Fertility Testing Q&A

adirat

Hi everyone,

Since several of us are starting fertility testing, and others of us who have knowledge on these topics aren't in WTO/TWW every day, I thought it may be helpful to have a thread dedicated to fertility bloodwork questions. You can post your questions about bloodwork that has been ordered, normal/abnormal ranges, next steps, concerns, or any other topic related to your early testing. 

This will generally be a safe space so feel free to ask your stupid questions or your graduate level ones Just keep in mind that this is a science-based board, so answers should come from your medical experience with your doctor. Online citations should be from reputable sources. 

I hope this will be a productive conversation. Like our supplements, postpartum, and CM/CP threads, please do resurrect this thread in the future as other questions arise.

If you have knowledge about a type of fertility bloodwork and you'd like to volunteer to be a resource, let me know and I'll edit this post to put your name in (see below).

Any testing questions: @saralee797

CD3 Bloodwork: @tripledaggerWed95976 @laurad75

7dpo Bloodwork: @tripledaggerWed95976

Progesterone: @nlwz123 @adirat @tripledaggerWed95976

AMH: @laurad75

Thyroid: @adirat (hypo) @sheknows6 (hyper)

Diabetes: @Willrunforwine21 (men) @sugargirl1019 (women)

HSG/Saline Sonogram: @eggplantface @laurad75

Fibroids: @eggplantface

APS/Hughes Syndrome: @Neikoda


(Note: This was originally "Fertility Bloodwork Q&A" but has expanded to include other aspects of fertility testing. We welcome questions on any testing or bloodwork topic.)

adirat

OK! I partially started this for selfish reasons so I will dive right in.

I have been diagnosed with hypothyroid (treated with levoxyl) and low progesterone, so I'm very familiar with the bloodwork, levels, and treatments for those two conditions. Ask away!

For me, I would like some information about AMH.

My gynecologist did CD3 FSH and AMH. My FSH was 7.9 and my AMH was 1.79. Both fall into the "normal" range but she said that an AMH of 1.79 is a bit lower than expected for my age (I am 27). I googled AMH charts, and some consider my number to be OK but others consider it to be low. But these are all charts on seemingly random websites -- I can't find anything reputable. Does anyone have insights on this? Should I be worried?

tripledaggerWed95976

Hi @adirat thanks for starting this!  I could be a resource for CD3, 7 DPO, and progesterone blood work.

eggplantface

I can answer questions about the HSG and saline sonogram and fibroid issues, in case anyone is dealing with that. 

I got all the blood work done but I didn't get much detail from my doctor so I can't help explain what the numbers mean

JuneRoseRuby

@adirat thanks for starting this! I know I will have tons of questions after Thursday's appointment! My H has type 1 diabetes so I will try to help out with what info I have learned about how male fertility is affected by type 1 diabetes. I also know that @WillRunForWine21 is a good resource too! 

linzrunz

It's not really blood work, but I have an ultrasound scheduled on Monday to check for any abnormalities or any red flags. Can we add that to the list? I'm curious as to what to expect and what exactly they'll be looking for. 

adirat

@linzrunz I actually just had an ultrasound to look for ovarian cysts, endometriomas, or something else that could be causing my severe ovulation pain on the left side. It included both internal (transvaginal) and external (abdominal) component. The tech took pictures of my uterus (noting shape and size) and each ovary (noting shape and size) -- though she couldn't find my left ovary so she just took pictures of the shadowing I had in the area where it should be and where I felt pain. If she'd been able to find my left ovary as quickly as my right, I estimate the entire thing would have taken ten minutes tops.  

The tech wasn't able to give me a diagnosis or tell me what she saw, which was frustrating, but when I asked about follicles, she did tell me that I had a follicle on my right ovary that looked about ready to go (I had my u/s on CD13 and according to temps ovulated on CD15). 

I didn't find it very uncomfortable except that the gel they use for the transvaginal ultrasound is very thick and gloopy, which is gross to find in your underwear half an hour later. 

Good luck!

linzrunz

Thank you @adirat!! I've had transvaginal ultrasounds before, but for completely different reasons. It's nice to know that it won't take too long. Thankfully I scheduled the appointments so that I have the ultrasound and then immediately go see the doc. I'll be going in on CD18 and I usually O between CD16 and CD18, so I was wondering if they'd be able to confirm O. And yes, the gel is definitely no fun! I feel like they always use SO much. 

nikkiandchris

Oh my gosh thank you, the timing on this is perfect. 

