When trying to get pregnant and maintain an healthy pregnancy, there are key things to know about your reproductive system and your partner’s. There are a number of fertility screening tests available for both women and men which can provide useful information about hormone levels, how to get and keep a healthy sperm count, sperm motility, and more.
Female Hormone Levels (Blood Tests)
1. Follicle Stimulating Hormone (FSH): taken on Day 3 of your cycle.
In women who menstruate (have periods), FSH helps control the menstrual cycle. It triggers the growth of eggs in the ovaries and gets the eggs ready for ovulation. Ovulation is when an ovary releases an egg so it can travel down a fallopian tube where it can be fertilized by sperm.
If you're age 45 or older, testing usually isn't needed. That's because high levels of FSH are a normal sign of perimenopause and menopause. As your ovaries release fewer eggs, your body makes more hormones to try to trigger ovulation.
FSH is often used as a gauge of ovarian reserve. Normal values are 3-20mIU/ml. In general, under 6 is excellent, 6-9 is good, 9-10 fair, 10-13 diminished reserve, 13+ very hard to stimulate. In PCOS testing, the LH:FSH ratio may be used in the diagnosis. The ratio is usually close to 1:1, but if the LH is higher, it is one possible indication of PCOS.
Higher levels of FSH are often a sign of a condition in the reproductive glands (ovaries or testicles) that prevents them from making normal levels of sex hormones. The pituitary responds by making more FSH to try to get them to work properly. High FSH may also be a sign of a condition outside of the reproductive glands that affects how the glands work.
Conditions linked to high FSH levels include:
- Ovaries that never developed normally
- Primary ovarian insufficiency (POI)
- Polycystic ovary syndrome (PCOS)
- Menopause or perimenopause
- An ovarian tumor
- Thyroid diseases or adrenal gland disorders
- A chromosomal disorder, such as Turner syndrome
Lower than normal levels of FSH in women and men are often a sign of a problem with the pituitary gland or hypothalamus. These problems may make it hard for your body to make FSH and LH. In women, low FSH levels may also be linked to rapid weight loss, being very underweight, or extreme exercise.
2. Estradiol (E2): taken with FSH test on Day 3 of your cycle
Estradiol, also called E2, is the main estrogen in nonpregnant females of childbearing age. It is the most important hormone during a female’s reproductive years, and is required for reproductive and sexual function as well as having an impact on the health of other organs and tissues.
Estradiol is a female sex hormone produced by the ovaries, adrenal gland and also the placenta during pregnancy. In females, estradiol acts primarily as a growth hormone for the reproductive organs including the vagina, the fallopian tubes, the endometrium and the cervical glands. Estradiol also enhances growth of the womb’s muscle layer, the myometrium. In addition, the hormone maintains oocytes (eggs in the ovary) and triggers a series of events that lead to ovulation.
Normal value is 25-75pg/ml. Levels on the lower end tend to be better for stimulating. Abnormally high levels on day 3 may indicate existence of a functional cyst or diminished ovarian reserve.
3. Luteinizing Hormone (LH): taken with FSH and E2 on Day 3 of your cycle
LH is a hormone released by the pituitary gland, located on the underside of the brain. The brain makes gonadotropin-releasing hormone (GnRH), which starts the changes toward sexual maturity. GnRH signals the pituitary gland to release two puberty hormones into the bloodstream: LH and follicle stimulating hormone (FSH).
You should have your LH level checked at the beginning of the cycle — classically Day 3 — along with your FSH, to evaluate for ovarian function. More commonly, the LH level should be checked midway through your cycle — Day 14 of a 28-day cycle. This is because the LH surge triggers ovulation. LH levels quickly rise just before ovulation. If you're trying to have a baby, this monthly increase in LH tells you when you're most likely to become pregnant.
Normal results for adult women are:
- Before menopause: 5 to 25 IU/L
- Level peaks even higher around the middle of the menstrual cycle
- Level then becomes higher after menopause: 14.2 to 52.3 IU/L
An increase in LH a couple of weeks after your period usually means you're ovulating normally. But high LH levels through the month may mean your ovaries aren't working properly. If you are:
- Childbearing age, higher than normal LH levels may mean you may have a disorder that affects your ovaries work, such as:
- Ovaries that never developed normally
- Primary ovarian insufficiency (POI)
- Polycystic ovary syndrome (PCOS)
- Thyroid diseases or adrenal gland disorders
- A chromosomal disorder, such as Turner syndrome
- 45 or older, high LH levels may mean you are approaching menopause.
4. Prolactin (PRL): taken with FSH, E2 and LH on Day 3 of your cycle
Prolactin is a hormone produced by the pituitary gland, a small gland at the base of the brain. Prolactin affects many body processes. But its main role is to signal breast tissue to grow during pregnancy and make milk for breastfeeding after birth. So, prolactin levels in pregnant women and new mothers are normally high. In nonpregnant women and men, prolactin levels are normally low.
