Whether you’ve come to this page because you’ve decided you want to have a baby and things aren’t happening yet, or you just want to know how your fertility is tracking, let’s go through my top fertility tests and what they mean for your reproductive health.
To keep things simple, I’m going to cover my favourite tests that are relevant for a large portion of my patients. Obviously there are some more specific tests that an individual person may need, but the following list covers the top ones that will give your health provider an idea of what’s going on in your body that may have an impact on your reproductive system.
In no particular order, my favourite fertility tests include Anti Mullerian Hormone (AMH), a hormone panel (includes oestrogen, progesterone, etc), Sperm testing, Thyroid Stimulating Hormone (TSH), vitamin D, and Methylenetetrahydrofolate Reductase gene test (MTHFR).
- Anti-Mullerian Hormone (AMH). The AMH test is not covered by Medicare, so it will cost you roughly $80, but it’s money well spent in my opinion. AMH is a hormone excreted by cells in the preantral and antral follicles of the ovaries, and it is used as a marker for ovarian reserve. So basically it can give a rough idea of how many eggs you have left. In women over 40 we expect this number to be low as they head towards menopause, however a low result for a younger woman can indicate that they need to consider having children earlier or protecting fertility through egg freezing. In my clinical experience I have seen patients with low results get higher results at later tests due to lifestyle changes, so even though the number has improved, the ovarian reserve itself has not, but this could be due to the quality of the eggs being improved, or the general reproductive system functioning better. Higher AMH results can be linked to polycystic ovarian syndrome (PCOS). Although AMH is not a diagnostic test for PCOS, it can help your doctor recognise the need for further testing that may ultimately diagnose PCOS.
- Hormone Panel (Oestrogen, LH, FSH, SHBG, Testosterone, Progesterone, DHEA). Your GP will usually be quite happy to do a hormone panel test when you see them for a basic fertility screening. These tests are often done at the same time at any point in the menstrual cycle, however it is often best to split them into times in the cycle that will give the most pertinent results. For example, LH (Luteinising Hormone) and FSH (Follicle Stimulating Hormone) are best tested on day 2 of the cycle to give information about how hard your body is having to work to ovulate. Progesterone should be tested on day 21 of the cycle in a regular 28 day cycle (or 7 days after suspected ovulation). This is to confirm whether ovulation has occurred, and can also show whether low progesterone may be contributing to infertility. The other hormones can be done at any time in the cycle, however it is usually easiest to do them on day 2 with the first lot of tests. A hormone panel can give your practitioner information about possible reproductive conditions that may be inhibiting fertility when left unmanaged such as PCOS.
- Sperm Testing (Semen Analysis). This one is so important yet often gets overlooked! Infertility is 50% male factor, and yet the majority of my fertility patients are women. Quite often the lifestyle advice I give my female patients will naturally impact their partners as well, but it’s always a great idea to get a sperm test done just to see where things are at. A sperm test will cover important issues such as motility (how well they move) and morphology (the shape), along with other information such as infections, number of sperm, volume of ejaculate etc. If the sperm have poor motility and morphology, that has a huge impact on fertility. The good news is that most problems with sperm can be easily fixed with the right treatment. Some conditions, like azoospermia (no sperm) can’t be treated, but it’s good to know sooner that this condition exists rather than trying to conceive for 12 months unsuccessfully. It is worth keeping in mind that the “healthy” parameters of a semen test are actually quite low in my opinion. Sperm results worldwide have been dropping, possibly due to toxin exposure, so with my patients I have higher standards that we aim to achieve through supplementation and lifestyle changes. Who wouldn’t want the best possible sperm when trying to conceive?
- Thyroid Stimulating Hormone (TSH). Your thyroid is heavily involved in the hormone function of your body, it’s actually a gland that produces some of your hormones! They often get overlooked because they’re not the obvious hormones like oestrogen and progesterone, but your thyroid hormones are involved in your metabolism and can heavily influence your menstrual cycle without you realising. Hypothyroidism (where the thyroid is unable to produce enough hormones) is linked to miscarriage and can be related to inability to conceive. In testing, the range for TSH is usually 0.4 – 4, however I ideally like to see the result come back between 1 and 2. In pregnancy, TSH is usually kept below 2.5 to reduce the risk of miscarriage, so it’s important to check that TSH isn’t above this range when trying to conceive.
- Vitamin D. Often thought of as “the sun vitamin”, vitamin D has actually been linked to reproductive conditions such as PCOS, low AMH, and endometriosis. The current range for testing is 50-150, however in natural medicine, and for fertility, we like to see the result come back over 120. Low vitamin D status is very common in Australia, partly due to working indoors, and partly because we have to avoid the sun so much. Women with darker skin tones are also more likely to be vitamin D deficient because the body has a harder time producing enough vitamin D from the sun, so it’s important for all women to get tested, regardless of sun exposure.
- Methylenetetrahydrofolate Reductase gene test (MTHFR). Genetic testing can be very useful in reproduction. IVF doctors will often do karyotyping (checking the chromosomes) of both partners to make sure certain genetic conditions aren’t passed on to their offspring (like cystic fibrosis), but we can also test for individual genes that may impact fertility. MTHFR is a gene involved in the processing of folate/folic acid. When this gene has a polymorphism, or “defect”, it doesn’t work as well and will result in a reduced ability to turn folic acid into 5-MTHF, which is the bioactive version of vitamin B9 (folate) that the body can actually utilise. A defect in the MTHFR gene has been linked to infertility, recurrent miscarriage, blood clotting disorders (these affect fertility too), and mood disorders. If you would like to read more about MTHFR, you can check out my blog post dedicated to it.
As you can see, there are many tests that can give a good idea of certain conditions that may be impacting fertility for both partners. Tests should always be interpreted by a qualified health care practitioner, preferably with further training in reproductive medicine, such as myself. If you would like me to be a part of your reproductive health care team, I am available for in-clinic consultations in Dural and St Leonards, and Skype consultations worldwide. If you have a friend who may benefit from this post, please consider sharing it with them.