Fertility Tests for Women
To help simplify it I’ve grouped the most common tests into 7 categories to make reading and deciding on them easier for you. From this list you can pick the most appropriate ones for your situation.
I suggest starting with Levels 1 + 2 to get a foundational view and then go from there.
Here’s an overview of each level:
Level 1: A variety of blood tests (and sometimes saliva)
Test for: Sexually Transmitted Infections, Hormones, Thyroid health, Nutrient levels and Adrenal Health.
Level 2: Antral Follicle Count
This is an internal ultrasound scan that’s easy to do, and will show how many follicles you are producing that month. It will also reveal the general health of your ovaries and uterus and confirm that you are ovulating.
Level 3: Fallopian tube health
This is a slightly more invasive test and would be carried out on the advice of your GP or Gynaecologist. If you have experienced any sexually transmitted infection, then this may be recommended for you to check the health of your fallopian tubes.
Level 4: Blood clotting disorders
Through a series of blood tests your Dr can investigate whether there are any clotting factors that could be interfering with implantation or pregnancy.
Level 5: Genetic testing
There are a variety of tests available for men and women to ensure that you don’t have any genetic issues that could cause embryo fertilisation or development problems.
Level 6: Immunological screening
This is a broad category of tests that look at how your immune system is functioning. The basic tests are quite affordable and easy to complete, but the bigger tests are more expensive and are usually only completed by sending samples to labs in the US.
Level 7: Other
There are a variety of other areas to investigate such as Fibroids, PCOS, Endometriosis, Cysts and Polyps and your Dr or Practitioner should advise you further on these.
Let’s look at each of these in more detail.
A VARIETY OF BLOOD TESTS
This level is divided into a further 5 different types of tests.
Your GP or Consultant should be happy to refer you for the majority of these.
Number 1 – Sexually Transmitted Infections
This series of tests will show whether you have come into contact with any infection in the past and whether anything is residual or still present.
If there is a positive response you may want to consider Level 3 testing, to assess the health of your Fallopian Tubes, as they can at times be affected by sexually transmitted infections.
You’ll need to be guided on this by your health practitioner.
Number 2 – Hormone Panel
This panel will show you the most important profile of your hormones, in relation to your fertility health.
The hormone tests are divided into the 2 phases of your menstrual cycle.
You will therefore need 2 separate blood tests for a complete hormone profile.
Hormone Blood Test 1 – needs to be completed on days 1-3 of your menstruation. Day 1 is the first day of proper bleeding.
You should test for the following:
FSH – is Follicle Stimulating Hormone and helps to stimulate the growth of your follicles before ovulation occurs.
Estradiol (E2) – is a type of Estrogen, and the follicles produce it as they grow. It counteracts the FSH and this counteraction helps to reduce the FSH as the E2 increases, and as the cycle evolves. E2 is involved in nourishing a variety of tissues within the body, including helping to thicken the endometrium ready for later implantation of an embryo. It is also involved in the thinning and production of cervical mucus before ovulation.
LH – is Luteinising hormone and this is primarily involved in triggering ovulation, and also the development of the corpus luteum, which is responsible for releasing the majority of progesterone once ovulation has occurred.
Prolactin – A hormone that can show over- activity of the Pituitary Gland – the gland that controls most hormone production, release and activity. I suggest measuring this, as high levels of it may interfere with ovulation and conception in general.
Testosterone – this is tested for a variety of reasons and is a good indicator of possible adrenal deficiency or fatigue. It is also linked to sexual arousal and libido levels.
AMH – is Anti Müllerian Hormone. It can indicate the activity and reserves of eggs within your ovaries. There may be a connection to Vitamin D levels (according to some studies), and it’s best tested twice a year as it can fluctuate. One clinicl trial has shown that testing AMH is best in the follicular phase as readings are higher at this time of the cycle. Pregnancy can still happen even when levels are low.
Hormone Blood Test 2 – needs to be completed 5-7 days AFTER ovulation.
This is to test for:
Progesterone (P4) – Progesterone is a very important hormone with a big role in your fertility health. It’s one that is often overlooked by western medicine, due to the increase in the use of synthetic Progesterone supplementation.
The timing of all of these hormone tests is crucial.
Any test taken outside of the suggested time frame cannot be sufficiently analysed and may give you incorrect readings. Please make sure that you test on the right days.
This hormone profile should be repeated every 6 months whilst you are on a fertility journey, and more often if any issues are identified.
Number 3 – Full Thyroid Panel
The thyroid is well known for its importance with fertility health, conception, and pregnancy.
Many doctors overlook aspects of the thyroid test panel, and so I encourage you to test the full profile as listed below.
This test will reveal how balanced your thyroid is, and how your body is producing energy, which is vital to pregnancy. It will also tell you whether there is an immune disturbance, which might also be impacting a pregnancy.
