What laboratory tests are recommended for a female trying to conceive?

Laboratory Testing for Preconception Care

For a woman trying to conceive, the essential laboratory tests include: complete blood count, urinalysis, blood type and screen, rubella immunity, syphilis, hepatitis B, HIV, gonorrhea, chlamydia, diabetes screening, and thyroid-stimulating hormone (TSH). 1

Core Laboratory Panel

Hematologic and Blood Type Testing

• Complete blood count (CBC) should be performed to identify anemia or other hematologic abnormalities that could impact fertility and pregnancy outcomes 1, 2
• Blood type and Rh screen is essential to identify potential Rh incompatibility issues 1
• Urinalysis should be conducted as part of baseline assessment 1

Infectious Disease Screening

The following infectious disease tests are recommended for all women planning pregnancy:

• Rubella immunity testing is critical, as rubella infection during pregnancy can cause severe congenital defects; women found to be seronegative should be vaccinated before conception 1, 2
• Syphilis screening should be performed universally, with prenatal screening rates approaching 98% in practice 1, 3
• Hepatitis B surface antigen (HBsAg) testing is recommended for all women, with screening rates exceeding 96% in prenatal populations 1, 2, 3
• HIV testing should be offered to all women planning pregnancy, though current screening rates are only 82-85% 1, 2, 3
• Chlamydia and gonorrhea screening should be performed, particularly given their impact on fertility and pregnancy outcomes 1, 2

Endocrine Assessment

• Thyroid-stimulating hormone (TSH) should be measured to rule out thyroid disorders that can significantly affect fertility and pregnancy outcomes 1, 2
• Diabetes screening (fasting glucose or hemoglobin A1c) is recommended, as uncontrolled diabetes increases risks of congenital anomalies and pregnancy complications 1

Additional Testing Based on Individual Risk Factors

Fertility-Specific Hormonal Assessment

For women with concerns about fertility or irregular cycles, consider:

• Anti-Müllerian hormone (AMH) is the most reliable marker of ovarian reserve and can be measured on any cycle day 2
• Day 21 progesterone (midluteal phase in a 28-day cycle) confirms ovulation 2
• Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) measured on cycle days 2-3 assess ovarian reserve and pituitary function 2
• Androgen levels, glucose tolerance testing, and insulin resistance screening should be considered in women with irregular cycles or suspected polycystic ovary syndrome 2

Risk-Based Additional Screening

• Hepatitis C antibody testing should be performed for women with risk factors including current or past injection drug use, intranasal drug use, or other high-risk exposures 4
• Cervical cytology (Pap smear) should be up-to-date according to routine screening guidelines, though it is not required specifically for preconception care 1

Important Clinical Considerations

What NOT to Routinely Test

The following tests are not necessary for healthy women planning pregnancy and may create unnecessary barriers to care 1, 5:

• Lipid panels (unless specific risk factors present)
• Liver enzymes (unless specific risk factors present)
• Thrombogenic mutation screening (unless history of recurrent pregnancy loss)
• Routine pelvic examination (not required for preconception assessment, though may be part of routine well-woman care)

Timing and Follow-Up

• Testing should ideally occur 3-6 months before attempting conception to allow time for interventions such as rubella vaccination (which requires waiting one month before conceiving) 1
• Women with positive infectious disease screening require appropriate treatment and counseling before conception 1
• Thyroid dysfunction should be optimized with TSH levels ideally <2.5 mIU/L before conception 2

Common Pitfalls to Avoid

• Do not delay preconception counseling waiting for "the perfect time"—approximately 50% of pregnancies are unintended, so opportunistic screening during routine visits is critical 1
• Do not require unnecessary tests such as routine lipid panels or liver enzymes in asymptomatic women, as this creates barriers to care without improving outcomes 1, 5
• Do not forget to update the reproductive life plan at every visit with women of reproductive age, asking about pregnancy intentions and timeline 1
• Do not overlook partner screening—male partners should also be screened for infectious diseases, particularly HIV and other sexually transmitted infections 1