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Conception isn’t always as easy as one might think. As many as 16% of couples in the United States have trouble conceiving. About one third is from female disorders, one-third from male disorders, and the remaining third has unknown causes (1).
After 6 months to a year of trying to conceive with no success, a couple may want to consider assistance for this precious journey. Some couples may need to enhance natural fertility through nutrition and lifestyle guidance, while others may need to go a step further into Assisted Reproductive Therapy (ART).
Either way, before jumping into ART, the next step should be a thorough lifestyle assessment, physical exam, and lab testing to gauge where the couple’s fertile markers stand.
What is a Lifestyle Assessment?
When first working with a couple seeking help, it is important to assess the medical history, current diet, and lifestyle to discern where the root of the problem may lie. Given that a significant number of infertility issues cannot be explained, a couples-based approach to assess lifestyle factors is a cost-effective way to improve reproductive success.
There is a strong association between diet, exercise and other psychosocial factors that affect ovulation, conception, implantation, and embryonic and fetal development (2). Modifiable factors in both men’s and women’s daily lives can positively affect endocrine and metabolic pathways that are critical for reproduction.
Factors that a physician may look at:
1. Underlying and unknown health conditions that may interfere with conception and taking a pregnancy to full term
2. Your diet and your partner’s diet to assess if it is optimized for your body to conceive
3. Stress and anxiety: each can play a role in metabolic changes to the body that interfere with conception
4. Micro-nutrient support through vitamins and supplements
5. Egg or sperm quality issues or irregularities in ovulation that can be addressed via integrative therapies
Key Labs to Test Fertility
The next step is testing with key fertility labs as well as general labs to get the best picture of the physiological aspects that may be the obstacle to a healthy conception and pregnancy. Many of the important labs are run on Day 3 of a woman’s menstrual cycle, while Progesterone is the only lab which is necessary to check 7 days after ovulation or Day 21 of a 28-day cycle.
Why Functional Normal or Fertile Ranges May Not Be Accurate
When looking at lab results, “normal ranges” that are provided as a guide with the lab results. Have you ever felt like there is something not right with your health, but your doctor told you that “all your labs are within normal ranges”? This is why many naturopathic, integrative, and functional doctors don’t look at the “functional normal” or fertile ranges that apply to those in optimal overall health and fertility health.
For example, when certain androgen hormones, like testosterone or DHEA-S, are too high, then this can indicate polycystic ovary syndrome (PCOS). When insulin is too high, it can indicate PCOS as well, however the normal range provided will actually present as high as some of the levels that functionally look like PCOS. What matters most with these labs is the entire picture – including the signs and symptoms of the individual – instead of a pre-determined norm based on a generic one size fits all approach.
Fertility Lab Testing Ranges
When you are working with your physician and fertility expert, discuss the following labs to ensure a clear picture of your optimal fertility:
FSH - Fertile range: 6-9 mIU/ml
LH – Fertile range: <7 mIU/ml; A surge of >20 mIU/ml is typical 48 hours prior to ovulation
AMH – Fertile range 1-4 ng/mL
Estradiol – Day 3 – Fertile range: 25-75 pg/ml
Progesterone – 7 days past ovulation or day 21 of 28 day cycle – Fertile range: >15 mg/ml
17-Hydroxyprogesterone – Day 3 – Fertile range: 20-100 ng/dl; Luteal phase – 100-500 ng/dl
Prolactin – Day 3 – Normal range <24 ng/ml
TSH – Functional normal range: 1.0-1.7 mIU/ml
Free Triiodothyronine (Free T3) – Functional normal range: 3.5-4.4 pg/ml
Free Thyroxine (Free T4) – Functional normal range: 1.5-2 ng/dl
Total Testosterone – Functional normal range: 20-30 ng/dl
Free Testosterone – Functional normal range: 2-3.6 pg/ml
DHEA-S – Functional normal range: 75-150 ug/dl
Sex Hormone Binding Globulin (SHBG) – Functional normal range: 18-114 nmol/l
Fasting Insulin – Functional normal range: <10 mlU/ml
AMH – Fertile range 1-4 ng/mL
Estradiol – Day 3 – Fertile range: 25-75 pg/ml
Progesterone – 7 days past ovulation or day 21 of 28 day cycle – Fertile range: >15 mg/ml
17-Hydroxyprogesterone – Day 3 – Fertile range: 20-100 ng/dl; Luteal phase – 100-500 ng/dl
Prolactin – Day 3 – Normal range <24 ng/ml
TSH – Functional normal range: 1.0-1.7 mIU/ml
Free Triiodothyronine (Free T3) – Functional normal range: 3.5-4.4 pg/ml
Free Thyroxine (Free T4) – Functional normal range: 1.5-2 ng/dl
Total Testosterone – Functional normal range: 20-30 ng/dl
Free Testosterone – Functional normal range: 2-3.6 pg/ml
DHEA-S – Functional normal range: 75-150 ug/dl
Sex Hormone Binding Globulin (SHBG) – Functional normal range: 18-114 nmol/l
Fasting Insulin – Functional normal range: <10 mlU/ml
Depending on your circumstances, you may need additional imaging or further advanced testing. These tend to be more invasive and range from an ultrasound of the uterus (sonohysterogram) to detect fibroids or other abnormalities, to a hysterosalpingogram to look for anatomical issues in the uterus and fallopian tubes that may be blocking a successful pregnancy.
No matter what stage you are in on your pregnancy journey, working to achieve optimal lab results is of utmost importance for your health and ultimately a healthy pregnancy. Your doctor and fertility specialist will help you understand more about these so that you can feel comfortable knowing you are under the best care.
