Fertility Blood Tests

Learn About Common Blood Tests for Male and Female Infertility

Blood work is an integral part of fertility testing and treatment.  The most basic fertility evaluation for the woman often includes testing for ovarian function (FSH and estradiol) as well as a few other hormones (TSH and prolactin).  Other scenarios (e.g. PCOS or recurrent pregnancy loss) may warrant other types of bloodwork to be analyzed.  Also, any couple pursuing intrauterine insemination (IUI) or in vitro fertilization (IVF) is required to have infectious disease screening prior to treatment.  Your physician will individualize the type of bloodwork to be ordered based upon your very specific situation.

Common Fertility Blood Tests

Anticardiolipin Antibodies

Blood Type and RH

Cystic Fibrosis

Estradiol

Follicle Stimulating Hormone (FSH)

Infectious Disease Screening

Insulin Resistance / PCOS Testing

Luteinizing Hormone(LH)

Lupus Anticoagulant (PT, Russell Viper Venom)

Progesterone

Prolactin

Quantitative HCG

Thyroid Stimulating Hormone (TSH)

What does this test check for? Cardiolipin is a molecule found in your blood platelets and various cell membranes. It is one of a group of molecules called phospholipids. You need cardiolipin in order to help regulate blood clotting throughout your body. Sometimes though, your body can mistake cardiolipin for a foreign substance. As a result, your body creates antibodies that attack the cardiolipin molecule. These anti-cardiolipin antibodies have been found to be present in greater amounts in women with recurrent miscarriage. There are 3 types of anti-cardiolipin antibodies. They are referred to as IgA, IgM and IgG. Anti-cardiolipin IgG is the only type of anti-cardiolipin antibody that has been implicated as a potential cause of recurrent miscarriage. When is this Test done? If you are coming to the Texas Fertility Center with a history of recurrent miscarriage and this test has not been previously performed, your physician will typically order this blood test following your initial consultation. Anti-cardiolipin antibodies can be measured anytime in your cycle, although it is best not to perform this test if you are in the middle of a miscarriage. Why is this test done? Many studies have suggested that antibodies produced by the immune system may play a major role in preventing successful conception. Though these studies are somewhat controversial, many reports indicate that women with anti-cardiolipin antibodies have a harder time getting pregnant and carrying their pregnancies to term. This may be because anti-cardiolipin antibodies can cause tiny blood clots in the placenta, preventing blood from flowing freely between the fetus and the mother Who needs this test? Though anyone can have anti-cardiolipin antibodies in their bloodstream, some people are more likely to have persistent anti-cardiolipin problems. People with autoimmune diseases, like Lupus and HIV/AIDS are more likely to have high levels of anti-cardiolipin. It has also been discovered that up to 15% of infertility patients also have higher-than-normal levels of anti-cardiolipin. What do the test results tell me? Normal Results: Normal results mean that you have typical levels of anti-cardiolipin antibodies in your blood. Abnormal Results: Abnormal results indicate that you have higher-than-normal levels of anti-cardiolipin antibodies in your blood. Levels that are slightly elevated may not be a cause for concern. Sometimes, anti-cardiolipin antibodies are elevated temporarily due to colds or the flu. Levels that are significantly elevated – especially levels of IgG - may interfere with your ability to become pregnant or carry a pregnancy to term. What will my TFC doctor do if this test is abnormal? Your doctor may suggest that you repeat the test to make sure that it is truly abnormal, as this is a difficult test for the laboratory to accurately perform. In the event that your levels are significantly abnormal, your physician may prescribe a medication to decrease the likelihood that you will form a clot - such as aspirin, heparin, Lovenox or prednisone.

ANTICARDIOLIPIN ANTIBODIES

What does this test check for?

Cardiolipin is a molecule found in your blood platelets and various cell membranes. It is one of a group of molecules called phospholipids. You need cardiolipin in order to help regulate blood clotting throughout your body. Sometimes though, your body can mistake cardiolipin for a foreign substance. As a result, your body creates antibodies that attack the cardiolipin molecule. These anti-cardiolipin antibodies have been found to be present in greater amounts in women with recurrent miscarriage. There are 3 types of anti-cardiolipin antibodies. They are referred to as IgA, IgM and IgG. Anti-cardiolipin IgG is the only type of anti-cardiolipin antibody that has been implicated as a potential cause of recurrent miscarriage.