I have a progesterone question, I was at an 8 at 7 or 8 dpo, and my OB said this was fine because it was above 5. But I see everywhere that above 10 is where it should be. Also, my FSH is 10.24, and the google rabbit hole was not friendly on this one. Again the OB said not to worry because I'm ovulating so it's not an issue? I guess my big question is what is my next step? I originally went in for testing after 8 months of trying because my LP is short (normally 8-9 days) and some cycles I spot beforehand. 

BertieMeetsGertie

I have a pelvic ultrasound scheduled next month to look for uterine polyps. I'll be sure to update you all after I get results! If anyone has pointers for that test, please share! I'm sure I just have to lie there, but maybe there's more to it. 

adirat

@linzrunz My doctor told me to make sure I came in before O so that they could see the size of the follicle and whether there was some other issue happening. It's a far cry from a follicle study, but I have to say, I felt so relieved to know there was an appropriately sized follicle there!

adirat

@nikkiandchris I don't know anything about FSH, sorry. Interested to hear what others have to say. Regarding progesterone, that's on the low end of the "normal" range on my progesterone bloodwork results sheet. If it were happening in isolation, I wouldn't worry, but *possible TW* given what you've said in the past about spotting and faint lines, I would look into it further. For what it's worth, my gynecologist didn't want to prescribe progesterone supplements until other testing like an ultrasound and HSG had been completed -- but I've never had a faint line and you have, so I'd guess that blocked tubes aren't an issue. 

TravelingCouple

This is great as I'm just beginning fertility testing, blood work being the first step. My OB is checking my FSH and progesterone on CD 16 and then again two days after my temp rise. This is clearly not 7dpo as when most people get tested. Not sure why now he's testing it at these two times and I'm wondering if I'm wasting my time. Anyone else had 2dpo blood work for FSH and progesterone?

kyersten

I am also starting fertility testing. DH and I did our initial bloodwork today (my understanding is it's mostly to see we are healthy? But I'm not really sure!)

Now I'm just waiting to start my period within the next week to start my next steps - day 3 bloodwork, a sonogram (I originally misunderstood and thought this was a transvaginal ultrasound but apparently this is different? Also on day 3), and HSG. DH also has to do his SA at some point, we are doing that at home.

I would like to know more about this day 3 sonogram. What does it see that the HSG doesn't? I feel a silly urge to remind them when I make the appointment that I'll still be bleeding, but I'm assuming they realize this! 

For the HSG, the doctor prescribed an antibiotic to start the day before. I've read I should also take a pain reliever before, does anyone suggest this?

Overwhelmed by all the testing but so excited to be on the path to get some answers. Doctor suspects a previous ruptured appendix could be causing an issue but we will know more by next month (hopefully). 

BertieMeetsGertie

@kyersten I'm interested to see if they think your appendix was an issue. I had an appendectomy 8 years ago. It wasn't ruptured, but I basically had horrible pain for a number of months and they couldn't figure out what was going on. Finally they did testing for appendicitis (like, duh!!). When they did the surgery they told me it appeared to have been chronically inflamed. 

leekat14

I'm having a laparoscopy and chromotubation done on Thursday and we are still waiting for SA for H.

spiderlover25

@linzrunz I had an u/s last week to check for fibroids and cysts around 10 dpo and the tech was able to tell me which ovary had ovulated. She said it collapses after ovulation. I think it's dependent on the tech how much information they share though. 

Anna_1021

First of all: @adirat thanks for starting this thread. I'll be lurking, reading, learning from all of you. Thanks.
Comes January we'll also go to this direction if I'm not KU by then (not sooner, because DH is quite reluctant to start fertility testing, I'm guessing it would break his optimism bubble. I'm nervous about prolong it for no good reason, but this way I'll at least have a couple well documented, charted cycle to show to the doc.)

I'm not sure if it's okay to ask about such basic things, and please feel free to direct me to Google I understand completely. But I'm new to this, and would be great if someone could explain the steps that are ahead. I see you mentioning different kind of tests, and I don't know what they are, or what's the usual order to conduct them in. Again, what you wrote so far was already helpful, and I can Google things I don't get yet, just thought maybe someone would be happy to share the main layout details.

zwink1

@adirat, thanks for starting this; this is great!  I don't have much to contribute or have any serious questions as we haven't gotten any results back yet.  We need to get Hs SA done this cycle still -hopefully this week- and then (if we don't have any luck this cycle) I'm doing a full CD3 work up plus thyroid testing.  I will definitely have more questions/more to contribute if/when we hit that point.  If both of those come back clear, we move on to an HSG.

