Latest / The Brilliant Fertility Podcast / Episode 045: Fertility Testing Part 1: What Blood Tests are Done for Female Fertility?

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Episode 045: Fertility Testing Part 1: What Blood Tests are Done for Female Fertility? · The Brilliant Fertility Podcast

• 0:05
  Speaker 1: Welcome to the Brilliant Fertility Podcast.
• 0:07
  Speaker 1: I'm your host, dr Katie Rose, and this podcast exists to help illuminate the path ahead of you.
• 0:13
  Speaker 1: With expert interviews, clinical pearls and real client success stories, my intention is to bring you hope for what's possible on this journey and to give you tools and resources to navigate the ups and downs on the road before you.
• 0:27
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• 0:33
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• 0:40
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• 0:41
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• 0:43
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• 0:47
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• 1:00
  Speaker 1: Welcome back.
• 1:13
  Speaker 1: I can't believe that we actually haven't talked about this yet on the podcast.
• 1:16
  Speaker 1: I was going through all of our past episodes and it's like what the hell have I not gotten into this yet?
• 1:19
  Speaker 1: Because labs are really quite important when it comes to understanding what's happening in your fertility, and it's it's one of the basics right, like we can't guess if we don't, or we can't treat if we don't test, and you know the the saying of like test, don't guess really does apply.
• 1:40
  Speaker 1: Um, in this episode I'm going to focus on the blood tests that are involved with understanding fertility, but I'm going to do this whole series on testing and please reach out to me If there's a question about fertility tests that you feel you've never gotten an answer for, because I know there are a lot of questions about them.
• 2:03
  Speaker 1: And it begins with at what point in the fertility journey do we start to test?
• 2:10
  Speaker 1: And then what do we test and what time in the cycle do we test?
• 2:16
  Speaker 1: So let's start with that question of when on the fertility journey are we testing?
• 2:21
  Speaker 1: Journey are we testing Now?
• 2:30
  Speaker 1: I am proactive in my practice.
• 2:31
  Speaker 1: I don't want to wait to find something when someone has already been trying for a year.
• 2:33
  Speaker 1: So I am seeing a lot of people who are also proactive and they're coming to me maybe a year before they want to start trying to conceive.
• 2:41
  Speaker 1: And we have to navigate this from an understanding that insurance often will not cover a test that they don't deem has a good reason to be tested.
• 2:55
  Speaker 1: So sometimes people are paying out of pocket if they don't have a clinical diagnosis or symptoms that we can code for in such a way that insurance would cover these tests of infertility.
• 3:09
  Speaker 1: You know couples have to be trying for at least one year if the woman is under 35 and at least six months if over 35 before testing is deemed to be necessary.
• 3:36
  Speaker 1: But if we can catch a lot of the underlying factors that impact fertility sooner, if we can start nourishing the body sooner, I'm a proponent of let's test sooner and we're able to catch things like nutrient deficiencies and inflammation and microbiome issues before they become a barrier to fertility.
• 4:03
  Speaker 1: They become a barrier to fertility.
• 4:10
  Speaker 1: So what are the tests that are done?
• 4:10
  Speaker 1: Now, if you were to reach that point in the journey of actually being diagnosed with infertility and you start a workup with an OBGYN or an REI, the hormones that they test are usually going to start with cycle day three blood tests and they're looking at FSH, which is follicle stimulating hormone, lh, which is luteinizing hormone, estradiol, which is E2.
• 4:34
  Speaker 1: It's our main form of estrogen that is produced by the follicles and the ovaries, and prolactin, which is a hormone coming from the posterior pituitary and it can interfere with ovulation.
• 4:48
  Speaker 1: So those are the main four hormones that are typically tested during cycle day two to four.
• 4:56
  Speaker 1: We usually try to get that on cycle day three and then they'll usually screen for thyroid issues with a TSH.
• 5:04
  Speaker 1: And then they'll usually screen for thyroid issues with a TSH.
• 5:08
  Speaker 1: Sometimes I see them going a little bit deeper, looking at glucose and hemoglobin A1C and vitamin D levels to rule out any issues with STIs or other viruses that could impact a pregnancy or the health of a fetus.
• 5:40
  Speaker 1: So you'll see, you know STIs, hiv, syphilis, the MMR titers, chickenpox titers, chicken pox titers just to ensure that someone has immunity.
• 5:47
  Speaker 1: Or in the situations if there was a condition that they didn't know they had that can be treated prior to a pregnancy, they can take care of that in advance.