When is this Test done?

If you are coming to the Texas Fertility Center with a history of recurrent miscarriage and this test has not been previously performed, your physician will typically order this blood test following your initial consultation. Anti-cardiolipin antibodies can be measured anytime in your cycle, although it is best not to perform this test if you are in the middle of a miscarriage.

Why is this test done?

Many studies have suggested that antibodies produced by the immune system may play a major role in preventing successful conception. Though these studies are somewhat controversial, many reports indicate that women with anti-cardiolipin antibodies have a harder time getting pregnant and carrying their pregnancies to term. This may be because anti-cardiolipin antibodies can cause tiny blood clots in the placenta, preventing blood from flowing freely between the fetus and the mother

Who needs this test?

Though anyone can have anti-cardiolipin antibodies in their bloodstream, some people are more likely to have persistent anti-cardiolipin problems. People with autoimmune diseases, like Lupus and HIV/AIDS are more likely to have high levels of anti-cardiolipin. It has also been discovered that up to 15% of infertility patients also have higher-than-normal levels of anti-cardiolipin.

What do the test results tell me?

Normal Results: Normal results mean that you have typical levels of anti-cardiolipin antibodies in your blood.

Abnormal Results: Abnormal results indicate that you have higher-than-normal levels of anti-cardiolipin antibodies in your blood. Levels that are slightly elevated may not be a cause for concern. Sometimes, anti-cardiolipin antibodies are elevated temporarily due to colds or the flu. Levels that are significantly elevated – especially levels of IgG – may interfere with your ability to become pregnant or carry a pregnancy to term.

What will my TFC doctor do if this test is abnormal?

Your doctor may suggest that you repeat the test to make sure that it is truly abnormal, as this is a difficult test for the laboratory to accurately perform. In the event that your levels are significantly abnormal, your physician may prescribe a medication to decrease the likelihood that you will form a clot – such as aspirin, heparin, Lovenox or prednisone.

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BLOOD TYPE AND RH

What does this test check for?

Blood group and Rh type

When is this test done?

This test is usually performed as part of the infectious disease panel which is ordered early in your evaluation.

Why is this test done?

It is very important for all women to know their blood type, as certain types of undiagnosed incompatibilities (called Rh incompatability) between a man and woman’s blood can lead to significant problems shortly after their baby is born. If these incompatibilities are known before or very early in pregnancy, these potential problems can be avoided. This test is also performed before some surgeries, so that in the unlikely event that a blood transfusion is needed, we can determine what type of blood a patient can safely receive.

Who needs this test?

All patients are tested to determine their blood type and Rh as part of the routine screening performed at TFC.

What do the test results tell me?

There are 4 blood groups: A, B, AB, and O, as well as two types of Rh (positive or negative). This test will give you both your blood type as well as your Rh factor.

What will my TFC doctor do as a result of this test?

This issue is usually only important once you are pregnant. For example, if you have a miscarriage and you are Rh positive and your partner is Rh negative, we will give you a medication that prevents you from making antibodies in a future pregnancy. Once you are pregnant with a healthy ongoing pregnancy and we have sent you back to your OB/GYN for continuing care, it will be up to them to give you treatment at the appropriate time during your pregnancy.

 

CYSTIC FIBROSIS

What does this test check for?

Cystic fibrosis is a common yet serious genetic disorder caused by a variety of different mutations in a gene located on chromosome 7. Every cell in the body has 46 chromosomes (one from the mother and one from the father). Genes are located on these chromosomes. These genes have specific functions in the body and act as a blueprint to control body functions. A specific gene on chromosome 7 is responsible for regulating the normal production of a certain protein called cystic fibrosis transmembrane regulator (CFTR). Any abnormality in this gene can lead to the defective production of this protein, leading to the development of cystic fibrosis. This disease causes a variety of problems including severe respiratory infections and/or obstruction of pancreatic and liver ducts as well as impaired protein digestion. In males, infertility can occur due to an absence of the vas deferens (the tubes that transport sperm from the testes).

