Prolactin is the hormone that also eventually stimulates the production of breast milk.
– Progesterone Test: This will check if ovulation has taken place. It should be taken 7 days before a period, so for a 28-day cycle it is done on day 21.
If a period doesn’t come 6-8 days after the test, then it will need to be repeated. A level of 30 nmol/l or more suggests ovulation has occurred.
This blood test will also verify whether a sufficient level of progesterone exists in order to maintain a sufficient luteal phase. The luteal phase begins the day after ovulation and lasts 12 to 16 days, during which time progesterone levels rise in order to provide a fertile environment for the egg.
– If the initial blood tests indicated a high LH to FSH ratio, an indication of Polycystic Ovary Syndrome, the patient’s doctor will most likely order an “Androgen Panel” to check levels of free testosterone and dihydroeprandrostone (DHEAS).
– Other tests that should be conducted on the day of LH surge include LH, FSH and Estradiol.
– In addition, a blood test for Thyroid Stimulating Hormone (TSH) may also be conducted in order to determine whether there are any thyroid problems that might be affecting her chances of getting pregnant.
– Rubella antibody levels: These are checked to see that immunity is present, as this is a good time to repeat the immunisation if not, rather than risk infection during pregnancy, which can cause foetal defects.
When going for blood tests it must be remembered that hormone levels fluctuate from day to day and doctors need a range to work with before making any definite conclusions as far as results are concerned.
In order to interpret blood results – they need to made in conjunction with one another – where there needs to be a symphony for different tests, of which each plays a part in the final diagnosis and treatment plan to follow.
Did you know? Male infertility is related to approximately 50% of all infertility cases and male infertility alone accounts for approximately 1/3 of all cases.
Male Hormone Testing
When a couple has not been able to conceive over the course of one year, both need to go through a comprehensive physical and medical history.
Testing for male infertility is simple and routine where a semen analysis is the first evaluation factor. If the sperm count is normal then there is no need to go into a male hormone investigation, however in the case of azoospermia (absence of sperm in the ejaculate), testing for levels of FSH and LH are of particular importance.
Other hormone levels that may be investigated include:
- Free Testosterone
Potential male infertility problems may be caused by imbalances in these hormones, for example, high levels of FSH and LH can be a sign of testicular problems, such as primary testicular failure.
Testing enables a specialist to differentiate between testicular failure and whether there is an obstructive cause, such as a blockage in a duct, which may require a testicular biopsy to remedy.
What the future holds – New blood tests for fertility treatment
Fertility specialists are increasingly doing blood tests for the hormone Anti-Müllerian (AMH) in order to evaluate ovarian reserve and to adjust treatment protocols and dosages. AMH has been mainly studied for its regulatory role in male sex differentiation and is a member of the transforming growth factor ß family of growth and differentiation factors.
However, new research has shown that in the ovary AMH has an inhibitory effect on primordial follicle recruitment as well as on the responsiveness of growing follicles to FSH.
Testing the AMH level can therefore be used as a marker for the number of growing follicles and can also serve as a marker in ovarian pathophysiology, such as polycystic ovary syndrome (PCOS), in which the follicle pool is enlarged.
In addition, serum levels of AMH correlate strongly with the number of follicles, suggesting that AMH levels by extension reflect the size of the primordial follicle pool.
Assessment of the ovarian reserve is particularly important in the IVF clinic, where AMH may be useful as a predictor of poor response.
Since a considerable proportion of sub-fertility is due to postponement of childbearing, measurement of AMH levels to assess the ovarian reserve may provide insight into the number of fertile years a woman has left.
However, in order to determine whether serum AMH level has prognostic value, additional prospective studies in a normal population are necessary to provide definite proof for this concept.
Should you go for fertility testing?
If you and your partner have been having trouble getting pregnant, it’s possible that one or both of you has a medically treatable fertility problem.
But before you start going for all sorts of tests, consider the following:
- If you are younger than 30 and trying to conceive, most doctors recommend well-timed intercourse for at least a year before considering testing and treatment. However, if you are closer to 35, it’s reasonable for both you and your partner to consider testing for treatable causes of infertility sooner, before age-related factors make it too difficult to conceive.
- Infertility testing and treatment can be difficult, sometimes traumatic, and expensive. Before starting infertility testing together, discuss how far you would be willing to go with testing and treatment. Only have testing for conditions that you are willing and financially able to have treated or that would help you move on to other options such as adoption.
- Prolonged infertility testing and treatment can intensify the stress of infertility. If you are becoming overly stressed or your relationship is suffering, ask your doctor to recommend a professional counsellor who can help you get through this crisis together.
- Remember that as a couple, you have the final word on how to use your infertility test results based on your medical information, goals, and values.
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