One of the first things you can do when you first begin your journey to Single Mother by Choice is getting some baseline labs so you and your doctor can get a better picture of your fertility status. Like most things that come up when you decide to become a SMC you may never have heard of any of these tests.⠀⠀⠀⠀⠀⠀⠀
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Day 3 labs (named so because they are done on day 3 of your menstrual cycle) usually include AMH, FSH, LH and estradiol. AMH doesn’t have to be tested on day 3 of your cycle but is usually done at the same time for convenience. Prolactin should also be tested at the beginning of your cycle. ⠀⠀⠀⠀⠀⠀⠀⠀⠀
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You can ask your regular OBGYN for these labs even before seeing a fertility specialist. Most clinics also require a well woman exam within the last year so you may be able to kill two birds with one stone with the right timing. Some SMCs prefer to go straight to an RE, which is also a valid choice, especially considering the unfortunate lack of fertility knowledge among OBGYNs that some women experience.
Estradiol
Estradiol, also known as E2, is a hormone that is secreted by the ovarian follicles, and is measured between day 2-4 of the menstrual cycle to assess fertility. ⠀⠀⠀⠀⠀⠀⠀⠀⠀
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E2 naturally fluctuates throughout the menstrual cycle, from 10-400pg/mL, with its lowest point in those early days. A desirable E2 on day 2-4 of your cycle is <80pg/mL. ⠀⠀⠀⠀⠀⠀⠀⠀⠀
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High levels of this hormone can indicate a low ovarian reserve (how many eggs you have left), which can make getting pregnant difficult. You may also have more trouble ovulating (even with treatment), and a lower success rate with IVF.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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E2 is measured in conjunction with FSH, since a high estradiol level (>100pg/mL) can cause FSH to be low, masking a true high FSH level, which can also indicate low ovarian reserve.
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A low estradiol level can also indicate PCOS or hypopituitarism. ⠀⠀⠀⠀⠀⠀⠀⠀⠀
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Some signs that your estrogen may be high (also known as estrogen dominance), include irregular periods, tender breasts, PMS, bloating or constipation, anxiety, mood swings, and headaches.⠀
FSH
Follicle Stimulating Hormone (FSH), produced in the pituitary gland, is the main hormone responsible for maturing eggs in the ovaries. Measuring FSH is a critical part of the initial evaluation of a SMC’s fertility status.⠀⠀⠀⠀⠀⠀⠀
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As a woman ages and the brain senses that estrogen is low, this signals the pituitary to make more FSH to stimulate the ovaries to produce a good follicle and more estrogen.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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While it seems like this would be a good thing, it’s actually not, as it signifies that pituitary is working overtime and is an indicator of low ovarian reserve, or decreased egg count.⠀⠀⠀
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A desirable FSH is lower than 9mIU/mL, and a level >40mIU/mL indicates menopause. FSH values of >10mIU/mL can be a predictor of poor response to stimulation meds and levels of >18mIU/mL can be a predictor of poor pregnancy outcome.⠀⠀⠀⠀⠀⠀⠀⠀
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It’s important to know your own levels so that 1) you can be prepared for possible outcomes of different fertility treatments and 2) you can try to improve your levels naturally before spending exorbitant amounts of money only to get poor results.⠀⠀⠀⠀
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FSH can change a lot depending on egg quality, which depends on ovarian health over the last few months and ovarian reserve. Both of which can be improved with lifestyle changes.
Luteinizing Hormone (LH)
LH or luteinizing hormone is also produced by the pituitary gland and helps to control the menstrual cycle. It also triggers the egg to release from the ovary, aka ovulation.⠀⠀⠀⠀⠀⠀
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When testing LH at the beginning of the cycle, days 2-4, it can be useful to detect hormone imbalances such as polycystic ovary syndrome (PCOS). If it is higher than FSH, especially at a ratio of 2:1, this can indicate PCOS.⠀⠀⠀⠀⠀⠀
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High LH levels can result in higher ovarian testosterone production, altered estrogen production, and abnormal ovulation. It can also result in poorer IVF outcomes and is used as a predictor of reduced ovarian reserve as with all of the day 3 labs.⠀⠀⠀
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A normal day 3 range for LH is <7mIU/mL.⠀⠀⠀⠀⠀⠀⠀⠀
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Low levels of LH can also be problematic, as they can be an indicator of poor nutrition, stress, or a pituitary disorder. Several studies have found that an LH of <3mIU/mL can result in a poor response to ovarian stimulation medications.
