Fertility Hormones: which to test + what they all mean
Blood work is a valuable tool to quantify hormone levels and fertility markers, which together give insight as to how our ovaries are functioning and the quality of the eggs they contain. If you are currently trying to conceive or thinking about getting pregnant in the next few years, testing your hormones can give you a lot of helpful information that will assist you in making informed decisions about your family planning.
If you’re new to learning about these hormones then all the abbreviations and numbers are enough to leave you feeling dizzy, but I’m going to explain what they mean for your health and fertility, and let you know exactly how you can test them yourself.
When to test + where
Most fertility hormones, unless otherwise indicated, are tested on cycle day 2 or 3 of your cycle (with cycle day 1 being the first full day of flow.) If you haven’t had a period in several months or longer, then typically it doesn’t matter when you test.
While most of our fertility hormones aren’t immediately impacted by eating a meal, prolactin is. If you plan to test prolactin then it’s best to test first thing in the morning while fasting.
There’s no certain age you need to be to start testing your fertility hormones, but because fertility can decline more rapidly in our 30s and early 40s, it’s a good idea to start testing early and re-test every 9-12 months to keep up to date with the state of your fertility. In reality, most people wait until they’ve actually started to conceive before taking a look at their fertility hormones.
If you see an OBGYN or a fertility doctor they can run these labs for you, but even with insurance getting all of these labs done can be costly. My friends at Modern Fertility make it easy for you to test all of these hormones affordably, either at home or at a nearby lab, whether you’re currently taking hormonal birth control or not. Take their quiz to find out which of the following hormones you should test for.
Keep in mind
I won’t be giving you exact levels or ranges for these hormones because they can vary depending on the lab used. However you test, there should be some explanation of what the “normal” levels are and where your results fall on that spectrum. If you have questions you should consult with a healthcare provider to understand your results.
It’s also important to remember that when you test hormones you’re getting a snapshot of what the level was that day. All hormones rise and fall. Especially with changes to diet, supplements, starting acupuncture, or exercise, many of these levels can change (sometimes dramatically) after just a few months. Even if you get results that are disappointing or scary, know that there are often things that can be done to optimize your health and fertility.
Anti-Mullerian Hormone (AMH)
This hormone is produced in the ovaries by cells that help small follicles (which contain eggs) to grow. Because eggs develop for 3 months before being released at ovulation, your AMH level is indicative of all the eggs that are brewing but still 2-3 months away from ovulation.
AMH is the single most significant hormone that indicates ovarian function. It tends to start high at puberty when follicles are plentiful and the number goes down with age as we release fewer eggs.
Typically AMH levels start to drop more significantly at 40 years old, and many fertility doctors have told me that the levels will only ever decline and never comes back up. However I’ve seen time and time again with my patients that it can double or triple once we start treatment.
How can that be? Keep in mind, AMH is produced wherever there are small follicles growing, when we boost circulation to the ovaries and improve how the ovaries function we can typically “wake up” more eggs than usual and thus increase AMH levels.
In some cases AMH may be abnormally elevated, not because fertility is “super high” but because the ovaries get stuck in a cycle of developing several immature follicles. Even with lots of small follicles the ovaries may have difficulty actually ovulating, this is common with Polycystic Ovarian Syndrome (PCOS).
Follicle Stimulating Hormone (FSH)
FSH is released from the pituitary in the brain and it stimulates follicle growth in the ovaries. It typically starts out at a low level at puberty, because the ovaries function well and are easy to stimulate. With age our FSH levels typically rise slowly because the ovaries become more and more difficult to stimulate. Finally it peaks at menopause as the ovaries are no longer responsive.
Second to AMH, this is the next most important factor in determining ovarian reserve and egg quality, because it tells us how responsive the ovaries are to being stimulated. Just like AMH, even though many people will say the level only ever goes up, I’ve seen FSH levels fluctuate dramatically (often reducing several points or dropping as much as 50% the original level) in response to factors like diet, lifestyle changes, herbs and acupuncture.
