Motherhood

Understand Your Fertility Tests

1 January

When trying to get pregnant and maintain an healthy pregnancy, there are key things to know about your reproductive system and your partners’. But it can be a bit overwhelming trying to understand all the hormone tests and fertility bloodwork results. So the American Pregnancy Association and Fairhaven Health helps break it down for you.

Hormone and fertility tests

A key piece of information to know is when during your menstrual cycle you can conceive. We call this your “fertility window.” You can determine your 10-day fertility window using our ovulation calculator. To know more precisely when you’re ovulating we recommend using Fairhaven Health’s urine-based tests kits (used to identify the surge in luteinizing hormone that occurs 12-48 hours before ovulation) or electronic fertility monitors, such as the OvaCue Wireless Fertility Monitor.

There are a number of home fertility screening tests available for both women and men which can provide useful information about hormone levels, how to get and keep a healthy sperm count, sperm motility, and more.

Fertility test levels

Fairhaven Health provides these charts to help patients better understand their hormone and fertility bloodwork and talk with their doctors. These charts are not for self-diagnosis or as a substitute for good medical care. NOTE: Each lab has its own normal values, and those presented in these charts are just an average.

If your test results indicate some gaps in nutrition, Fairhaven Health offers a high-quality line of supplements to support your fertility health and your partner’s, such as best-selling FertilAid and clinically-validated FH PRO.

Female Hormone Levels

Hormone to Test
Time
to Test
Normal
Values
What Value Means

Follicle Stimulating Hormone (FSH)
Day 3
3-20mIU/ml
FSH is often used as a gauge of ovarian reserve. In general, under 6 is excellent, 6-9 is good, 9-10 fair, 10-13 diminished reserve, 13+ very hard to stimulate. In PCOS testing, the LH:FSH ratio may be used in the diagnosis. The ratio is usually close to 1:1, but if the LH is higher, it is one possible indication of PCOS.

Estradiol (E2)

25-75pg/ml
Levels on the lower end tend to be better for stimulating. Abnormally high levels on day 3 may indicate existence of a functional cyst or diminished ovarian reserve.

Estradiol (E2)
Day 4-5 of meds
100+pg/ml or 2x Day 3
There are no charts showing E2 levels during stimulation since there is a wide variation depending on how many follicles are being produced and their size. Most doctors will consider any increase in E2 a positive sign, but others use a formula of either 100 pg/ml after 4 days of stims, or a doubling in E2 from the level taken on cycle day 3.

Estradiol (E2)
Surge/hCGday
200+ pg/ml
The levels should be 200-600 per mature (18 mm) follicle. These levels are sometimes lower in overweight women.

Luteinizing Hormone (LH)
Day 3
< 7mIU/ml
A normal LH level is similar to FSH. An LH that is higher than FSH is one indication of PCOS.

Luteinizing Hormone (LH)
SurgeDay
>20 mIU/ml
The LH surge leads to ovulation within 48 hours.

Prolactin
Day 3
< 24ng/ml
Increased prolactin levels can interfere with ovulation. They may also indicate further testing (MRI) should be done to check for a pituitary tumor. Some women with PCOS also have hyperprolactinemia.

Progesterone (P4)
Day 3
< 1.5ng/ml
Often called the follicular phase level. An elevated level may indicate a lower pregnancy rate.

Progesterone (P4)
7 dpo
> 15ng/ml
A progesterone test is done to confirm ovulation. When a follicle releases its egg, it becomes what is called a corpus luteum and produces progesterone. A level over 5 probably indicates some form of ovulation, but most doctors want to see a level over 10 on a natural cycle, and a level over 15 on a medicated cycle. There is no mid-luteal level that predicts pregnancy. Some say the test may be more accurate if done first thing in the morning after fasting.

Thyroid Stimulating Hormone (TSH)
Day 3
.4-4uIU/ml
Mid-range normal in most labs is about 1.7. A high level of TSH combined with a low or normal T4 level generally indicates hypothyroidism, which can have an effect on fertility.

Free Triiodothyronine (T3)
Day 3
1.4-4.4pg/ml
Sometimes the diseased thyroid gland will start producing very high levels of T3 but still produce normal levels of T4. Therefore measurement of both hormones provides an even more accurate evaluation of thyroid function.

Free Thyroxine (T4)
Day 3
.8-2ng/dl
A low level may indicate a diseased thyroid gland or may indicate a non- functioning pituitary gland which is not stimulating the thyroid to produce T4. If the T4 is low and the TSH is normal, that is more likely to indicate a problem with the pituitary.

Total Testosterone
Day 3
6-86ng/dl
Testosterone is secreted from the adrenal gland and the ovaries. Most would consider a level above 50 to be somewhat elevated.

Free Testosterone
Day 3
.7-3.6pg/ml

Dehydroepiandrosterone Sulfate (DHEAS)
Day 3
35-430ug/dl
An elevated DHEAS level may be improved through use of dexamethasone, prednisone, or insulin-sensitizing medications.

Androstenedione
Day 3
.7-3.1ng/ml

Sex Hormone Binding Globulin (SHBG)
Day 3
18-114 nmol/l
Increased androgen production often leads to lower SHBG

17 Hydroxyprogesterone
Day 3
20-100 ng/dl
Mid-cycle peak would be 100-250 ng/dl, luteal phase 100-500 ng/dl

Fasting Insulin
8-16 hours fasting
< 30mIU/ml
The normal range here doesn’t give all the information. A fasting insulin of 10-13 generally indicates some insulin resistance, and levels above 13 indicate greater insulin resistance.