AMH
You will hear a lot about AMH once you decide to take this SMC journey, like so much you would think it is the end all be all of fertility labs…but guess what…it’s not! While some doctors consider it the “gold standard” of fertility testing, it’s only a small part of the big picture to understanding your ovarian reserve.⠀⠀⠀⠀⠀
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So, what is it?⠀⠀⠀⠀⠀⠀⠀
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AMH or Anti-Mullerian Hormone is produced by the cells of growing follicles in the ovary, therefore it generally correlates with the number of eggs a woman has left at any given age. What AMH does NOT measure is egg quality, this is a common misconception.⠀⠀⠀⠀⠀⠀⠀⠀
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What AMH is a better marker for is response to IVF stimulation medications. Lower AMH can lead to a poor response to IVF medications and result in less eggs retrieved.⠀⠀⠀⠀
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AMH can be tested at any stage of your menstrual cycle, and can also fluctuate from month to month, so it can be useful to test it multiple times before any fertility treatment. ⠀⠀⠀⠀⠀⠀⠀⠀
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In general, an AMH of above 1.0 ng/mL is considered optimal fertility, and a level below 0.3 ng/mL is considered very low/undetectable.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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The good thing about AMH is that even with a very low number, achieving pregnancy is not impossible. It’s important to remember quality over quantity, all it takes is one good egg!
Prolactin
The prolactin hormone is produced by the pituitary gland and is responsible for milk production after delivering a baby. Abnormally high levels of prolactin inhibit FSH secretion and therefore cause irregular periods and/or anovulation. MIlder cases of high prolactin levels can cause a luteal phase defect and inadequate progesterone production. This may result in an inadequate uterine lining and difficulty for an embryo to implant.
Prolactin should be tested first thing in the morning and in the first half of the menstrual cycle. A normal or desirable prolactin level for non-pregnant women is <25ng/mL.
High levels of prolactin may be caused by a pituitary adenoma (a type of cyst), hypothyroidism, polycystic ovary syndrome (PCOS), some medications and/or birth control pills, and stress.
Other tests for SMCs
Full thyroid panel
A lot of new SMC are not aware how much thyroid function can affect fertility, and since your own RE may or may not mention it or offer it at your first appointment, it is strongly encouraged for SMC to ask to include a FULL thyroid panel (including antibodies) at baseline testing.
Thyroid function is regulated through the hypothalamus-pituitary axis (or HPA axis), where the hypothalamus (part of the brain that produces hormones) cues the pituitary gland, which sends a signal to the thyroid via thyroid stimulating hormone (TSH) to release triiodothyronine (T3), thyroxine (T4), and calcitonin.
If your thyroid is underactive (hypothyroidism), then TSH will be high, think of pressing on a gas pedal to get the car to go faster, the pituitary has to send more TSH to get the thyroid to respond, and T3 and T4 will be normal to low. If it is overactive (hyperthyroidism), then TSH will be low, and T3 and T4 are high.
In order to get a full picture though, you should also ask for thyroid antibodies. Presence of antibodies can be an indication of either Hashimoto’s Thyroiditis, the most common cause of hypothyroidism, or Grave’s disease, the most common cause of hyperthyroidism.
Since the HPA axis controls some of the most crucial hormones related to fertility, any dysfunction in the system can throw off your menstrual cycle and thus your ability to get pregnant. If you have either increased or heavier menstrual bleeding or fewer or lighter menstrual cycles, these can be an indicator of thyroid dysfunction.
Vitamin D
Having an optimal Vitamin D level before TTC is so crucial, yet many women aren’t told this and don’t know to start testing it at the beginning of their journey. Since it can take months to go from a deficient level into the optimal range, every SMC should know this at least 6 months prior to TTC!
Vitamin D is actually a hormone, and has receptors throughout the body including the ovaries, uterus, placenta, hypothalamus and pituitary gland. It has also been found to play a role in autoimmune diseases such as endometriosis and PCOS. It has been suggested that women with higher Vitamin D levels are at a lower risk of developing endometriosis. Vitamin D supplementation has also been shown to improve lipid profiles, decrease androgen levels, & improve blood pressure in women with PCOS.
Optimal Vitamin D levels are associated with:
- enhanced ovulation
- higher odds of conception
- improved embryo implantation rate
- improved outcome of fertility treatments
- higher IVF pregnancy rates and live birth rates
- reduced pregnancy complications
Up to 80% of women have Vitamin D levels below the bare minimum of 30ng/mL (75nmol/L), with newer research suggesting even higher optimal levels for fertility and miscarriage prevention of at least 40ng/mL (100nmol/L).
While you can get it from the sun (try the DMinder app to see how much you’re getting), and from a few food sources, it’s likely you will need to supplement. Your dosage depends on how deficient you are and other lifestyle factors. Work with a practitioner (like me) who can run the test, suggest an appropriate amount to take, and follow up with subsequent testing every 3 months while TTC and through pregnancy.
Progesterone
A progesterone test is NOT done on cycle day 2-4. It is a blood test done 7 days after ovulation, or suspected ovulation, or cycle day 21 if your cycle is 28 days long. This test can be done to confirm ovulation.
Ovulation can be confirmed with a level above 3ng/mL (9.54nmol/L). Low levels indicate that ovulation did not occur and no egg was produced.
If you’re a SMC at the beginning of your journey, or even in the middle of it, the more you know about your own fertility the better. If you’re unsure of where to start I have a free checklist, Single Mothers by Choice: Thinkers to Tryers that will take you through the year before you actually start trying to conceive.
Do you need more help? Schedule a free 20-minute discovery call to see if we are a good fit to work together, and let me help you through your TTC journey.