Prolactin affects fertility in women by hindering ovulation. For this reason, a woman who is breastfeeding may not have her periods. However, some women may have high levels of prolactin even though they are not breastfeeding. This can lead to infertility. The normal range for prolactin in your blood is:
- Non-pregnant female/assigned female at birth: less than 25 ng/mL;
- Pregnant people: 80 to 400 ng/mL
Higher-than-normal prolactin levels can have different causes:
- Prolactinoma, a benign (noncancerous) tumor growing on the pituitary gland. This is the most common cause. This type of tumor makes prolactin, which leads to higher-than-normal levels of prolactin in the blood. This may also indicate further testing (MRI) should be done to check for a pituitary tumor.
- Certain health conditions, such as hypothyroidism (underactive thyroid), kidney disease, and chest injuries
- Other pituitary gland tumors.
- Some women with PCOS also have hyperprolactinemia.
Lower-than-normal prolactin levels are rare but may be a sign of a pituitary disorder. Without enough prolactin, a woman may not make enough milk to breastfeed after birth. This is usually the only symptom of abnormally low prolactin levels.
5. Progresterone (P4): taken on day 21 of your cycle, or 7 days before the next cycle.
Progesterone belongs to a group of steroid hormones called ‘progestogens’ (which are hormones that have a similar action to the natural hormone progesterone). Progesterone is mainly secreted by the corpus luteum in the ovary during the second half of the menstrual cycle. It plays an important role in the menstrual cycle and in maintaining the early stages of pregnancy.
During the menstrual cycle, when an egg is released from the ovary at ovulation (approximately day 14), the remnants of the ovarian follicle that enclosed the developing egg form a structure called the ‘corpus luteum’, which literally translates as ‘yellow body’ due to its appearance. This releases progesterone and, to a lesser extent, oestradiol. The progesterone prepares the body for pregnancy in the event that the released egg is fertilised. If the egg is not fertilised, the corpus luteum breaks down, the production of progesterone falls and a new menstrual cycle begins.
If the egg is fertilised, progesterone stimulates the growth of blood vessels that supply the lining of the womb (endometrium) and stimulates glands in the endometrium to secrete nutrients that nourish the early embryo. Progesterone then prepares the tissue lining of the uterus to allow the fertilised egg to implant and helps to maintain the endometrium throughout pregnancy.
Although the corpus luteum in the ovaries is the major site of progesterone production in humans, progesterone is also produced in smaller quantities by the ovaries themselves, the adrenal glands and, during pregnancy, the placenta.
| Stage | Progesterone level (ng/mL) |
| pre-ovulation | < 0.89 |
| ovulation | ≤ 12 |
| post-ovulation | 1.8–24 |
A progesterone test is done to confirm ovulation. Progesterone levels start to rise midway through the menstrual cycle. It continues to rise for about 6 to 10 days, and then falls if the egg is not fertilized. Levels continue to rise in early pregnancy.
The following are normal ranges based upon certain phases of the menstrual cycle and pregnancy:
- Female (pre-ovulation): less than 1 ng/mL or 3.18 nmol/L
- Female (mid-cycle): 5 to 20 ng/mL or 15.90 to 63.60 nmol/L
- Postmenopausal: less than 1 ng/mL or 3.18 nmol/L
On day 7 post ovulation (about day 21 of your cycle), a level over 5 ng/mL probably indicates some form of ovulation, but most doctors want to see a level over 10 on a natural cycle, and a level over 15 on a medicated cycle. There is no mid-luteal level that predicts pregnancy. Some say the test may be more accurate if done first thing in the morning after fasting.
6. Anti-Müllerian hormone (AMH): can be taken any day of your cycle
Anti-mullerian hormone (AMH) is released by ovarian cells during the female reproductive years. It is an indicator of ovarian reserve. The AMH levels gradually increase in girls from birth and peak at around age 25. After that, AMH levels decline as the primordial follicle pool diminishes with age and becomes undetectable at menopause. Below are AMH levels in relation with ages:
| AGE | AMH levels |
| 20–25 years | 4.23 ng/mL |
| 26–30 years | 3.48 ng/mL |
| 31–35 years | 2.43 ng/mL |
| 36–40 years | 1.28 ng/mL |
| 40–44 years | 0.52 ng/mL |
Studies indicate a correlation between AMH levels and the number of retrieved oocytes during an ovarian stimulation cycle, aiding in predicting ovarian response for individuals undergoing in vitro fertilization (IVF).
AMH also plays a role in indicating the timing of menopause. Research suggests that AMH becomes very low or undetectable approximately five years before the onset of menopause. However, AMH is not an indicator of successful conception because pregnancy involves various factors, such as the quality of the egg, ovaries, sperm, and womb.
AMH value interpretation:
- AMH <0.5 ng/mL: Lower egg count than average. Such a result anticipates challenges in achieving more than three follicles during IVF. The low opportunity of conception
- AMH <1.0 ng/mL: Limited ovarian reserve and reduced chance of conception.
- AMH >1.0 ng/mL but <3.5 ng/mL: Favorable response to IVF stimulation.
