Recommended Laboratory Tests for Female Fertility Assessment
The recommended laboratory tests for assessing fertility in a female patient include complete blood count, thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, estradiol, anti-Müllerian hormone, prolactin, and progesterone levels, along with screening for sexually transmitted infections. 1
Hormonal Assessment
- Ovarian Reserve Testing: Anti-Müllerian hormone (AMH) is the most reliable marker of ovarian reserve and should be measured regardless of cycle day 1
- Ovulatory Function: Midluteal phase progesterone (day 21 of a 28-day cycle) to confirm ovulation 1, 2
- Pituitary Function: Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) measured on cycle day 2-3 to assess ovarian reserve and pituitary function 1, 2
- Estradiol: Measured on cycle day 2-3 to complement FSH assessment 2, 3
- Thyroid Function: Thyroid-stimulating hormone (TSH) to rule out thyroid disorders that can affect fertility 1
- Prolactin: To identify hyperprolactinemia, which can cause anovulation 2, 3
Infectious Disease Screening
- Sexually Transmitted Infections: Testing for chlamydia, gonorrhea, syphilis, and HIV 1, 2
- Rubella Immunity: Rubella seronegativity screening with vaccination if indicated 1
- Hepatitis B: Surface antigen testing 1, 2
Hematologic Assessment
- Complete Blood Count (CBC): To identify anemia or other hematologic abnormalities that could impact fertility 1
- Hemoglobin A1c or Fasting Glucose: To screen for diabetes or insulin resistance, particularly in women with PCOS 2, 3
Timing Considerations
- For women <35 years: Initial evaluation after 12 months of unsuccessful conception attempts 2, 4
- For women ≥35 years: Expedited evaluation after 6 months of unsuccessful attempts 2, 4
- For women >40 years: Immediate evaluation is warranted 2
Common Pitfalls to Avoid
- Inappropriate Timing: Hormonal tests must be properly timed within the menstrual cycle for accurate interpretation. FSH, LH, and estradiol should be measured on cycle days 2-3, while progesterone should be measured midluteal phase 2, 3
- Overlooking Male Factor: Remember that male factor contributes to 40-50% of infertility cases, so concurrent semen analysis of the male partner is essential 2
- Misinterpreting AMH: While AMH is a good marker of ovarian reserve, it does not predict time to pregnancy or likelihood of live birth in women without known fertility problems 3
- Incomplete Evaluation: Fertility assessment should include not only laboratory tests but also imaging studies such as transvaginal ultrasound to evaluate ovarian morphology and hysterosalpingography to assess tubal patency 1, 2
Additional Considerations
- For women with irregular cycles or suspected PCOS: Consider additional testing for androgen levels, glucose tolerance, and insulin resistance 1, 3
- For women with suspected endometriosis: Laparoscopy may be required for definitive diagnosis 1, 2
- For women with recurrent pregnancy loss: Consider karyotyping and thrombophilia testing 1, 2
Remember that laboratory testing is just one component of a comprehensive fertility assessment that should also include imaging studies and, when indicated, surgical evaluation.