Coping with Infertility

Lesson 2: Initial Testing and Diagnosis

Blood Tests - Which Ones and When

In Lesson 1, section 8 we glanced at which blood tests should be ordered and on which day of the woman's cycle they should be ordered on, but we did not go into any kind of details about them. That is what we will do here, explore each blood test, and when it should be done. Let's start by looking at the tests that should be done on Cycle Day 3 first.

• Estrogen
• LH
• FSH
• Prolactin
• TSH (Thyroid Stimulating Hormone)

Estrogen, LH, and FSH levels are read together to determine if there is an ovulatory problem. The 'normal' levels for each hormone will vary from lab to lab, but the averages are:

• Estrogen – 25 to 75 mIU/ml
• LH – 7 mIU/ml or less
• FSH – 3 to 25 mIU/ml
• Prolactin – 24 ng/ml or less
• TSH - .4 to 4 mIU/ml

The following are tests that should be done 7 to 10 days after ovulation, or that can be performed at any time during the woman's cycle.

• Progesterone
• Total Testosterone
• Free Testosterone
• Androstenedione

Progesterone, testosterone, and androgen levels should also be evaluated in conjunction with the results from the cycle day 3 tests. As with the other hormone tests, the 'normal' levels will vary from lab to lab, but the averages are:

• Progesterone (7 to 10 days after O) – 10 ng/ml or greater
• Total Testosterone – 6 to 86 ng/dl *many labs consider a level above 50 to be elevated.
• Free Testosterone – .7 to 3.6 pg/ml
• Androstenedione – .7 to 3.1 ng/ml

Estrogen levels - lower is better in this case. The lower the level the more likely stimulation of an egg and development can be expected.

LH levels - lower is also better in this case. An elevated level of LH and a lower level of FSH could be a sign of PCOS and additional tests should be ordered.

FSH levels - lower levels of FSH signal a better ovarian reserve. The LH and FSH levels should be close to a 1:1 ratio when PCOS testing is being done and evaluated.

Prolactin levels - when compared to the other female hormones, a non-breastfeeding woman should have very low levels. If the level of prolactin is raised, additional testing should be performed as this hormone can interfere with ovulation.

TSH levels - low levels as well as high levels can signal a problem with thyroid function. If the levels are 'low normal' or 'high normal' additional thyroid testing should be ordered.

Progesterone levels - levels below 10 do show ovulatory function, but most doctor's prefer to see levels of 10 or higher. Levels below 5 may indicate a lack of ovulation.

Total Testosterone levels - testosterone is a normal hormone found in both the male and female, however, levels over 50 are considered high by most doctors and indicate the need for additional testing.

Free Testosterone levels - this is the level of testosterone that is 'free' in the blood and not 'binded' to sex hormone binding globulin (SHBG).

Androstenedione levels - androgens are normally produced, but elevated levels of androgens can interfere with normal egg development and ovulation.

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