When is this test done?

We recommend screening of all couples who are attempting pregnancy. As this is a genetic test, results will not change over time – ie. if you are positive, you will always test positive and if you are negative, you will always test negative. This test can therefore be performed at any time in your life. We will recommend it at your first visit if you have not been previously tested.

Why is this test done?

Cystic fibrosis is an autosomal recessive genetic disease. In order for a child to have the disease, both parents must carry the same mutated gene and both must pass the abnormal gene to the offspring. If only one parent passes the abnormal gene to the offspring, the child will be a carrier but not affected by the disease. If testing determines that you and your partner carry the same mutation, we can offer you a procedure that can allow you to have children that are not affected by this disease.

Who needs this test?

Cystic fibrosis is more prevalent in certain ethnic groups. Caucasians from Northern Europe and Ashkenazi Jews have the highest incidence of cystic fibrosis although other ethnic groups may also be affected. Males who have an abnormal semen analysis where no sperm is seen may have a congenital absence of the vas deferens and should be tested for the CF mutation.

What do the test results tell me?

The test for cystic fibrosis will indicate whether a patient carries the mutation which causes cystic fibrosis.

What will my TFC doctor do as a result of this test?

If the test results indicate that both partners carry the CF mutation, pre-implantation genetic screening may be offered. This screening of embryos allows the couple to have embryos that are not affected or embryos that are carriers but not at risk for the disease to be transferred during an IVF cycle.

 

ESTRADIOL

What does this test check for?

Estradiol is a type of estrogen, which is the major female reproductive hormone. Estradiol is the primary type of estrogen produced by your ovaries. As follicles grow and develop, the cells surrounding the eggs produce and secrete estradiol. This hormone causes a variety of effects throughout the cycle, including thickening of the uterine lining and triggering of the spontaneous LH surge that leads to ovulation.

When is this Test done?

We obtain estradiol levels for a variety of different reasons at a variety of different times during the menstrual cycle (see below).

Why is this test done?

The estradiol blood test measures the level of estradiol in your blood stream. It is commonly performed in women 35 years of age and older in conjunction with a Day 3 FSH test in order to evaluate your ovarian reserve. We also measure estradiol levels on a regular basis during gonadotropin stimulation in order to optimize gonadotropin dosing.

Who needs this test?

A high Day 3 estradiol level can indicate that your ovarian reserve is diminished which can predict a poor response to fertility medications and a lower chance for pregnancy. Patients undergoing stimulation with fertility medications will have their estradiol monitored during the stimulation to evaluate the effectiveness of the medication and to adjust the medication dosage as needed.

What do the test results tell me?

The estradiol blood test is extremely safe and straightforward. We will give you a CPL laboratory requisition that you will take to the lab on the day(s) that you are to get your estradiol measured. When the estradiol level is being checked as part of the panel to evaluate your ovarian reserve, your blood will be drawn on day 2, 3 or 4 of your menstrual cycle. If you are undergoing gonadotropin stimulation – either for IUI or IVF – we will tell you which days you will need to have your blood drawn, as it will vary based on your response to the stimulation medication. When drawn as part of the ovarian reserve testing panel, the estradiol level will give your physician an indication of how likely you are to successfully respond to ovarian stimulation. When drawn as part of a stimulation cycle, the estradiol level will help your physician determine the optimal dose of gonadotropin to give you in order to maximize your follicular development and chance for pregnancy while minimizing your risks of multiple pregnancy and ovarian hyperstimulation syndrome.

What will my TFC doctor do as a result of this test?

Your physician will review the results of the test and make recommendations on the treatment option that will optimize your chances for achieving a pregnancy.

 

FOLLICLE STIMULATING HORMONE (FSH)

What does this test check for?

Follicle stimulating hormone is a hormone produced in the pituitary gland, a small gland located at the base of the brain. In women, FSH stimulates the growth of follicles (eggs) within the ovary. In men, FSH stimulates the testes to produce mature sperm.

When is this test done?

FSH levels are generally checked on day 2, 3 or 4 of the patient’s menstrual cycle.

Why is this test done?