• 5:57
  Speaker 1: And then blood typing.
• 5:59
  Speaker 1: So of course, like that side of things, the blood typing and the disease conditions, those aren't necessarily something that I focus on in my practice, but that is going to be standard of care as part of the REI workup that is.
• 6:29
  Speaker 1: Oftentimes they're looking at this from the lens of if this person were to pursue fertility treatments with us, like IUI or IVF, how might we expect them to respond to these treatments?
• 6:35
  Speaker 1: It's not necessarily looking at it from this functional lens of how can we optimize this person's fertility or what underlying barriers might there be to optimal fertility.
• 6:50
  Speaker 1: It's very much from this lens of if this person were to pursue these treatments, how would we be approaching them.
• 6:58
  Speaker 1: And I think we have to remember that.
• 7:02
  Speaker 1: And we have to remember that all practitioners have their limitations.
• 7:06
  Speaker 1: And if you dive into the world of assisted reproductive technology that may be.
• 7:15
  Speaker 1: One of the limitations is that many of the providers are looking at it from the lens of pursuing those treatments pursuing those treatments.
• 7:30
  Speaker 1: So the timing of those tests is really important.
• 7:31
  Speaker 1: Unfortunately, I do occasionally see someone who has been worked up by a non-fertility trained provider who they've run the FSH, lh and estradiol at a different time of the cycle and that really can't tell us anything.
• 7:43
  Speaker 1: We need to know what the hormones were during that very narrow window to understand the baseline of how the pituitary is communicating with the ovaries and how the ovary is responding at that part of the cycle.
• 7:56
  Speaker 1: So if you've had that tested on cycle day 15, like that really cannot give us accurate information.
• 8:05
  Speaker 1: And the same goes for people who've said well, I've had my progesterone tested on cycle day 21 and I wasn't ovulating.
• 8:13
  Speaker 1: The progesterone level is only going to be detectable after ovulation in a significant level and we can't make an assumption that it that ovulation is happening on day 14 for everyone.
• 8:29
  Speaker 1: So there's a barrier to that understanding.
• 8:36
  Speaker 1: Again, when we have this level tested at any other time of the cycle, then what I aim for, which is seven days post ovulation for progesterone.
• 8:47
  Speaker 1: I don't often see fertility clinics running a progesterone after ovulation because, again, they're not necessarily looking at this picture as how are we supporting this whole being in optimizing their fertility?
• 9:03
  Speaker 1: Naturally they're looking at it as well.
• 9:06
  Speaker 1: If we already know from day three labs how their ovaries are likely responding, we're probably going to medicate anyway and we're going to be following by ultrasound and having that progesterone level doesn't add that much value for them.
• 9:20
  Speaker 1: So it's maybe one in five people that I have seen who've already been worked up by an REI who have had a progesterone level checked after ovulation.
• 9:31
  Speaker 1: So again, progesterone is a hormone, essentially stands for progestation.
• 9:37
  Speaker 1: It's only produced after ovulation and it helps ensure that the uterine lining, the endometrial lining, stays stable so that when an embryo is trying to implant and start forming that placenta, that it can do so.
• 9:54
  Speaker 1: So the progesterone is very much involved in the receptivity and the stability of that lining and it peaks at about seven days post ovulation.
• 10:05
  Speaker 1: So that's usually when I will try to time our testing.
• 10:08
  Speaker 1: Now someone ovulates on cycle day 20, and we test their progesterone on day 21, we might already start to see a little bit of an elevation, but it won't be at its peak.
• 10:20
  Speaker 1: So if someone ovulates cycle day 20, I'm going to want to test that cycle day 27 to really understand what's happening in their luteal phase.
• 10:31
  Speaker 1: If someone ovulates early, say, I just had someone who in my practice conceived after having had a miscarriage last fall and no pregnancy for six months.
• 10:44
  Speaker 1: Um, so we did our workup.
• 10:47
  Speaker 1: We found that, based on her cycle tracking, she was actually ovulating quite early.
• 10:51
  Speaker 1: So cycle day nine and in our first set of tests, when we tried to time that about cycle day 16, 17, that we tested her progesterone, we were able to catch that she really had quite a healthy progesterone level.
• 11:05
  Speaker 1: So she's conceived on this most recent cycle and because we know when she ovulated, because we know what that progesterone level looked like, we feel pretty confident about where this particular pregnancy is right now because we have an understanding of those values for her as an individual.
• 11:26
  Speaker 1: So the timing matters Again.