Estrogen is actually an umbrella term for a bunch of different compounds, E2 being one of them that is an important indicator of fertility released from the ovaries.
E2 may be elevated in cases of PCOS, ovarian cysts, fibroids, or endometriosis. High levels are also typically linked with hormonal imbalance symptoms such as PMS, menstrual headaches, or irregular cycles.
Low E2 levels are common when ovarian function is low and there aren’t many follicles producing estradiol. This pattern is usually associated with symptoms of skin dryness, vaginal dryness, low libido, hot flashes, or night sweats.
The thyroid is a small gland located in the throat that regulates metabolism for every cell in the body, including follicles and the eggs they contain. A properly functioning thyroid is hugely important for not just fertility and hormone balance, but also energy levels, sleep, digestion, water metabolism, brain function, and memory.
The 2 most common hormones that are tested to determine thyroid function are TSH (Thyroid Stimulating Hormone) and free T4.
Much like how FSH is the signal from the brain that stimulates the ovaries, TSH is the signal from the brain that stimulates the thyroid. If the thyroid is functioning well then the level remains low, but if the thyroid isn’t functioning well then TSH levels rise in cases of hypothyroidism. It’s also possible for TSH to be too low because the thyroid is over functioning in cases of hyperthyroidism.
Free T4, aka thyroxine, is the hormone that’s actually produced by the thyroid. It quantifies the output of the thyroid so we know how well it’s actually functioning.
If either or both of these hormones are out of range it’s typically recommended to follow-up with a full thyroid panel and to consult an endocrinologist. Remember, thyroid health is essential for fertility.
This hormone stimulates lactation, or milk production. it also prevents the body from ovulating, usually for several months after giving birth.
It’s typically only produced in significant amounts in the postpartum period, but it can be elevated in some individuals who have never given birth. A high PRL level is detrimental to fertility because it can inhibit ovulation and negatively effect pregnancy. In my clinic I’ve noticed a correlation between high PRL levels and high stress and/or irregular sleep schedules. If you plan on conceiving anytime soon then it’s important to regulate these levels right away.
In some cases PRL may be too low, which usually points to issues with the pituitary.
Luteinizing Hormone (LH)
Another hormone produced in the pituitary, LH regulates ovulation and typically peaks mid-cycle which causes an egg to release. The rest of the cycle LH should be relatively low. When it is grouped in with all the other hormone tests on cycle day 3 we’re looking to make sure it’s not elevated when it shouldn’t be.
If LH is elevated early in the cycle it typically causes difficulty with ovulation and irregular cycles. Possible causes include PCOS, menopause or peri-menopause, or pituitary dysfunction. If LH is too low, it may also indicate pituitary dysfunction.
Testosterone is an androgen, meaning it’s a “male sex hormone,” but it’s produced in small amounts in female bodies too. Typically T levels start out higher at puberty and decreases with age, but there are several reasons our bodies may over or under produce it.
Normal T levels are necessarily not just for reproductive function, but also energy levels, muscle mass, sleep cycles, and libido. If T is deficient or excessive, it can negatively effect ovulation, egg quality, and fertility, and may also indicate dysfunction of the ovaries or adrenal glands.
It’s common that T is elevated in cases of PCOS (along with E2, LH, and AMH) but it may also be elevated all on its own. Common symptoms of elevated T include oily skin, acne, increase of body hair growth, decrease of head hair growth, and irregular menstrual cycles.
Low T in women is common after 40 years old, as E2 and AMH decrease and FSH rises. Symptoms may include fatigue, muscle weakness, low libido, and irregular menstrual cycles.
Piecing it all together
Even with all this info, once you get all your results back you may still be scratching your head and wondering what it all means. Book a consultation with me and we’ll go over what your hormone levels mean for your fertility and overall health, as well as what you can do to improve your chances of getting pregnant.