FSH and estradiol levels are checked on cycle day 2, 3 or 4 of the patient’s cycle to help assess the patient’s ovarian reserve. In males, the FSH level (along with other hormone tests) is performed to evaluate testicular function.

Who needs this test?

FSH levels are checked in patients 35 years of age and over as well as in other patients who exhibit signs of ovulatory dysfunction or ovarian failure. In males, the test is ordered if testicular failure is suspected.

What do the test results tell me?

Elevated FSH levels may be a predictor of diminished ovarian reserve. As the ovarian function decreases, the pituitary has to produce more FSH in an attempt to stimulate the ovaries to produce follicles. Menopause occurs when the ovaries stop working. Menopausal women therefore have very high levels of FSH, as the pituitary makes more and more FSH in a vain attempt to get the ovaries to respond. Similarly in males, elevated FSH levels may indicate testicular failure.

What will my TFC doctor do as a result of this test?

Your physician will review your test results and recommend the best treatment option to optimize your chances for pregnancy.

 

INFECTIOUS DISEASE SCREENING

All patients undergoing cycles involving intrauterine insemination (IUI) or In-vitro Fertilization (IVF) are required to have infectious disease screening (IDS). These tests are required to be updated every 12 months.

These tests, listed below, include screening for certain communicable diseases.

Females Male

Blood Type and Rh Factor Blood Type and Rh Factor

HIV 1 and 2 HIV 1 and 2

Hepatitis B Surface Antigen (HbSAg) Hepatitis B Surface Antigen (HbSAg)

Hepatitis B Core Antibody (HepB CoreAb) Hepatitis B Core Antibody (HepB CoreAb)

Hepatitis C Antibody (HCV antibody) Hepatitis C Antibody (HCV Antibody)

RPR (Syphilis) RPR (Syphilis)

Rubella (German measles)

Varicella (Chicken pox)

For patients undergoing Third Party Reproduction (donor oocytes, donor sperm, gestational carriers), there are additional tests that are required by the FDA. These tests are performed at a special laboratory using FDA-approved test kits.

 

INSULIN RESISTANCE/PCOS TESTING

What does this test check for?

Insulin is a hormone produced by the pancreas that is released in small amounts after each meal to help transport glucose to the body’s cells. Insulin resistance is the condition that results when one’s body fails to respond appropriately to normal levels of insulin. The body can compensate for insulin resistance by producing more insulin. This can create an imbalance in the relationship between glucose and insulin. This imbalance may cause abnormal effects in a variety of different organ systems throughout the body.

When is this Test done?

The insulin level is best obtained early in the morning and patients must fast for 8-12 hours prior to having this test drawn to obtain accurate results.

Why is this test done?

This test can be performed for a variety of indications. In our practice, we order a fasting insulin level if we suspect that a patient may have polycystic ovarian syndrome.

Who needs this test?

Patients with suspected polycystic ovarian syndrome.

What do the test results tell me?

An elevated glucose or insulin level may be an indicator of insulin resistance.

What will my TFC doctor do as a result of this test?

Medications may be used to enhance your body’s ability to respond to insulin. Other medications may be used to help you ovulate regularly.

 

LEUTEINIZING HORMONE (LH)

What does this test check for?

Luteinizing hormone is a hormone produced in both men and women. It is secreted from a small gland, called the pituitary gland, which is located at the base of the brain. Like FSH, LH is a gonadotropin hormone (because it stimulates the gonads), and it is necessary for fertility. In women, LH helps trigger ovulation and it also stimulates the corpus luteum to make progesterone after ovulation. In men, LH helps the testes produce and secrete testosterone.

When is this Test done?

At TFC, we rarely draw blood LH levels. Rather, we ask women to use a urine ovulation prediction kit that measures LH. We prefer urine kits as women may have to check their LH levels daily for a week or more and it is just not practical (or enjoyable) to have blood drawn every day. Urine LH levels have been repeatedly proven to be accurate enough for IUI scheduling and ovulation confirmation.

Why is this test done?

The LH test is typically performed to detect ovulation, so that either intercourse or IUI can be appropriately timed. However, the LH test can also be used to evaluate anovulation, ovarian failure, and PCOS. In men, an LH level may be ordered along with FSH and testosterone levels in order to assess testicular function.