Edit: @Anna_1021 Your Dr should give you a breakdown of the testing path s/he wants to take, and that could change depending on results.  That being said, I believe most start with the least invasive testing they can do based on your symptoms.  Regarding my note above, we're starting with a SA because nothing's less invasive than that  That's sort of a joke, but not really.  At the same time, my Dr gave me a CD3 bloodwork order. I would say that CD3 blood work is the most common first step for female testing. Individual tests will obviously vary by Dr, for example I have potential thyroid issues and that was last tested in March, so my Dr added thyroid evals on, but hormones typically tested include FSH (follicle-stimulating hormone), LH (luteinizing hormone), estradiol/E2, or AMH (anti-mullerian hormone).

I'm sure someone else can add much more info to that.

adirat

Thanks, everyone -- I'm glad this is useful for all of you! 

@Anna_1021
In addition to what @zwink1 I thought this was useful: https://www.thebump.com/a/what-to-expect-at-a-fertility-clinic-appointment 

Bababatty

@kyersten A sonogram is the image produced by the ultrasound, is my understanding. I'd guess they're doing a transvaginal ultrasound because that's pretty standard for day 3 u/s and u/s monitoring once you start treatments. Don't worry, they know you're still bleeding. They usually have an absorbent pad on the table. :-)

ETA An HSG checks to see if there are blockages in your tubes, by injecting dye into your uterus through a catheter. The u/s checks your lining and follicles.

eggplantface

kyersten said:

I am also starting fertility testing. DH and I did our initial bloodwork today (my understanding is it's mostly to see we are healthy? But I'm not really sure!)

Now I'm just waiting to start my period within the next week to start my next steps - day 3 bloodwork, a sonogram (I originally misunderstood and thought this was a transvaginal ultrasound but apparently this is different? Also on day 3), and HSG. DH also has to do his SA at some point, we are doing that at home.

I would like to know more about this day 3 sonogram. What does it see that the HSG doesn't? I feel a silly urge to remind them when I make the appointment that I'll still be bleeding, but I'm assuming they realize this! 

For the HSG, the doctor prescribed an antibiotic to start the day before. I've read I should also take a pain reliever before, does anyone suggest this?

Overwhelmed by all the testing but so excited to be on the path to get some answers. Doctor suspects a previous ruptured appendix could be causing an issue but we will know more by next month (hopefully). 

The CD3 transvaginal ultrasound is to count the number of follicles on your ovaries when they're "resting." The purpose of the HSG is to check the uterine cavity for any protrusions and check that the tubes are clear. It's done with an x-ray (machine is hanging above your abdomen), not ultrasound, and doesn't look at ovaries. When I had the CD3 ultrasound the first time I was 35 and my doc said 10 follicles combined was what they wanted. They may want a higher number if you're younger, but the doc can answer that for you. They'll also inevitably see any possible fibroids or polyps in the uterus, but the actual diagnosis of those will come with the HSG and/or saline sono.

They will expect you to be bleeding so don't feel self-conscious about that. If they don't offer to let you use the bathroom before they take you in the room, just ask, in case you need to remove a tampon. And in an effort to make you less concerned about the bleeding: I used to have super heavy periods before I had fibroids removed, and it was so heavy during my first CD3 test that they pulled out the wand and it was Shining elevator all over the floor. But they know it's coming! They had a disposable mat down already

I didn't have an antibiotic for the HSG, but your doc may be more cautious or something in your history makes him/her want to have that extra layer of protection. I do recommend taking a dose of ibuprofen an hour or so before the procedure, it helps with cramps if you get them. Some women find it painful, some don't, so it's kind of a crap shoot how you'll fare.

And good luck! I know it's seems like a lot but it really is nice to get information about what's going on.

laurad75

This is great thread since these questions come up a lot.  I am happy to be a resource for CD 3 blood work, HSG and AMH.  

kyersten

@adirat I am loving this thread! There is so much out there on the world of google, but it is nice to get information from the ladies on here, that I "know" and can ask specific questions.

@BertieMeetsGertie Apparently appendix removal can actually improve fertility (https://www.cnn.com/2016/08/02/health/female-fertility-improves-without-appendix-or-tonsils/), according to the study cited in this article. So supposedly an appendectomy isn't always a bad thing.

