Trouble-shooting Your Fertility Test Results

When a woman or couple is trying to conceive, many tests may be done. It can be difficult to understand what these results mean. In my experience, most patients don’t understand them, even after seeing a fertility specialist. I think knowledge is power. And you wanna be empowered in your fertility journey right? So here is a basic outline of what tests may be done and what they indicate..

Usually when a woman tells her GP that she is trying to get pregnant, they’ll run a bunch of blood tests. The first ones are for STI’s and if the GP is thorough, they’ll include Iron, Vit D and a Thyroid study in the bloods.

Vitamin D is often low, so a good supplement is needed. If they are really low, it’s worth talking to a nutritional medicine practitioner for correct dosage of Vit D, such as Dr. Jessie Fayers at Freedom Chinese Medicine in Ivanhoe, Melbourne.

If you’ve been trying to conceive with no success for 12 months (or 6 months if you’re over 35), then other tests are done:

1. Pelvic Ultrasound – Can show any structural issues, lining thickness and will give a AFC, antral follicle count. This is the number of maturing eggs visible. Usually visible on both sides. You add these together to get the total count.  The AFC is the single most important indicator of your follicular reserve – egg count. An AFC lower than 8 is indicator of a lower reserve. If this is you, try not to despair, there is much that can be done to improve egg quality (it only takes one!) and optimise follicular reserve. Contact us to discuss.

2. Base hormone tests. This is a blood test taken at Day 2 or 3 of your menstrual cycle (day 1 is counted as the first day of  flow- not spotting). Your base hormones should include oestradiol, progesterone, prolactin, testosterone, FSH and LH. These are usually within normal range.

3. Progesterone tests are often overlooked but well worth doing. This is another blood test which should be taken 7 days after your usual ovulation time (if you know it). Often on Day 21, but if you ovulate late or early, this test should be done accordingly, ie. bloods taken on Day 17 if you ovulate on Day 10. The most thorough way to test progesterone is to take two more blood samples every second day after the first. That is, Day 21, 23 and 25. Seem excessive?

I can’t tell you how many women I’ve seen in 22 years of private practice, who have had trouble conceiving or keep miscarrying because of low progesterone. It’s a simple test, and often a simple fix.

12 days of sufficient progesterone levels are necessary to support implantation of a fertilised embryo. So, if you tend to have short cycles, it’s worth working out when you ovulate (via urine test, cervical mucous, BBT, bloods or u/sound). To ensure that there is at least 12 days between when you ovulate and when you bleed.

4. AMH

If your over 35 or if your pelvic ultrasound showed a low AFC, another blood test will be recommended; an AMH test.  This measures a hormone related to your egg count/ follicular reserve. It’s a fairly new test which is only really useful to indicate potential response to IVF and/ or how far you are from menopause.

The graph below shows the change in normal AMH range with age.  The breadth and value of this range reduces with age, which reflects the diminishing ovarian reserve.

However, age is not everything! When I had my AMH tested at 36yo it was 6, at 40 it was 2. Yes, I’ve felt the anguish, worry and tears. I went on to conceive naturally at 41yo. Yes I did a lot of work to improve my health, nutrition & fertility. You can too. Drop me a line to hear what I did and get a fertility plan tailored to you.

There are no guarantees of course, but there is the satisfaction that comes from knowing you’re doing what you can to improve your chances. Here’s me & my healthy daughter:

 

5. Semen analysis for him (if there is one).

Been told that his semen is AOK? Do you know that the levels for “normal sperm” have been lowered dramatically in the last 30 years. Now, this doesn’t matter if your going for IVF/ ICSI. However, if you’re trying to conceive naturally or via IUI, read on..

In 1987, the normal levels for sperm morphology, that is sperm shape (- one head, one tail or two heads, missing tail) was 50%. Now it is at 3%. That is, it is considered normal for 97% of the sperm to be misshapen. Once again, this doesn’t matter with IVF as the healthy sperm can be selected. But if not, your partner/ donor’s sperm should be above 15% normal to have a decent chance of natural conception.

Morphology is considered the most significant semen parameter. Research shows that the percent of morphologically normal sperm are significant predictors of time to pregnancy. Even independent of sperm concentration.¹

I hope this helps navigate some of those fertility tests. Of course, they can be more complex if you have PCO or endometriosis. Wherever you’re at, we are experienced in helping every step of the way.