Who needs this test?

Abnormal LH levels can have numerous adverse effects on fertility. The LH surge is required to induce ovulation; suboptimal levels of LH may not be adequate enough to induce ovulation. LH secretion at the wrong time of your cycle can interfere with ovulation.

What do the test results tell me?

A timely urinary LH surge suggests that ovulation is occurring.

What will my TFC doctor do as a result of this test?

Failure to detect an LH surge suggests that you may need an injection of medication to cause ovulation to occur. If you do not have a regular LH surge, your physician may choose to give you Ovidrel™ to induce ovulation.

 

LUPUS ANTICOAGULANT (PT, RUSSELL VIPER VENOM)

What does this test check for?

Lupus anticoagulant is a specific type of molecule that can be produced in your bloodstream. It is actually a protein, which causes your blood to clot differently than it normally should. Along with anticardiolipin antibody, lupus anticoagulant raises your risk of forming blood clots, especially in the small blood vessels of the placenta, which can lead to a variety of complications including miscarriage.

When is this Test done?

If you are coming to the Texas Fertility Center with a history of recurrent miscarriage and this test has not been previously performed, your physician will typically order this blood test following your initial consultation. The lupus anticoagulant can be measured anytime in your cycle, although it is best not to perform this test if you are in the middle of a miscarriage.

Why is this test done?

Many studies have suggested that antibodies produced by the immune system may play a major role in preventing successful conception. Though these studies are somewhat controversial, many reports indicate that women with lupus anticoagulant have a harder time getting pregnant and successfully carrying their pregnancies to term. This may be because these antibodies can cause tiny blood clots to form in the placenta, preventing blood from flowing freely between the fetus and the mother

Who needs this test?

Though anyone can have lupus anticoagulant, some people are more likely to have persistent problems as a result. People with autoimmune diseases, like Lupus and HIV/AIDS are more likely to have high levels of lupus anticoagulant. It has also been discovered that up to 15% of infertility patients also have the lupus anticoagulant circulating in their bloodstream.

What do the test results tell me?

There is actually no one test used to detect lupus anticoagulant. Instead, a series of clotting tests are used to check for the antibody. We prefer the Activated Partial Thromboplastin Time (aPTT) and the Modified Russel Viper Venom Time (VPTT). Both of these test look at how long it takes your blood to clot in a test tube. A longer clotting time can indicate they you have lupus anticoagulant in your blood.

What will my TFC doctor do as a result of this test?

Your doctor may suggest that you repeat the test to make sure that it is truly abnormal, as this is a difficult test for the laboratory to accurately perform. In the event that your levels are significantly abnormal, your physician may prescribe a medication to decrease the likelihood that you will form a clot – such as aspirin, heparin, lovenox or prednisone.

 

PROGESTERONE

What does this test check for?

Progesterone is a very important hormone produced by the ovaries. It plays a vital role in both ovulation and pregnancy. After an egg is released from your ovaries, the follicle from which the egg was expelled becomes the corpus luteum. The corpus luteum secretes small amounts of estrogen and large amounts of progesterone. This progesterone prepares the uterine lining for implantation.

When is this Test done?

This test is typically ordered 7 days before the expected onset of a menstrual period or 7 days following ovulation, (8 days following an LH surge), in order to document that ovulation has occurred normally. For example, if you have regular, 28 day cycles, the optimal time to check a progesterone level will be on day 21 of your cycle. This test may also be performed regularly during early pregnancy to assess the health of the pregnancy.

Why is this test done?

A progesterone level can provide your doctor with valuable information. It can be used to determine if ovulation has occurred. It can also be measured during the early stages of pregnancy to determine if supplemental progesterone will be required before the placenta starts producing the progesterone necessary to sustain the pregnancy.

Who needs this test?

Women with ovulatory dysfunction and women who are being treated with clomiphene citrate are the patients most likely to benefit from a serum progesterone level. In addition, women with spotting or bleeding early in pregnancy or pregnant women who have a history of recurrent miscarriage can also benefit significantly.

What do the test results tell me?