Blood Glucose Levels

Type of Test
Time to Test
Normal Values
What value means

Fasting Glucose
8-16 hours fasting
70-110mg/dl
A healthy fasting glucose level is between 70-90, but up to 110 is within normal limits. A level of 111-125 indicates impaired glucose tolerance/insulin resistance. A fasting level of 126+ indicates type II diabetes.

Glycohemoglobin/ Glycosylated Hemoglobin (HbA1c)
anytime
< 6%
An HbA1c measures glucose levels over the past 3 months. It should be under 6% to show good diabetic control (postprandial glucose levels rarely going above 120). Good control reduces the risk of miscarriage and birth defects.

Glucose Tolerance Test with Insulin (GTT / IGTT)

Time
Normal Glucose Values
Normal Insulin Values
What the Results Mean

Fasting
< 126 mg/dl
< 10 mIU/ml
Normal glucose results are 70-90, 111 or over is impaired, 126 or over is diabetic. Insulin levels above 10 show insulin resistance.

? hour
< 200 mg/dl
40-70 mIU/ml
A truly normal glucose response will not exceed 150.

1 hour
< 200 mg/dl
50-90 mIU/ml
Some want to lower the threshold on glucose to < 180 to identify early stages of diabetes. Insulin > 80 shows insulin resistance, or a level 5 times that of the fasting level (i.e., a fasting of 11 followed by a 1 hour > 55)

2 hours
< 140 mg/dl
6-50 mIU/ml
A truly normal glucose response is 110 or lower. Insulin > 60 is IR.

3 hours
< 120 mg/dl

4 hours
< 120 mg/dl

Cholesterol, Triglycerides and C-Peptide

What to Test
Time to Test
Normal Values
What value means

Triglycerides (TG)
8-16 hours fasting
< 200mg/dl
Borderline high is 200-400, high is 400-1000, and very high is >1000. Elevated levels are a risk factor for coronary artery disease.

Cholesterol Total
8-16 hours fasting
< 200mg/dl
A level of 200-239 is borderline high, and a level 240+ is high. Increased levels are associated with increased risk of heart disease.

low-density lipoprotein cholesterol (LDL)
8-16 hours fasting
< 160mg/dl
This is the “bad” cholesterol. In someone with one risk factor for heart disease, < 160 is recommended, with 2 risk factors < 130, and those with documented coronary heart disease the target is < 100

high-density lipoprotein cholesterol (HDL)
8-16 hours fasting
> 34mg/dl
This is the “good” cholesterol which may be increased through a healthy diet and exercise. The HDL level is usually estimated by taking total cholesterol and subtracting LDL, rather than by direct measure.

C-peptide
8-16 hours fasting
0.5to 4.0 ng/ml
Levels increase with insulin production.

Creatinine

< 1.4mg/dl
Levels1.4 mg/dl and higher may indicate renal (kidney) disease or renal dysfunction.

Male Hormone Levels

Hormone to Test
Normal Values
What value means

Testosterone
270-1100 ng/dl
Testosterone production is stimulated by Leydig cells in the testicles. Low levels of testosterone combined with low FSH and LH are diagnostic of hypogonadotropic hypogonadism.

Free Testosterone
.95-4.3 ng/dl

% Free Testosterone
.3% – 5%
A normal male has about 2% free, unbound testosterone

Follicle Stimulating Hormone (FSH)
1-18 mIU/ml
Basic hormone testing for males often only includes FSH and testosterone.

Prolactin
< 20 ng/ml
A level two or three times that of normal may indicate a pituitary tumor, such as a prolactinoma, which may lead to decreased sperm production. Elevations can be treated with bromocriptine.

Luteinizing Hormone (LH)
2-18 mIU/ml
LH stimulates Leydig cells and production of testosterone. A problem with LH levels alone is rarely seen, so testing is only needed if testosterone level is abnormal.

Estradiol (E2)
10-60 pg/ml

Progesterone (P4)
.3-1.2 ng/ml

Progesterone in Pregnancy

When
Normal Values
What Level Means

Mid-Luteal Phase
5+ ng/ml
As mentioned above, a level of 5 indicates some kind of ovulatory activity, though most doctors want to see a level over 10 on unmedicated cycles, and over 15 with medications. There is no mid-luteal level that predicts pregnancy.

First Trimester
10-90 ng/ml
Average is about 20 at 4 weeks LMP, and 40 at 14 weeks LMP. It is important to note that while a higher progesterone level corresponds with higher pregnancy success rates, one cannot fully predict outcome based on progesterone levels. Progesterone supplementation is unlikely to help if started after a positive pregnancy test.

Second Trimester
25-90 ng/ml
Average is 40 at beginning, 90 at end.

Third Trimester
49-423 ng/ml
Usually peaks at about 175.

Excellent graph at http://www.repro-med.net/progesterone-levels-during-pregnancy.

hCG Levels in Early Pregnancy

Days Post Ovulation/Retrieval
Weeks/Days LMP
Average Singleton Level
Average Twin Level

10
3w 3d
25

12
3w 5d
50

14
4w 0d
100

16
4w 2d
200

Early-detection pregnancy tests (detecting 20 miu/ml hcg) can assist you in detecting pregnancy before your missed period.

Oral Glucose Tolerance Test for Gestational Diabetes

Time
Normal Values
Gestational diabetes is diagnosed if 2 or more levels are above the normal range. It is treated through diet, insulin injections, and sometimes with metformin. You may want to check All About Gestational Diabetes.

Fasting
< 105 mg/dl

1 hour
< 190 mg/dl

2 hours
< 165 mg/dl

3 hours
< 145 mg/dl