Fertility Blood Work Offers Vital Clues about Causes of Infertility
When couples decide to visit Dr. James Douglas for infertility treatment, the first step is often a thorough medical interview and then a complete fertility evaluation. This process will provide Dr. Douglas with critical information about what may be hindering your efforts to conceive. A key component in this process is fertility blood work.
What constitutes a fertility blood test?
A variety of issues can impact female infertility, including structural abnormalities, medical conditions such as polycystic ovarian syndrome (PCOS), hormonal imbalances and maternal age. Before moving on to more invasive procedures, Dr. Douglas typically begins with blood work. These specialized blood tests can measure the levels of various hormones and blood chemicals. If your numbers don’t fall in the normal range, Dr. Douglas will have more data and can decide the best way to proceed so that you can get pregnant.
The protocol for fertility blood work
To gather the most accurate information, the blood draw may need to occur on a certain day in your cycle. For example, follicle stimulating hormone (FSH) is checked at the beginning of your cycle, usually on day 3, while progesterone is measured during the lutueal phase, 12 to 16 days after ovulation. Our staff will review all the details with you about each specific test.
Common fertility blood tests
The following list provides some of the fertility blood work Dr. Douglas may order. Not every patient will need each of these tests. After your initial consultation, Dr. Douglas will determine which tests he thinks are applicable to your situation. Reviewing this information will give you an idea of what to expect for this element of the fertility evaluation.
We want to make sure that 17-hydroxyprogesterone (17-OHP) levels are in the normal range because occasionally the adrenal gland makes excessive amounts of androgens. An over-secretion of androgen can cause elevated 17-OHP levels which can in turn interfere with ovulation. This is called congenital adrenal hyperplasia. Once this condition is found it can be corrected with medication to help patients ovulate normally.
Cardiolipin helps regulate blood clotting in our bodies. With infertility patients, specifically those dealing with recurrent miscarriage, the clotting factors aren’t working properly and may actually cause clots in the wrong places. With particularly abnormal levels, Dr. Douglas may prescribe a medication, like aspirin, heparin, Lovenox or prednisone, to decrease the chances that you will form clots that may interfere with a normal pregnancy.
Estradiol, the primary type of estrogen produced by your ovaries, plays an important role in achieving a successful pregnancy. When the follicles grow and develop, the cells surrounding the eggs produce and secrete estradiol, which causes various effects throughout the cycle, including thickening of the uterine lining and triggering of the spontaneous LH surge that leads to ovulation. We often run this blood test in women over age 35 with a Day 3 FSH test to evaluate the ovarian reserve.
Also called the day 3 FSH, follicle stimulating hormone is produced in the pituitary gland of women. The FSH stimulates the growth of follicles (eggs) within the ovary. Usually, FSH levels are checked on day 2, 3, or 4 of the patient’s menstrual cycle, and this level helps determine the patient’s ovarian reserve. Dr. Douglas often checks FSH levels in patients 35 years of age and over, as well as in other patients who exhibit signs of ovulatory dysfunction or ovarian failure.
Designed to regulate the uptake of glucose into the body's cells, elevated insulin may suggest an increased likelihood of polycystic ovarian syndrome (PCOS), a medical condition that can impact your ability to conceive. Oral medications such as Metformin can increase your body’s capability to process glucose and help control PCOS.
Like any anticardiolipin antibody, lupus anticoagulant, has to do with the blood clotting process. A positive test for lupus anticoagulant can lead to a higher risk of forming blood clots in the small blood vessels of the placenta. These small clots cause complications like miscarriages. Dr. Douglas usually recommends this test for patients with a history of recurrent miscarriage. If your levels are abnormal, just as with anticardiolipin antibody, Dr Douglas may choose to prescribe a medication to decrease the chances of forming clots. Oral medicines, such as aspirin or prednisone, or injectable, like heparin or Lovenox, can increase the odds of conception.
Secreted from the follicle that ovulated, progesterone supports both implantation and maintenance of pregnancy. Rising levels of progesterone help prepare the lining of the uterus for implantation of the fertilized egg. Testing the progesterone level can let Dr Douglas know if ovulation has occurred and how well your body would maintain a pregnancy. At IVF Plano, we will monitor progesterone during a normal cycle, but will also check levels in women who have a history of recurrent miscarriage or spotting in early pregnancy.
Produced by the pituitary gland, the hormone prolactin promotes lactation, the production of milk. Too much prolactin production, a condition called hyperprolactinemia, can prevent normal ovulation. Hyperprolactinemia may present with symptoms such as irregular cycles or a milky breast discharge. Dr. Douglas typically treats elevated prolactin levels with an oral medication that will correct the hormonal imbalance.
Although testosterone is thought to be a male hormone, small amounts are present in women and aid in ovarian function, bone strength, and sex drive. If your levels become too high, you may have trouble conceiving. One of the most common problems seen in our office is Polycystic Ovarian Syndrome (PCOS). When a woman has PCOS their ovaries makes too much testosterone and this elevated level of testosterone causes abnormal ovulation or anovulation. Patients with PCOS may also notice dark hairs in places they don’t want them and excessive acne. Weight gain and insulin resistance are also associated with increased testosterone in the body.
Your body needs thyroid stimulating hormone (TSH) and thyroxin (T4) to cause oocyte growth and then ovulation. High TSH levels typically show that thyroid hormones are not being produced (hypothyroidism), and low TSH may suggest hyperthyroidism. Both hypo- and hyperthyroidism can interfere with normal ovulation. Patients who report irregular menstrual cycle will need a TSH blood test. Also during pregnancy, normal thyroid function is also important for the development of the brain of the baby.