When Doubt is Setting In, Perhaps this Will Help
Originally Posted May 1, 2014
The standard for western involvement in the process of fertility begins at the one year mark. If a couple has yet to conceive while having unprotected sex for one year then your doctor will begin to make the necessary referrals or start ordering a barrage of tests. Sometimes, I recommend that a couple start this process a little sooner.
The reason is that if you have been trying to conceive for a little while, frustration might be starting to set in and perhaps a little bit of doubt. Could something be wrong? By getting a few blood tests drawn, you can nip that little voice in the bud and get back to trusting the process and enjoying the journey.
First, it’s important to remember that with perfect fertility the average 25 year old woman has a 25%chance of conceiving per month. Percentages decrease slightly as we age, but trust me you still have lots of time. This number isn't meant to scare you into starting IVF tomorrow, rather put your fertility into context that it takes time at 25% it’s likely that it would take 4 months to have a positive test. If it hasn't happened yet and you have been trying for a little bit of time, don’t lose hope.
If you require some peace of mind you may desire to talk to your physician and put that doubt to rest or identify if there really is something that you should be focusing on and pursuing treatments for, here is the list of tests you should be asking for.
Blood tests to assess your fertility accurately need to be taken at particular days in your cycle. The most important day is Day 3 of your cycle, and then a second test can be done at day 21 (this day is supposed to be approximately 7 days past ovulation, so if your cycle is different from the average 28 day cycle adjust accordingly. If you are new to this, Day 1 is the first day of your period.
Day 3 Tests:
FSH: Follicle Stimulating Hormone value identifies how hard your body is working to stimulate the follicles in your ovary for maturation. Reproductive Endocrinologist s (RE’s) will look at this number as one of the indicators for ovarian reserve. They like to see this number under 10 to be considered normal and have good response.
LH: Luteinizing Hormone is also being release at this time to encourage the maturation of the follicle and stimulate the production of estrogen to help prepare for ovulation and what will be the corpus luteum. This is the hormone is indicated when you are doing ovulation predictor kits. You have a large surge 24-36 hours prior to your ovulation. On Day 3, this range should be smaller than the FSH, when it is higher than the FSH it can be an unofficial possible indicator to look for PCOS.
Estrogen: Estradiol is often checked on Day 3 as a double check for FSH ranges. On day 3 it is expected to see a low FSH and a low Estrogen range to indicate that ovarian reserve and function are optimum. If the FSH is low and the Estrogen level is high, it is possible that the estrogen is suppressing the FSH number and not giving an accurate value. If this happens, it is best to recheck both hormones on a subsequent cycle on day 2 to identify an estrogen leak and see if your FSH is higher.
TSH: Thyroid Stimulating Hormone. This hormone is crucial to your fertility and everyday life; quite often it’s the missing link in unexplained infertility cases. Your TSH value indicates how hard your body is working to keep your thyroid functioning. Your thyroid is responsible for the metabolism of every cell in your body, and this includes your ovaries. Small fluctuations in your thyroid can affect your ovulation, menstrual cycle and ability to carry a healthy baby to term. Both Hypothyroidism (high TSH) and Hyperthyroidism (Low TSH) have impacts on your chances of conceiving. The Optimal Functional Level for Fertility and Pregnancy is between 1.5-2.0.
Day 21 Tests
Day 21 Tests are used to evaluate if you ovulated. Some doctors will run your FSH, LH and Estradiol tests again to see where they are at this stage of the cycle but the most important ones are progesterone and prolactin.
Progesterone: indicates that you ovulated when the value is over 10. Progesterone is secreted from the corpus luteum that released the egg. A healthy corpus luteum will secrete enough progesterone to support a possible pregnancy through to the formation of the placenta at around 8-10 weeks of pregnancy. If this value is extremely low, it’s possible you haven’t ovulated and could indicate an ovulatory disorder. If you have successfully ovulated it could determine that the corpus luteum is weak and requires some attention.
Prolactin: is a hormone that is often elevated in post- partum to promote sufficient lactation. If it is elevated when you are trying to conceive it could be the reason for low progesterone levels. If this lab value is elevated, you will need to have it tested again, to confirm the irregularity as it could be a benign tumor on your pituitary gland, a condition known as hyperprolactinemia. Its treatable, it just needs to be diagnosed and once it’s under control your progesterone levels will come back to normal.
When you get your results and they are all read in the normal ranges, take a deep breath and let it sink in. Your body is capable, the potential is there, and your pregnancy will happen when the timing is right. Enjoy this time as a couple and trust.
XO Ashley