• 11:28
  Speaker 1: If someone has tested progesterone on cycle day three and it's a 0.3, well, that's normal, we expect that.
• 11:35
  Speaker 1: But someone might look at that lab and be like, oh my God, my progesterone is low.
• 11:38
  Speaker 1: What does that mean?
• 11:39
  Speaker 1: And if you weren't aware about the timing then that could cause so much unnecessary anxiety.
• 11:46
  Speaker 1: So I really love to just with my one-on-one patients like walk them through line by line, like this is everything that we tested, this is what it means at this time of the cycle and this is what we can do about this if it needs optimization.
• 12:03
  Speaker 1: So the standard minimum that is provided from a fertility clinic is an okay understanding if you are only looking at IVF.
• 12:21
  Speaker 1: It's really not enough if we want to understand how to optimize someone's body for a healthy pregnancy, and that's a huge gap in care.
• 12:33
  Speaker 1: It's really frustrating to know that there's this enormous window of opportunity for someone to be nourished differently, to have their body be truly prepared for a healthy pregnancy, to improve their egg quality and sperm quality, when we have this very minimum set of labs done.
• 12:58
  Speaker 1: So I'm including in the show notes for today my fertility lab guide.
• 13:03
  Speaker 1: This is a super simple two page guide.
• 13:06
  Speaker 1: It's essentially a spreadsheet of.
• 13:09
  Speaker 1: Here are the tests that I run, here is the time of the cycle that I run them.
• 13:15
  Speaker 1: Here is what this test represents.
• 13:17
  Speaker 1: So, for example, with FSH, follicle stimulating hormone, it is telling us about the communication from the pituitary gland and the brain to the ovaries and here's the reference range that is on these labs.
• 13:32
  Speaker 1: But we also want to know is there an optimal range for these values when it comes to fertility?
• 13:39
  Speaker 1: So the lab guide is really, really simple, but gives an overview of the blood tests that I run in my practice with all of my fertility patients, the timing of when we test these in the cycle, what the reference range is versus what the actual optimal range is.
• 14:03
  Speaker 1: One example that I love to give is for vitamin D.
• 14:06
  Speaker 1: There's this really wide reference range from most labs.
• 14:11
  Speaker 1: I believe with LabCorp it's like 30 up to 90.
• 14:17
  Speaker 1: So that's a huge wide range, and so people can come back with a vitamin D of 30 and think, oh, that's totally normal.
• 14:24
  Speaker 1: But we know that when it comes to fertility, a vitamin D level of 50 is associated with a decreased risk of miscarriage, increased rates of fertilization, and vitamin D is involved in every step of the fertility journey.
• 14:42
  Speaker 1: We could and should do an entire episode just about vitamin D levels, but that's an example of the reference range being really wide.
• 14:50
  Speaker 1: But then us knowing that there's actually a more optimal range for fertility and if we don't test we would never know and it's such an important marker that isn't being tested in most of those clinics and it's such an inexpensive thing to supplement or to modify your lifestyle so that you're getting more sunlight during the times when it's optimal for vitamin D conversion.
• 15:16
  Speaker 1: Yeah, I think we need to do a whole vitamin D episode, don't we?
• 15:19
  Speaker 1: But that's another example.
• 15:23
  Speaker 1: So in the lab guide I do break down what these markers represent and in the different categories like inflammation, nutrient deficiencies, blood sugar regulation or insulin resistance.
• 15:39
  Speaker 1: All of these factors are really important when it comes to optimizing fertility because they are involved in egg quality and oxidative stress and ensuring that the body feels safe to conceive when we have an abundance of nutrients and low inflammation and a healthy blood sugar regulation.
• 16:03
  Speaker 1: So if you click the link in the show notes, you can download that lab guide instantly.
• 16:09
  Speaker 1: There are some emails that you'll receive afterwards that will help guide you through that as well and give you an even deeper understanding of how that guide can support you.
• 16:20
  Speaker 1: And, of course, my legal team would want me to say that this is not medical advice.
• 16:26
  Speaker 1: This is for educational purposes only, not medical advice.
• 16:33
  Speaker 1: This is for educational purposes only, and you'll want to communicate with your providers that you want to order these labs.
• 16:38
  Speaker 1: And the next episode we'll talk about how to communicate effectively to get what you need, how to advocate for yourself, because it can be really challenging when you present these guides to someone who's like are you trying to undermine my authority?
• 16:58
  Speaker 1: That is a very valid challenge.
