FERTILITY TESTS

It is best to seek the help of a specialist in reproductive medicine and fetal medicine if you are under 35 and have not achieved a pregnancy within 12 months. For couples over 35, this is recommended after 6 months of trying.
We know that walking into a fertility clinic for tests can be stressful when you do not know what to expect. To help, our fertility specialists have put together this article outlining a few things you should know. We will introduce you to the different types of infertility tests and give you a general idea of what counts as a positive or negative result for each test.

What kinds of tests are there for fertility assessment?

When you visit our Centre, the specialist in reproductive medicine and fetal medicine, Alexandros Traianos, will want to know your full medical history and any previous treatments you may have had, including a review of the results of any previous infertility tests.
A general physical examination of both partners will probably also be needed, where required, in order to assess your general health. Not every type of infertility test will be needed in every individual case, so this basic assessment can give the specialist an idea of where to start.
Infertility tests fall into two main types. First, there are blood tests: these can analyse the presence and/or the amount of different hormones. The second type is imaging, which can help the fertility specialist "see" inside your reproductive system to identify what, if anything, the problem is. In this article we will look at the blood tests.

Blood tests for infertility

The human body naturally produces a whole range of powerful hormones, each of which plays a different role in the complex system that regulates menstruation, ovulation and the reproductive cycle, including pregnancy. Blood tests help a doctor assess these hormones. Usually, your doctor will order them before starting any fertility treatment.
When looking at the results for the various hormone levels, it is important to remember that they vary between individuals and can indicate different things depending on many factors, such as age and general health history.

Oestradiol

Oestradiol is one of the most potent of the group of steroid hormones known as oestrogens. It controls the development and maintenance of female sexual characteristics and acts on the female reproductive organs, including the lining of the vagina and the fallopian tubes. Oestradiol is produced by the developing follicles — the tiny sacs in the ovaries that contain eggs — and it leads to the production of fertile mucus by the cervix, while also preparing the lining of the uterus for a fertilised egg or embryo to implant.

• Oestradiol levels are measured in picograms per millilitre (pg / ml).
• Normal levels vary widely depending on the phase of the menstrual cycle and can range from 30 to 400 pg / ml.

Anti-Müllerian hormone (AMH)

Anti-Müllerian hormone is produced mainly in a woman's ovaries.

• AMH levels in the blood are measured in nanograms per millilitre (ng / ml).
• Normal levels are considered to be at least above 1.0 ng / ml, although very high levels may indicate a different problem. Follicle-stimulating hormone (FSH). Follicle-stimulating hormone is produced by the pituitary gland in the brain. Blood levels fluctuate with the menstrual cycle. The rise in FSH during the first half of the cycle stimulates the growth of the follicles and, as they mature, it acts together with other hormones to trigger ovulation. After ovulation, feedback to the pituitary suppresses the release of FSH, bringing levels down.
• FSH is measured in international units per millilitre (mIU / ml).
• A good level for a baseline test, when FSH should be low, is probably below 10 mIU / ml, but the results need careful interpretation by a fertility specialist as part of the overall hormonal balance.
• Unusually high FSH levels may indicate low ovarian reserve.

Luteinising hormone (LH)

After the initial stimulation of the follicles by FSH during the first part of the menstrual cycle, a surge of LH produced by the pituitary gland triggers the release of an egg from the follicle — the process known as ovulation. Measuring this surge is often used to predict a woman's most fertile time.

Progesterone

• Progesterone prepares the uterus so that it is ready for the implantation of a fertilised egg or embryo after ovulation. If you become pregnant after ovulation, progesterone levels rise and help to maintain the pregnancy. If you do not become pregnant, progesterone levels fall, and this helps to start a new menstrual cycle.
• In a normal menstrual cycle, progesterone levels fluctuate throughout the month.
• You would expect the highest levels in the middle of the luteal phase of your cycle, and concentrations above 3 ng / ml usually indicate that you have ovulated.
• Levels of 8–10 ng / ml are desirable for pregnancy.

Androgens

It is normal to produce small amounts of "male hormones", or androgens, such as testosterone and DHEA-S. However, overproduction leading to unusually high levels could affect follicle development and ovulation. Raised testosterone levels are often found in polycystic ovary syndrome (PCOS), which can be associated with infertility.

• Testosterone in the blood is measured in nanograms per decilitre (ng / dL).
• Normal levels in women range between 15 and 70 ng / dL in most laboratories.
• Levels either below or above this range can cause fertility problems as well as other symptoms.

Prolactin

Prolactin has many functions, but it is best known for stimulating milk production in women who are breastfeeding. It is also raised during pregnancy. When you are not pregnant, the body usually has low levels of this hormone. High levels could be a side effect of certain medications or could be produced by a small growth in the pituitary gland in the brain, and they can lead to menstrual irregularities.

• A normal prolactin level for women who are not pregnant or breastfeeding is below 25 ng / ml in most laboratories.
• Almost all cases of hyperprolactinaemia are easily treated with oral medication.

Thyroid hormones

An underactive thyroid is known as hypothyroidism. Recent research by a team at Harvard Medical School showed that, among women with unexplained infertility, low thyroid function was twice as common as in women without the condition.
Blood tests for thyroid levels usually measure the amount of thyroid-stimulating hormone (TSH) released by the pituitary gland. When circulating thyroid hormone levels are low, the brain works "overtime" to try to restore the optimal level.

• TSH is measured in milli-international units per litre (mIU / L).
• A normal TSH level ranges from 0.4 to 4.0 mIU / L, and levels above this range usually indicate an underactive thyroid. It is important to remember that, with all of these blood tests, a single measurement of a particular hormone cannot be considered diagnostic of fertility or infertility, as hormones fluctuate constantly. For some hormones, the day of the menstrual cycle on which the measurement is taken is crucial. For others, there may be reasons for abnormal results that are unrelated to fertility. A qualified and experienced fertility specialist is essential to interpret blood test results and make treatment recommendations.

*The content of this blog is not intended to replace professional medical advice, diagnosis or treatment. Always seek the advice of qualified healthcare providers with any questions you may have about medical conditions.