Depending upon where you are in your cycle, your progesterone level will be different. Progesterone levels are essentially undetectable until after ovulation. At that time, they start to rise, peaking approximately seven days after ovulation. From that point, they start to fall, reaching a low approximately 13-14 days after ovulation. If you are not pregnant, you will start a menstrual period once your progesterone level falls below 2-3 ng/mL. If you are pregnant, the progesterone level will fall as described above, but it will then spontaneously rise 10-12 days after ovulation in order to support the pregnancy.

What will my TFC doctor do as a result of this test?

If your mid-luteal progesterone level indicates that you are not ovulating, medication such as clomiphene citrate may be prescribed to induce ovulation. Once you are pregnant, if your progesterone level is below 15 ng/mL, your physicians may suggest that you start taking supplemental progesterone in order to decrease your risk of miscarriage.

 

PROLACTIN

What does this test check for?

Prolactin is a hormone produced by the pituitary gland. The primary function of Prolactin is to promote lactation (the production of milk).

When is this Test done?

In order to obtain an accurate prolactin level, you should abstain from intercourse and breast stimulation for 24 hours before the test. You should also have your blood drawn early in the morning and avoid eating breakfast until after the test has been performed, as food – especially protein – can impair the accuracy of the test.

Why is this test done?

This test is ordered as a standard part of the evaluation of ovulatory dysfunction, as hyperprolactinemia (too much prolactin production) can interfere with normal ovulation. We will also recommend testing your prolactin if you have a milky breast discharge, which can also interfere with normal ovulation.

Who needs this test?

Patients with irregular cycles or a milky breast discharge will usually benefit from having this test performed.

What do the test results tell me?

Patients with elevated Prolactin levels may require additional testing to rule out a tumor in the pituitary gland. These tumors are typically benign and are almost always treated with medication.

What will my TFC doctor do as a result of this test?

Most patients with an elevated prolactin level will be treated with an oral medication.

 

QUANTATATIVE HCG

What does this test check for?

This test is commonly referred to as a pregnancy test, HCG or ’beta” HCG.

When is this Test done?

This test is used to diagnose and monitor a pregnancy.

Why is this test done?

HCG levels are used to confirm a pregnancy as well as to assess the ongoing health of an early pregnancy (before it is large enough to monitor with ultrasound). The levels are also monitored in a failing pregnancy, after a miscarriage or after treatment of an ectopic. In a healthy pregnancy, hCG levels continue to rise until approximately 10-12 weeks’ gestation. They then plateau and begin to fall.

Who needs this test?

This test is ordered to confirm or rule out a pregnancy. It is also used in pregnant patients to assess the health of the pregnancy.

What do the test results tell me?

A test result of greater than 5 is considered a positive pregnancy test. Non-pregnant patients and males should have no detectable HCG in their bloodstream.

What will my TFC doctor do as a result of this test?

Patients with a positive HCG will be monitored for several weeks to determine the health of the pregnancy. After an intrauterine pregnancy with normal fetal heart motion has been confirmed, the patient will be referred back to her OB for continued care during the pregnancy and delivery.

 

THYRIOD STIMULATING HORMONE (TSH)

What does this test check for?

TSH or thyroid stimulating hormone is secreted by the pituitary gland and acts on the thyroid gland to cause the secretion of thyroid hormones (T3 and T4). A high TSH levels typically indicates that thyroid hormones are not being produced (hypothyroidism), whereas a low TSH may indicate hyperthyroidism. Both hypo and hyperthyroidism can interfere with normal ovulation.

When is this Test done?

A TSH can be performed at any time during your cycle. You do not need to be fasting when the test is performed.

Why is this test done?

A TSH level is typically performed to diagnose thyroid disease.

Who needs this test?

This test may be ordered by your physician if he/she suspects that you are either clinically hypo or hyperthyroid or if you do not have regular menstrual cycles.

What do the test results tell me?

An underactive thyroid may cause irregular menses, weight gain, fatigue and a feeling of being cold.

An overactive thyroid may cause irregular cycles, weight loss, rapid heartbeat, nervousness, and a feeling of being warm.

What will my TFC doctor do as a result of this test?

Patients who have an underactive thyroid may be placed on medication to regulate the thyroid level. Patients with an overactive thyroid may be referred to a specialist to determine if additional treatment is necessary.