• 17:03
  Speaker 1: I have such a deep appreciation for why providers would feel uncomfortable with that and also, having been in the patient seat too many times where I have been unheard, unseen, totally dismissed and brushed off, it is so important that you learn how to advocate for yourself.
• 17:27
  Speaker 1: So in our next episode, we will be walking through some important ways of communicating and calling power back to yourself so that you can get what you need from those tests, and improving communication with your provider with your provider.
• 17:57
  Speaker 1: The other factor that I really want to get into with these labs is knowing that some of what you might be taking could interfere with the lab values themselves.
• 18:03
  Speaker 1: So, for example, I have a lot of people who come in already taking a prenatal or taking B complex.
• 18:12
  Speaker 1: What I'm going to be getting at here is that if we have any supplement that has biotin in it biotin is used in a lot of lab assays and it can actually disrupt us getting accurate results with certain hormones, thyroid panels being one of them.
• 18:30
  Speaker 1: Other hormones can be impacted by that as well, so I often advise people to stop any supplement that has biotin in it at least five days before they do their blood test.
• 18:45
  Speaker 1: That really helps make sure that we are getting an accurate level.
• 18:49
  Speaker 1: Now, am I perfect in reminding every single person to do that?
• 18:54
  Speaker 1: No, no provider is perfect, but I'm telling you this now so that hopefully, you remember to do that and it doesn't disrupt it so much Like.
• 19:06
  Speaker 1: I haven't seen such huge variations that I'm having people often go back and retest, but especially with my patients who have had a lot of really complicated thyroid pictures, that's a situation in which, if we've had a hard time getting their thyroid regulated, I'm definitely a stickler about no biotin supplements for them around the time of their testing, if someone is on thyroid hormone medication as well, and when we're testing these hormones.
• 19:46
  Speaker 1: In general, I will say like, in order to have a really clear standard and clear baseline for future testing, I do like to have people have their tests on fasted and if they take thyroid hormone, uh, not take their thyroid hormone the morning of the test and if they're fasted they can take it immediately upon having their blood drawn.
• 20:17
  Speaker 1: But we want to be able to have consistency in these lab results.
• 20:23
  Speaker 1: So if we're testing cycle day three hormones and for one test they were taking their prenatal vitamin that has 5,000 micrograms of biotin and they ate breakfast and then they went in at noon and did their labs, and then we want to recheck in a couple of months and they go fasted first thing in the morning without taking their supplements for five days.
• 20:42
  Speaker 1: Those two tests have such big variables that we really can't get an accurate understanding of how much progress we were able to make.
• 20:54
  Speaker 1: And I think this also leads us into the question of how often should I be getting these tests done, especially if something was out of range, and we want to follow up with that.
• 21:09
  Speaker 1: So there are some tests that we can see a faster progress with, and so if I'm looking at thyroid, for example.
• 21:21
  Speaker 1: Um, thyroid hormones themselves like TSH.
• 21:26
  Speaker 1: That takes like three, four weeks or so once we start addressing thyroid concerns to really see a difference and similar with vitamin D.
• 21:35
  Speaker 1: Usually we'll wait three, four weeks to retest thyroid or vitamin D markers, maybe up to six weeks.
• 21:44
  Speaker 1: There are other things that take a little bit longer to really see a big impact with, and one of those is thyroid antibodies.
• 21:51
  Speaker 1: Thyroid antibodies are really important to test.
• 21:55
  Speaker 1: You can go back and listen to the episode on thyroid health but I test these as part of understanding the immune system, especially if someone has had a previous pregnancy loss where they have hypothyroid symptoms.
• 22:09
  Speaker 1: But I usually will wait longer than that four to six week timeframe to retest thyroid antibodies.
• 22:17
  Speaker 1: I'll wait maybe three months or so because even once you have started to modulate the immune system and it stops reacting to self and producing those antibodies, it still takes a while for the body to break down, metabolize those antibodies that have been circulating before.
• 22:37
  Speaker 1: So the timing of tests want to be realistic about which tests can be followed up with in a certain timeframe.
• 22:47
  Speaker 1: And that's going to really come down also to the individual because we don't know what those markers are going to look like for you until we see them the first time.
• 23:03
  Speaker 1: Even though I do this blood panel for the vast majority of my patients, it's also based on your history as an individual, what your family history is, what your cycle history has been, to really have a good understanding of what we're testing, why and what expectations we have from that.