- AMH >3.5 ng/mL: Adequate egg supply. Monitor to avoid ovarian hyperstimulation syndrome (OHSS), which is a response to excess hormones or medications prescribed for IVF.
Usually, a woman of reproductive age will have normal AMH levels falling between 1.0 and 4.0 ng/mL. And the most favorable AMH level to IVF stimulation ranges from 1.0 to 3.5 ng/mL. AMH levels provide insight into the remaining quantity of eggs in the ovary, whether your ovaries might be aging at an accelerated rate, and how effectively you respond to injectable fertility drugs. However, it cannot predict a successful pregnancy. Other factors must also be considered, such as age, sperm count and motility, smoking, preexisting medical conditions, or other health problems, such as irregular ovulation, blocked fallopian tubes, endometriosis, pelvic scarring, and so on.
7. Relationship between hormone test results and PCOS
There has been much debate about the definition of Polycystic ovary syndrome (PCOS). A refined definition was agreed at a recent joint European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine (ESHRE/ASRM) consensus meeting. It depends upon the presence of two out of three criteria: oligo- and/or anovulation, hyperandrogenism (clinical and/or biochemical), polycystic ovaries, with the exclusion of other aetiologies. The pathophysiology of PCOS is likely to be multifactorial and polygenic. There is a significant body of evidence suggesting that excess ovarian androgen production is central in the pathogenesis of PCOS
Polycystic ovary syndrome (PCOS) is the most common gynecological endocrine disorders affecting up to 10% of all females in their reproductive age, and its cause of onset is still elusive. A spectrum of recent research reflected diverse associations between increased plasma level of anti-Mullerian hormone (AMH) and different clinical features of PCOS.
This is because people who have polycystic ovary syndrome (PCOS) have a lot of antral follicles. This means they also have high levels of AMH. High AMH levels can suggest PCOS in people who may not have symptoms of the condition. Having too much AMH can stop ovulation from happening. In a normal ovary, AMH keeps the follicles from developing too early. If this happened, they would release an egg that isn’t ready yet. However, when AMH levels are too high, they “put the brakes” on and stop an egg that is ready from being released.
According to this research, mean serum levels of LH and AMH, and LH/FSH ratio were significantly different between compared groups. In the PCOS group, the mean serum AMH level was 6.78 ng/mL and LH/FSH ratio was 1.53 while those of controls were 2.73 ng/mL and 0.53, respectively (p < .001). The most suitable compromise between 81% specificity and 79% sensitivity was obtained with a cutoff value of 3.75 ng/mL (26.78 pmol/L) serum AMH concentration for PCOS prediction, with an AUROC curve of 0.9691.
According to this research,women with PCOS exhibited significantly higher levels of FSH (4.38±2.05) and LH (12.22±3.31) compared to the control group (FSH: 3.10±1.21; LH: 2.35±1.30). Additionally, the level of prolactin hormone was significantly elevated in women with PCOS (1.30±0.41) compared to the control group (0.66±0.62). Unit is microU/mL.
According to this research, mean serum AMH levels were significantly higher in PCOS group as compared to subjects without PCOS but infertile (9.9±1.1vs2.1±0.3ng/ml, respectively; P< 0.001). Mean FSH levels were markedly lower in women with PCOS (6.4±0.3ng/ml) relative to those without PCOS (10.1±0.9ng/ml; P< 0.001). However, LH:FSH ratio was not consistently higher in PCOS group and no significant differences were found in mean LH, TSH and prolactin levels of the two groups.
Men semen analysis
Semen Analysis is the first step in understanding your fertility and can help detect some of the issues that prevent couples conceiving naturally. The three most important results are: Sperm Count, Sperm Motility, and Sperm Morphology.
Sperm Count, Concentration & Volume
The sperm count relates to how many sperm you have in your semen sample. You will see a number indicating your total sperm count. This is the amount of sperm in the ejaculate. Ideally you want to see 39 million or more.
You will also see a reading for the sperm concentration. This is the number of sperm in 1mL of semen. 15 million or more per mL is considered a healthy concentration. Semen volume is also a useful metric. It is the amount of fluid you ejaculate and 1.5mL or more is categorised as a healthy amount.
Sperm Motility
The sperm motility relates to how many of your sperm are moving well. These will be indicated as two different results. One will show the total motility, which is how many of your sperm are moving in total and 42% or more is considered healthy.
The other is what’s known as the progressive motility, which is how many of your sperm are moving in an effective forward pathway. Having 30% or more moving forward is considered a healthy proportion.
Sperm Morphology
Sperm morphology is related to the shape of your sperm. This includes head, neck and tail. Having 4% or more of your sperm a healthy shape and size is considered normal.
Source: American Pregnancy Association
https://www.news-medical.net/health/What-does-Estradiol-do.aspx
https://medlineplus.gov/lab-tests/follicle-stimulating-hormone-fsh-levels-test/
https://www.yourhormones.info/hormones/progesterone/
https://www.medparkhospital.com/en-US/disease-and-treatment/anti-mullerian-hormone-test
https://examenlab.com/for-men/understanding-your-semen-analysis-test-results/
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