However, the way my doctor explained it, infection from the appendix (in my case, my appendix was ruptured before it was removed due to a misdiagnosis) can travel down to the fallopian tube on the same side of your appendix and, if let go long enough (as was my case), can spread to damage the other tube as well. Since yours was inflamed, it probably wouldn't hurt to mention it to an RE. My doctor was really interested in that part of my history, but we won't know really what is going on until the results of the tests.

@Bababatty and @eggplantface Thank you for the information! My RE office calls it a sonogram, but it sounds like they mean transvaginal ultrasound. I'll clarify with them when I go again. Thank you for the information on that and on the HSG! I bleed a lot on day 3 so when they said when they wanted to do the ultrasound, I was kind of dubious - but I am glad to hear they prepare for it. It also helps to clarify why they are doing each one, thank you!

swimsister

@adirat this is so great!

1) Some of you have been trying less than 1 year and are already going down this path, did you know you had a pre-existing condition or other reason that you decided to get a jump start on this?

2) Does SA typically come first or blood work or are they done in conjunction with each other?

WillRunForWine21

@adirat echoing the others with gratitude.

Also echoing @JuneRoseRuby i can talk about type 1 diabetes/neurological complications on the guy side. my H first SA had everything on the cusp of low (count, motility, testosterone) so he has to go back for a repeat. we decided after theach second SA we would talk about more testing. mostly we would want to be in  a financial place where we can make treatment decisions solely on medical advice vs. finances so it would likely be a bit before more testing but it's amazing to have this resource.

laurad75

@swimsister I am AMA (41) so when we started trying my doctor ran baseline bloodwork.  My AMH count was 'very low' so we were referred to an RE right away.  They ordered additional blood work, HSG and SA for H.  

adirat

sorry I am on mobile but I will update the lead post when I get home tonight. Glad this is useful!

@laurad75 I am 27 and my AMH came back at 1.79 -- my gyno said this is normal range but a little low for my age. Info online is so conflicting -- on some charts 1.79 is normal and on others it is low. What was your experience? Should I be more aggressive with testing? We are in cycle 7 but I have endometriosis. 

@swimsister I am on cycle 7 and beginning testing. I have endometriosis (suspected -- I have all the symptoms but declined to have exploratory surgery when I was diagnosed at age 20. But, I responded to medication for it and my gyno said I should operate as though I have it for sure). My gyno told me to begin fertility testing after six unsuccessful cycles because every cycle I don't conceive is a cycle where my endometriosis pain and bleeding get worse and potentially cause more damage. She started me with bloodwork and an ultrasound. She also wrote a prescription for an SA for my husband -- she recommended it asap since it is by far the least invasive type of test. (of course has he done it yet, no)

laurad75

@adirat From what I understand, they are looking for it to be about 2 or higher so 1.79 wouldn't be anything to panic about.  Mine was .22 which is in the 'very low' range.  Was your FSH tested too?  At 27 I suspect you will have to hit the one year mark before most doctors will agree to get more aggressive.  

adirat

@laurad75 thanks, that is helpful to know. My fsh was 7.9 which she said was normal. 

Anna_1021

@zwink1 @adirat Thanks for the answers. I'll check the article and also lurk here more. Learn
My doc said to keep trying for a year and only come back after that. Due to some issues even though the 1 year mark has passed timewise we are only at about cycle 9-10. Dr wasn't very supporting last time with my ttc bsc so I only want to visit him again after that 12 cycles, and with some sort of an action plan in mind.
Considering switching to another doc but want to give him one more chance (he has great reviews and our first encounter was great). 
Anyhow, thanks  

JuneRoseRuby

@swimsister My H has type 1 diabetes which is a know to affect fertility, and I am right around the corner from one year anyways. I think most of the girls that have gone to the RE already before a year mostly have known diagnoses/conditions/age that affect fertility.  Since your age is still relatively young and you haven't been TTC for a year yet, I wouldn't worry yet if you don't have any known fertility factors. 

Bababatty

@swimsister I think a lot of people who suspect they may have an issue but have not seen or are not ready to see an RE get the SA done first with a urologist or PCP. We did that because we were 90% certain DH had a problem based on existing medical condition and treatment for it. We turned out to be right, but the lab we used was terrible so those results were worthless. Honestly, I'd have rather we waited and did it with the RE's own lab--as we did several months later as part of our initial panel of testing. Of course that was just our experience.