• 23:35
  Speaker 1: Some of these tests really I can it can make a pretty solid assumption, based on a good history, what they might look like with you know, for example, blood sugar, insulin, um, c-reactive protein telling us about inflammation.
• 23:53
  Speaker 1: A lot of times people will have a symptom or a history that will guide us towards that test.
• 24:00
  Speaker 1: And sometimes people are completely asymptomatic and the only symptom is unexplained infertility.
• 24:09
  Speaker 1: So we can't make these assumptions Even when we have a really solid history.
• 24:15
  Speaker 1: We want to listen to that communication of the body.
• 24:18
  Speaker 1: Even if they don't have pain or obvious inflammation, there still can be underlying factors that are involved.
• 24:26
  Speaker 1: And in our next episode we'll talk more about the communication with your provider how to get labs that you need and then in the following episode we'll be diving more into what other tests can we look at, what other ways of testing can we pursue to better understand things like the microbiome and mitochondrial health.
• 24:51
  Speaker 1: So I'm excited about this series and helping you better understand your tests.
• 24:56
  Speaker 1: But what I want to leave you with because I know that there's such a wide range of how people feel about testing and and some people are really excited and they want to test everything, they want to know what's going on in their body and they're excited for those results.
• 25:15
  Speaker 1: But sometimes there's also a dread, like a fear of looking under the hood, because there could be something wrong and you don't really want to deal with it.
• 25:27
  Speaker 1: Because there could be something wrong and you don't really want to deal with it.
• 25:31
  Speaker 1: And so I just want to acknowledge all of the feelings that can come alongside these tests and the feelings that can come alongside getting the results back and having that range of dread, dread or fear or even excitement about having those values.
• 25:49
  Speaker 1: These numbers aren't a reflection of you, your character, your worth, your value, and so if you are nervous about getting tests done, I do feel it's very important to also be acknowledging that part of you that is nervous or scared, and this is something that we address in the Brilliant Fertility Program, often with using EFT tapping to process the emotions or what we're noticing in the body.
• 26:24
  Speaker 1: When we think about those tests, like, oh my goodness, are you getting all clenched up in the chest when you think about them?
• 26:30
  Speaker 1: And you think about, oh my God, my FSH came back high and am I never going to be a mother because my body isn't communicating right and my ovaries are failing.
• 26:38
  Speaker 1: It's like whew.
• 26:39
  Speaker 1: The thought spiral can really really flow quickly if we don't have tools to support that.
• 26:51
  Speaker 1: So you're not alone.
• 26:54
  Speaker 1: If you've been on that spiral before, goodness, I have been on it personally and I do this for a living, right Like no one's perfect.
• 27:03
  Speaker 1: I remember when I got my thyroid labs back when I was first diagnosed with Hashimoto's and seeing those elevated antibodies, I I was so surprised at how much emotion I felt and what a failure.
• 27:20
  Speaker 1: I felt like, like my goodness, like I do this for a living.
• 27:23
  Speaker 1: Like how did this happen?
• 27:24
  Speaker 1: This is, it was just wild.
• 27:28
  Speaker 1: And being able to notice that that was occurring for me and I took a little drive, a slow drive around my neighborhood and did some tapping and then just let the tears flow and and then was able to be more objective about it and be like, okay, now that I have this information, I can do something about it.
• 27:51
  Speaker 1: Right, and that is how I, as a practitioner, look at this information is.
• 27:55
  Speaker 1: It gives us a benchmark, it gives us a place to start from, but it does not determine who you are as a person.
• 28:03
  Speaker 1: And just because something might be outside that optimal range, it doesn't mean that you're a failure.
• 28:05
  Speaker 1: It doesn't mean that it's your fault.
• 28:05
  Speaker 1: It doesn't mean you're as a person.
• 28:06
  Speaker 1: And just because something might be outside that optimal range, it doesn't mean that you're a failure.
• 28:09
  Speaker 1: It doesn't mean that it's your fault.
• 28:11
  Speaker 1: It doesn't mean you're a bad person, and I just want to put that out there for everyone so that you can get what you need and have this understanding of what your body is asking for.
• 28:25
  Speaker 1: So hit me up with your questions on labs, because our final um in this series, our final episode of this series, will be um answering the audience questions and really diving in to some of the lab questions that you have about your fertility.
• 28:43
  Speaker 1: All right, I hope you guys have a wonderful rest of your day.
• 28:48
  Speaker 1: Thank you for being here.
• 28:49
  Speaker 1: As always, I am sending you so much love.