This single blood test can be carried out at any time of your cycle to test for the following 7 aspects:
TSH – can be an initial indicator to show that the thyroid is struggling. Most GP’s only check this and don’t do the other tests in this panel. The TSH can be completely healthy, even when the other areas are out of balance. Measuring it alone is not of much help to you.
Free T3 – is the active form of thyroid hormone that your body uses to make protein and energy.
Free T4 –is an inactive form of the thyroid hormone that your thyroid converts to T3 for your body to use.
Reverse T3 – shows whether there is an issue converting T4 into T3.
Anti-Thyroglobulin – an antibody that reveals whether there’s an immune imbalance
Anti-Thyroid Peroxidase – also an antibody that shows whether there’s an immune imbalance
Thyroid antibodies may reflect metabolic irregularities and hypothyroidism even when TSH and T4 levels appear normal. Thyroid antibody levels may rise in response to trauma, dysbiosis, inflammation (including thyroiditis), or progressive thyroid degeneration.
Your GP or practitioner should be able to guide you with this as thyroid testing and interpreting the results are a little more complex.
This panel should be repeated once a year, if the result is normal, and more often if the result is abnormal.
Number 4 – Nutrient Profile
What I’ll share here is just the tip of the iceberg when it comes to nutrient testing.
The following panel are the most basic tests to complete to ensure your nutrient levels are sufficient.
Before you decide on taking any supplements please complete a comprehensive nutrient profile, to prevent you from overdosing on unneeded supplemented nutrients.
Some supplements can create serious and permanent health issues that are irreversible, when taken in situations where they are not needed. One example is Vitamin B6, which causes permanent nerve damage if overdosed for extended time periods.
The following tests should be completed as a minimum:
Vitamin B6 – is a vitamin that is involved in many aspects of nutrient metabolism and helps to create proteins, blood cells and many other important compounds. It is also important for the immune system and stable hormone levels. It is also very important during pregnancy.
Vitamin B12 – is a vital nutrient for brain and nerve function, as well as being involved in the production of red blood cells. A red meat or general meat free diet will often create a deficiency of B12, as there aren’t many non-red meat sources of it.
Folate – is a B vitamin and is involved in blood production and neural tube development during pregnancy, as well as having a selection of other involvements in the body. Folate is often referred to as Folic Acid, which is the synthetic form of Folate. Folic acid should be avoided in supplements and the natural form of folate should be taken instead.
Vitamin D – is a fat-soluble steroid and is responsible for increasing the absorption of calcium, iron, phosphate and zinc. Vitamin D is produced in the skin by exposure to sunlight, which creates a reaction with existing cholesterol to manufacture the Vit.D. Magnesium is also vital for the activation of Vitamin D so make sure you get daily doses of magnesium too.
Zinc – is very important for development and the immune system, and should be at good levels before, during and after pregnancy.
Ferritin – is a special protein that stores iron. If this is low it indicates that there is an iron deficiency and further investigation should be carried out.
Selenium – belongs in the antioxidant category and is involved in a variety of functions. One key involvement is in the transformation of thyroid hormones, which makes it helpful in some cases of treating Hashimoto’s (Thyroid Auto-Immune Disease).
If any of these areas are out of balance then dietary changes should be made to adjust these levels, and supplementation may need to be considered depending on your individual health presentation. I always recommend making these decisions with the help of a practitioner that can safely guide you.
This panel should be repeated every 6 months.
Number 5 – Adrenal Health Profile
This is to test for Cortisol and DHEA.
These tests will show how well your adrenal glands are working.
They will also reveal whether your body is showing signs of stress, that may need to be addressed.
The adrenals are small glands that sit on top of your kidneys. They are involved in the production of a variety of hormones and also have a connection to the thyroid gland. If the adrenal glands are tired and under-active, due to stress or long-term physical or emotional exhaustion, then it could make conceiving difficult until treatment has addressed the issue.
This test should be repeated once a year if it is healthy, or more often if it shows some disturbance in adrenal health.
To help you save time and money, you can do many of the blood tests together.
The hormone panel is the only one that needs to be specifically timed. And the other tests can be done together whilst checking hormones if you wish.
Just make sure that your hormone panel is divided into the 2 specific parts of the cycle as I mentioned.
ANTRAL FOLLICLE COUNT ULTRASOUND SCAN
This is a scan to count how many follicles each ovary has in that current cycle.
It’s a trans-vaginal ultrasound scan and it can usually be completed within 15-30 minutes.
It should ideally be carried out in the second half of your cycle around 6 – 8 days after ovulation, as this stage of the cycle provides the most information.