@Anna_1021 I think all REs are different, but at my first appointment they gave us a checklist of all the tests and tasks we needed to accomplish and told us to come
back when that was done. Off the top of my head it included Day 3 bloodwork and u/s to see how many follies I had; a whole panel of additional bloodwork--what all of this bloodwork entailed, I don't know since it ended up being irrelevant to our issue, but IIRC there were STD tests in there, too. We also opted for genetic testing to ensure we weren't carriers for anything horrible. That was optional.; an HSG; an SA; and possibly some others. This was standard for their office. Good luck!

Dilynne

I have very general questions.

I have an appointment coming up on Friday to talk to my doctor about the fact that I'm not ovulating. Someone told me what blood work to ask for and I don't remember what they said or what thread they said it in.

Can anyone tell me what blood work I should be requesting? Depending on how this appointment goes and if she is dismissive of my concerns, I may be looking for another doctor in the near future. 

As a small backstory reminder - we've been actively TTC for 8 months, and 3 months in she put me on Metformin without doing any blood work other than a prenatal vitamin panel. 

eggplantface

@Dilynne I can't remember specifically what some of the tests were looking at on each day, but here's the tests my RE ordered and on what days:

CD1 bloodwork
CD3 bloodwork and ultrasound
Between CD5 and CD12: HSG
Between CD5 and CD12: saline sonogram, if needed (I needed it, it maps the uterus with more detail if you have polyps or fibroids, but most women don't need it)

My gyno also ordered a progesterone test for 7DPO (and make sure it's 7DPO and not just CD21. I told her I don't ovulate until CD21 and she was all "oh, then do it 7 days after that"). However, my RE said he doesn't normally test progesterone, and I don't know why because it seems like low progesterone is a potential issue. Others may have more info on that.

Like I said, I can't remember what days they look for which hormones in the bloodwork, but they measure AMH (egg reserve), FSH, and estrogen.

Here is the link to my RE's practice: www.shadygrovefertility.com
They have a lot of information about testing and fertility.

kyersten

@eggplantface I'm at shady grove fertility as well and like them a lot so far!

RedBreast35

@Dilynne I think I found where you asked about bloodwork in WTO.  It was @antoto who answered and I copied & pasted what she wrote because she mentioned some tests I hadn't heard about before:
  "If it were me I would call in to request testing for next month with an OB - Ask for CD3 blood work for androgens, AMH, TSH, 3 hr. Glucose, Prolactin, and DHEA-S.  Then an ultrasound on CD 14 (or when you turn an LH test positive) and progesterone bloodwork on CD21 (or 7 days after confirmed ovulation).  Without that info, since you have been TTC less than a year, it might be tough getting in with an RE until Feb if you hit the year mark (although I hope you won't)."

[Deleted User]

RedBreast35 said:

@Dilynne I think I found where you asked about bloodwork in WTO.  It was @antoto who answered and I copied & pasted what she wrote because she mentioned some tests I hadn't heard about before:
  "If it were me I would call in to request testing for next month with an OB - Ask for CD3 blood work for androgens, AMH, TSH, 3 hr. Glucose, Prolactin, and DHEA-S.  Then an ultrasound on CD 14 (or when you turn an LH test positive) and progesterone bloodwork on CD21 (or 7 days after confirmed ovulation).  Without that info, since you have been TTC less than a year, it might be tough getting in with an RE until Feb if you hit the year mark (although I hope you won't)."

So those are the tests my RE ran, but I know I had some tests done before then.  I think it's the test for egg reserve/health - estrodiol or something?  I'll try searching for my notes and see what I can find.

Dilynne

@RedBreast35 How did you find that!! Thanks  

@antoto Thanks

I'm glad ya'll are helping me out.  No one I know is even thinking about TTC so it's a little lonely over here.

laurad75

@Dilynne That's why we all love this community so much!

saralee797-2

I am 32 and no previous history of anything. Same for my H. My OB said if I wasn't KU within 6 months to call her. I did after 8 months (some NTNP) and when I told her I had a couple long cycles she referred me to an RE. We completed all the testing and everything came back normal except for my TSH. I was prescribed Synthroid and they did f/u blood work. Point is, if you think something is up and are interested in getting the testing done, it can't hurt to ask. I think it depends on the doctor whether they will refer you or not. I know mine did not start trying until she was older so that might have something to do with it. I think it is important to advocate for yourself. I am happy to be a resource on any of the testing and what to expect. Feel free to PM me too.