What blood tests are used to assess female fertility?

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Blood Tests for Female Fertility Assessment

The most important blood tests for assessing female fertility include luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, and anti-Müllerian hormone (AMH), which together provide critical information about ovarian function and reserve. 1

Primary Blood Tests for Fertility Assessment

Ovarian Reserve Testing

  • Anti-Müllerian Hormone (AMH)

    • Gold standard for assessing ovarian reserve
    • Correlates with antral follicle count and predicts ovarian response
    • Advantages: minimal variation throughout menstrual cycle, not affected by hormonal contraceptives 2
    • Low AMH suggests diminished ovarian reserve but doesn't predict oocyte quality or pregnancy chances

  • Follicle-Stimulating Hormone (FSH)

    • Should be measured on cycle day 3
    • Elevated levels (>10 mIU/mL) suggest diminished ovarian reserve
    • Inversely correlated with AMH levels 3
    • An FSH level of 12.1 mIU/mL correlates with an AMH of approximately 0.5 ng/mL

  • Estradiol

    • Measured on cycle day 3
    • Helps interpret FSH results (elevated estradiol can falsely suppress FSH)
    • Elevated levels may indicate advanced follicular development or diminished ovarian reserve 1, 4

Ovulatory Function Testing

  • Luteinizing Hormone (LH)
    • Helps assess ovulatory function
    • LH:FSH ratio >2:1 may suggest polycystic ovarian syndrome
    • Best measured on day 1-3 of menstrual cycle 4

Secondary Blood Tests

  • Thyroid Function Tests

    • TSH to screen for thyroid dysfunction
    • Thyroid abnormalities can impair fertility and increase pregnancy complications 1

  • Prolactin

    • Elevated levels can inhibit ovulation
    • Important when irregular menses or galactorrhea are present 1

  • Androgens (Testosterone, DHEAS)

    • Indicated when clinical signs of androgen excess are present
    • Helps diagnose PCOS and other causes of anovulation 1

Special Considerations

Timing of Tests

  • FSH, LH, and estradiol should be measured on cycle days 1-4 (ideally day 3)
  • AMH can be measured at any point in the cycle 2

Interpretation Challenges

  • AMH levels must be interpreted in context of age and clinical presentation
  • Low AMH in young women with normal menstrual cycles may not indicate immediate fertility problems
  • FSH values may fluctuate between cycles; consider repeating abnormal results 1

Risk Factors Requiring Earlier or More Comprehensive Testing

  • Age >35 years
  • History of chemotherapy or radiation
  • Previous ovarian surgery
  • Family history of early menopause
  • Smoking history 1

Clinical Application Algorithm

  1. Initial Screening: AMH, FSH, LH, estradiol on cycle day 3
  2. If abnormal FSH/LH: Add thyroid function tests and prolactin
  3. If signs of androgen excess: Add testosterone and DHEAS
  4. If abnormal results: Consider transvaginal ultrasound for antral follicle count 1

Common Pitfalls

  • Relying solely on AMH as a "fertility test" - it reflects quantity not quality of eggs
  • Testing FSH on incorrect cycle day
  • Failing to consider age as the strongest predictor of fertility
  • Not repeating abnormal results before making clinical decisions 2

Blood tests provide valuable information about fertility potential but should be interpreted alongside imaging studies and clinical presentation for comprehensive fertility assessment.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Evaluation of Female Fertility-AMH and Ovarian Reserve Testing.

The Journal of clinical endocrinology and metabolism, 2022

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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