There are 4 helpful areas that the scan can assess for you:
- A follicle count – to look at how many follicles you have present in each ovary that month. In my experience this is a much more reliable way of assessing your fertility and ovarian activity and reserve, compared to measuring AMH. Many women are told to check their AMH, but it seems unreliable at giving a clear indication of ovarian reserve. Scanning lets you actually see how many follicles your body is producing in each cycle that you scan. Each follicle should contain at least 1 egg. The scan cannot tell you however, what the health of the eggs are, but AMH is also unable to do this.
- Your ovarian health – can also be assessed using this scan. The ovaries will be measured in size and checked for any abnormalities such as cysts. This is also good to check for PCOS, and general Ovarian Cysts.
- Ovulation – can be confirmed if you carry out the scan 6 -8 days after you think you have ovulated. The scan can show the Corpus Luteum – the remaining body of the follicle that ruptured and released an egg. This is the best method for confirming ovulation.
- Your womb health – can be assessed, including how well the Endometrium has thickened and whether it is thick enough for implantation.
This scan can be carried out as many times a year as you like. If everything is healthy, then I suggest 2 scans on average per year, to keep an eye on your follicle count.
If you experience several scans with low levels, it may help you to decide on moving towards IVF at an earlier point in your journey than you may have originally considered.
Scanning allows you to have a clear picture of what is physiologically happening to numbers of follicles each month.
FALLOPIAN TUBE HEALTH
Checking the health of your fallopian tubes is important if you want to conceive naturally. This type of test allows you to discover whether your tubes are ‘patent’ (open). If they are not patent, it means that there could be a reduction in your ability to get pregnant naturally – depending on the severity.
The way to check this is with a hysterosalpingogram (HSG), which is a test that requires injecting a liquid into your fallopian tubes and then using an x-ray to see whether the liquid flows all the way through. If it does, it indicates that your tubes are open.
There is an alternative option that doesn’t use x-ray, and this is called a HyCoSy or Tubal Patency Test. This uses a saline (salt water) solution and an ultrasound, which is a healthier option.
BLOOD CLOTTING DISORDERS
Your consultant may like to test you to make sure that you don’t have any type of clotting issue.
This is usually considered when someone has experienced one or more miscarriages.
Clotting disorders can cause problems with implantation, and they can also affect the early weeks of pregnancy and stop the proper nourishment of the baby.
A low dose of aspirin is often given as a preventative, but in Classical Chinese Medicine we like to be cautious with blood thinners in the early days of pregnancy.
What I recommend instead is to have this area properly investigated and tested and then only take medication if it’s absolutely needed.
If there is a clotting disorder, then using aspirin or other drugs such as Clexane is a sensible strategy.
This is a much deeper level of testing. It would mostly be carried out if everything else looks okay, but still no pregnancy is happening or you’re experiencing recurrent miscarriage.
There are a selection of genetic tests that you can do to help clarify whether there is a genetic issue that’s causing you problems.
As an example, there are tests that check your individual chromosomal make-up, called Karyotyping. This can be carried out for you and your partner and ensures that there is no genetic issue with each of you.
Chromosomal testing – is another option and is usually called PGD or PGS. It can be carried out during IVF, to assess the health of your embryos and ensure that they are genetically healthy. Clinics vary on their opinions of this type of testing. Some agree with it and others are against it.
MTHFR – this is one of the more common tests to establish whether you have a gene abnormality that relates to your ability to transform Folate into a usable form.
It can also tell you whether you are genetically susceptible to developing clotting disorders, which could be an issue in pregnancy.
This test will only tell you whether you do or don’t have the gene abnormality, but it doesn’t tell you whether the gene is expressing (whether it’s active and actually causing a problem). You will need to see a specialist in this field to find this out.
As a general precaution for anyone trying to conceive, in case you do have the MTHFR issue, you can avoid using a folic acid supplement. Instead use a Methylated Folate product. This is broken down for you to properly absorb, and won’t cause you any issues. The test is still necessary to confirm whether you do or don’t have an MTHFR issue, but switching off Folic Acid will be better for your health regardless.
Your fertility consultant will suggest a specific path to take for this level of testing.
As with genetic testing, immunology is a large and complex area.
There are many different tests that you can carry out for your immune system.
Due to the usual high cost, many couples avoid these tests until later on their journey.
If you have not conceived after 2+yrs of trying or you have had repeated miscarriages, then it’s worth considering this testing level. There could be an immune disturbance that is causing problems for conception or pregnancy.
Speak to your fertility consultant or gynaecologist about these options.
There are a variety of other issues that can disrupt your chances of implantation and a healthy pregnancy, such as:
Fibroids, PCOS (Polycystic Ovarian Syndrome), Endometriosis, Cysts and Polyps are the most common. All of these can be investigated with your Doctor, depending on what your general health presentation is like.
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