1. Glucose Metabolism:
Diets that are high in carbohydrates can increase fasting glucose and your Hba1c. If these levels are high, it can decrease ovulation in some women, especially in PCOS. It is important to get these markers tested to make sure your insulin and glucose are in balance.
a. Fasting Insulin
b. Fasting Glucose
c. HbA1c
2. Testosterone
Androgens aka testosterone will help to mature the follicle during the first half of the cycle. However, we don’t want too much testosterone either. There is a fine balance between testosterone and estrogen to build a healthy follicle. Additionally, as we age our testosterone starts to decline which can impact egg quality.
a. Free testosterone
b. Total testosterone
c. DHEA-S
d. Androstenedione
3. Reproductive Hormones:
Estrogen is produced in the first half of the cycle to build the follicle that will eventually release an egg during ovulation. Progesterone is predominant in the second half of the cycle after ovulation occurs. These hormones are important to see if a woman is building a strong follicle, if she is ovulating and if she has adequate progesterone levels to sustain a pregnancy. Estrogen levels are tested on cycle day 3 and then estrogen and progesterone are tested 7 days after ovulation.
a. Estradiol
b. Progesterone
4. Pituitary Gland Hormones:
The pituitary gland that sits in our brain produces FSH and LH. The function of FSH is to prepare the follicle for ovulation. As estrogen rises high in the cycle before ovulation, the LH surge occurs which triggers the release of the egg from the follicle. Typically these tests are done on the third day of your menstrual cycle and we should see them less than 10 and at a 1:1 ratio.
Prolactin comes from the pituitary and signals to the mammary glands to produce milk. High levels of androgens and stress can result in high prolactin.
a. Follicle Stimulating Hormone (FSH)
b. Luteinizing Hormone (LH)
c. Prolactin
5. Thyroid Health:
Thyroid testing is very important for fertility. When there is a thyroid dysfunction it can prevent ovulation and can impair fertility, especially if there are autoimmune markers present. If antibodies to the thyroid are present it can increase your risk of miscarriage. Also, for best fertility outcomes, it is best to keep TSH at 2.5 mIU/L or less.
a. Thyroid Stimulating Hormone (TSH)
b. Free T4
c. Free T3
d. Anti-thyroperoxidase
e. Anti-thyroglobulin
6. Ovarian Reserve
AMH – Anti-Mullerian Hormone
AMH, also known as Anti-Mullerian Hormone is a hormone that is produced by the follicles that remain in your ovaries. Specifically, AMH is produced by the granulosa cells that surround the egg. This hormone gives us an idea of where you are in terms of your ovarian reserve. This means, how many follicles you have left in your ovaries. We know as we age that the number of eggs we house will eventually start to decline, so it is important to use AMH as a marker. However, keep in mind, it does not mean that having a low AMH will prevent you from becoming pregnant.
7. Nutritional Markers
There are various nutritional markers to consider as well when it comes to fertility. These markers will help to determine how healthy your overall body is. Looking at various markers such as your iron status, Vitamin D, Vitamin B12, cholesterol panel and liver/kidney function is important in assessing your body for fertility.
a. Lipid/Cholesterol Panel
b. Ferritin
c. Vitamin B12
d. Vitamin D
e. Kidney function
f. Liver Enzymes
