Part 1: The basic blood tests
Knowing what fertility tests to ask of your Doctor is important to get a good picture of the hormonal state of your gynaecological system. Different hormones play different roles within preconception, conception and pregnancy and many fertility and pregnancy issues stem from either a lack or an excessive level at their particular cycle times. Whilst there are many tests necessary to give us a good idea of what is going on, you should at least be able to request FSH and Progesterone from your GP – so make a start with these. Getting a better idea of your hormone picture will give you some indicator of why you may be struggling to conceive or have a history of miscarriage. Similarly, if you are looking to begin trying for a baby, this is certainly a good place to start to get a good indicator of your current levels.
FSH (Follicle-stimulating Hormone)
Your FSH and LH are indicators of how responsive your ovaries are at the beginning of the cycle, necessary to stimulate the growth of new follicles in the ovary. If the FSH is too high, your pituitary gland is needing to pump out more of the hormone to get the ovaries to respond and stimulate; this lack of response is not a good thing, so we’d like the FSH to be on the lower side. Whilst the FSH typically rises with ageing, fertility health suggests this figure should be under 8. Above 10, and this needs to be addressed with acupuncture and possibly Chinese herbal medicine; anything near to 30 indicates a peri-menopausal state. This can still be treated as peri-menopause is not actually menopause, but this will need to be addressed asap.
So, the FSH test is important to indicate how responsive your ovaries are each month. It will be a blood test on 1-3 of your cycle, i.e. during the period.
Your progesterone is necessary to encourage the implantation of an embryo (a fertilised egg) and support the early stages of pregnancy until approximately 14 weeks, when the placenta takes over. If the result is above 30, this indicates that ovulation has taken place; under 30, and the progesterone is too weak to suggest ovulation has happened, so it may have been missed that month, or perhaps there are some more severe ovulatory problems going on that need to be treated. To be sufficient at supporting early pregnancy, it should ideally be above 50. Many issues with early miscarriages can often be due to low progesterone levels, so it is an important test, not just to indicate ovulation but that it’s sufficient to support the first trimester of pregnancy.
Timing your progesterone test is really important: it’s a blood test that needs to be done 7 days after ovulation*. So you’ll need to be sure when you’ve ovulated that month and then book your test 7 days later. I appreciate that this isn’t going to be possible if you don’t know when you ovulate but be aware that the results won’t be reliable if it’s not 7 days after ovulation. Quite often the test is still done at a random time with patients who have irregular menstrual cycles and are not sure if they are ovulating at all: this is then confirmed when the progesterone is under 30.
So FSH and Progesterone are the first and foremost tests to ask for. You should be able to request them at no cost from your GP, or any private health clinic for about £100.00.
In Part 2, I will talk about some of the other important hormones tests that are helpful to understand and may indicate other issues that need to be treated and corrected.
*Often called a “Day 21 test”, but this assumes that you have ovulated on day 14, so results can be invalid if you haven’t! Be specific about the day on which you have progesterone tested. Remember 7 days after you have ovulated that month. It’s best to do at-home ovulation tests daily between days 9-20 of your cycle to catch the ovulation in case it’s early or later than expected. Once you get a positive ovulation result, you can book your progesterone test 7 days later.