This is almost always one of the first questions we get asked when a new fertility patient comes to see us. “What labs do I need to run to asses my fertility, and what do them mean?”
We love labs and we use them often. The thing is, while labs can be profoundly helpful for getting a broad picture of what might be going on with someone’s fertility (and general reproductive health) they are by no means the *only* markers of fertility. Can high FSH and low AMH markers be stressful? Sure, because these lab patterns may indicate less than ideal egg reserve. But is it possible that folks with lab patterns like this may still conceive? Absolutely — we see it every day.
Here’s where generally suggest starting for fertility:
Reference ranges given here are for folks with ovaries.
FSH (cycle day 3): used as a tool to asses ovarian reserve. Numbers below 10 mIU/ml are generally considered optimal. Numbers above this may begin to raise concern about reserve. When evaluating for PCOS, it is helpful to run this lab along with LH, in which case we’re looking for a 1:1 ratio. If LH is higher that FSH, the patient should be screened for PCOS.
LH (cycle day 3): this is the hormone that surges before ovulation — it’s what triggers the positive “OKP” tests. It’s also a helpful marker when screening for PCOS. A normal number on cycle day 3 is generally below 7 mIU/ml.
Estradiol (cycle day 3): the most active form of estrogen, essential to nearly all aspects of ovarian and uterine health. “Normal” estrogen levels are considered to be between 25-75 pg/ml on cycle day 3.
Prolactin (cycle day 3): when elevated, this hormone may suppress ovulation and contribute to irregular cycles. Prolactin can be elevated for a few reasons, the most common being breastfeeding. Occasionally other causes may contribute as well, like pituitary tumors or, in some cases, PCOS. Normal range in folks not nursing/lactating is less that 25 ng/mL.
AMH: blood levels of this hormone are thought to reflect the size of the remaining egg supply or “ovarian reserve”. Lower numbers may suggest diminished ovarian reserve, and higher numbers may suggest PCOS or other ovarian cysts. 1.5-4 ng/ml broadly considered normal.
TSH: thyroid stimulating hormone can impact nearly every aspect of health, and is especially important to review in a fertility and pregnancy work up. A “normal” range is broadly considered to be between 0.4-4, though for fertility, we typically prefer to see this number closer to 1-2.5. mIU/ml.
DHEAS: an androgen hormone primarily made by the adrenal glands (and secondarily by the ovaries and testes). It is an important hormone to support overall vitality, energy and egg quality. Commonly high in PCOS. A “normal” range is considered to be between 35-430 ug/dl. We typically like to see it somewhere in the middle of that range.
Testosterone (cycle day 3): another androgen hormone produced by the adrenal glands and ovaries. Necessary for egg quality and sperm health. Often high in PCOS. Broad normal range is between 6-86 ng/dl.
SHGB (cycle day 3): a substance that binds androgens and estrogens. Often low when estrogen and/or testosterone is high, and vice versa. Hormonal contraceptives may impact SHGB levels. Normal ranges are broadly considered to be between 18-144 nmol/L.
Progesterone (7 Days Past Ovulation): essential for a healthy uterine lining, implantation and a healthy pregnancy (not to mention feeling good!), this hormone raises sharply after ovulation and continues to climb throughout pregnancy. A lab at 10 ng/mL or above indicates that ovulation occurred.
There are, of course, many other helpful labs available to assess a persons overall health picture. This is by no means an exhaustive list, but rather a jumping off point for those seeking to better understand the most commonly run reproductive health labs.
Remember, lab markers are just one piece of your unique fertility story, and you can absolutely influence how your story is written.
Stay hopeful,
❤️ your NHRH team
