Day 3 Fertility Test Interpretation
These day 3 hormone results indicate normal ovarian reserve and excellent reproductive potential for a 35-year-old woman, with all values falling within optimal ranges for fertility.
FSH Assessment
The FSH level of 6.04 mIU/mL is excellent and indicates normal ovarian reserve. 1, 2
- In women of peak reproductive age (20-25 years), the day 3 FSH geometric mean is 5.6 IU/L with an upper limit of 9.5 IU/L 3
- For women aged 40-45 years, the geometric mean rises to 9.6 IU/L (95% CI: 3.8-23.8 IU/L) 3
- FSH levels <15 mIU/mL are associated with the highest pregnancy rates in IVF (17.0% per attempt), compared to moderate levels (15-24.9 mIU/mL) at 9.3% and high levels (>25 mIU/mL) at only 3.6% 4
- This patient's FSH of 6.04 mIU/mL places her in the optimal prognostic category 4
Estradiol (E2) Assessment
The E2 level of 24.8 pg/mL is ideal and within the normal baseline range. 1, 2
- In women aged 20-25 years, day 3 E2 geometric mean is 44.0 pg/mL (95% CI: 20.4-95.0 pg/mL) 3
- Elevated day 3 E2 (≥80 pg/mL) is associated with lower pregnancy rates (14.8% vs 37.0%) and higher IVF cancellation rates (18.5% vs 0.4%), even when FSH is normal 5
- When day 3 E2 reaches ≥100 pg/mL, there is a 33.3% cancellation rate with no pregnancies achieved 5
- This patient's E2 of 24.8 pg/mL is well below any concerning threshold and indicates excellent ovarian responsiveness 5
LH Assessment
The LH level of 4.06 mIU/mL is normal for early follicular phase. 2
- Normal follicular phase LH ranges from approximately 4.78-13.2 IU/L 6
- An LH:FSH ratio >2 suggests PCOS and likely anovulation 2
- This patient's LH:FSH ratio is 0.67 (4.06/6.04), which is normal and excludes PCOS 2
- LH <7 IU/mL may indicate hypothalamic dysfunction, but in the context of normal FSH and E2, this LH level is appropriate for early follicular phase 2
Progesterone Assessment
The progesterone level of 0.281 ng/mL is appropriately low for day 3, confirming proper cycle timing. 1
- Day 3 progesterone should be at baseline levels (typically <1 ng/mL in early follicular phase) 6
- Mid-luteal progesterone ≥5 ng/mL (≥16 nmol/L) confirms ovulation occurred, while levels <5 ng/mL may indicate anovulation 1
- This baseline level is expected on day 3 and does not indicate any dysfunction 1
Clinical Implications and Next Steps
This hormone profile indicates normal ovarian reserve with excellent fertility potential. 3, 4, 5
- All parameters fall within optimal ranges for reproductive success 3, 4, 5
- If evaluating ovulation, a mid-luteal progesterone measurement (approximately day 21 in a 28-day cycle, or 7 days before expected menses) should be obtained to confirm ovulation 1
- For irregular cycles, timing should be adjusted to approximately 7 days before expected menses rather than using calendar day 21 1
Important Caveats
- In women aged 40-45 years, 22% show normal day 3 FSH and E2 in one cycle but elevated values in a consecutive cycle, so a single normal result may not fully represent ovarian reserve 3
- If fertility concerns persist despite normal testing, consider repeating day 3 hormones in a subsequent cycle to confirm consistency 3
- Anti-Müllerian hormone (AMH) testing can provide additional information about ovarian reserve without cycle-day dependency 2