What's a Hormone Panel? … Do I Need One?
You've been trying to get pregnant for a while. At first it was fun and light-hearted. But, it's been a few months and you're still getting your period. No positive pregnancy test to be seen. What's going on?
One of the first steps women take when they aren't getting pregnant is to see their gynecologist. If you read the blog post on your cycle and fertility window, you know that hormones run the show when it comes to fertility and pregnancy. A gynecologist is a great place to start, but they might not take a close look at your hormones depending on your age and how long you've been trying to conceive. Generally, a gynecologist will if: 1) you have been trying to conceive for six months or more and you’re over age 35, or 2) you've been TTC for twelve months and you’re under 35yo old. A reproductive endocrinologist specializes in this and will want to do a basic fertility workup to get the full picture of what's happening with your hormones, no matter what. This is called a hormone panel.
When Should I Get A Hormone Panel?
There are a few things to consider before scheduling a hormone panel. First, if you have been on any type of hormonal birth control you need to wait a few months (at least) three months to have an accurate depiction of your hormones. If you've been using an injectable birth control such as Depo Provera, it may take up to 10 months before you start to ovulate again. Non-hormone methods like condoms or copper IUDs don't have a wait period at all.
If you haven’t been on hormonal birth control and haven't been able to get pregnant, you'll want to get a hormone panel sooner rather than later to have a good understanding of where you are at. I see many women waiting to do any fertility tests because they don’t want to get too stressed about the process. That's definitely a valid reason, however, in order to change your hormonal pattern (reproductive cycle Day 1 to Day 1) it can take anywhere from three to six months. In order to be proactive, it's better to have all the information early. If you discover from your panel that you have less than ideal egg quality it gives you six months to improve your health, and thus egg quality, before you start feeling scared, stressed, or overwhelmed.
Now that you're ready to schedule your appointment, you'll want to be strategic about the timing. There are two different tests to schedule. In order to get an accurate reading, you have to run a Fertility Hormone Blood Test Panel on cycle day 3. This is when hormone levels are at their lowest or baseline levels. Any other day will not give an accurate reading. Yes, this means knowing and tracking your cycle well in order to determine Day 3. Don't worry! There are lots of apps that can help you with this.
This panel is made up of the three most commonly ordered tests to evaluate the reproductive abilities in women. It will show if the hormones that govern your reproductive cycle are in range and balance. Reference values may vary among different laboratories and each provider can differ in what he/she will consider an optimal range. Cycle Day 3 hormone panels include:
1. Follicle-stimulating hormone (FSH) - stimulates the growth and maturation of ovarian follicles (eggs). A mid-cycle surge of FSH will initiate the production of estradiol by the egg. FSH and estrogen work together in further development of the egg follicle.
FSH lab range: Ideally this should be below <10mIU/mL.
2. Luteinizing hormone (LH) - Rising estrogen levels cause LH to rise exponentially peaking approximately 36hrs before ovulation. A surge of LH triggers the final maturation and the release of an egg from the follicle (ovulation).
LH lab range: 1.4-7.8mIU/mL
3. Estradiol (E2) - responsible for growth of follicles and endometrial lining. High levels of estradiol at this point in the cycle could also signal poor egg quality or quantity.
Estradiol (E2) lab range: 51-57pg/mL. Many providers like to see E2 under 50pg/mL
Another test that is often recommended is progesterone. Progesterone levels in the luteal phase of your cycle show whether or not ovulation has occurred. This is a blood test performed in the mid-luteal phase of the cycle, approximately seven days after ovulation (typically day 21 of a 28 day cycle). Adequate progesterone levels are important in preparing the endometrial lining for implantation and support embryonic development before the placenta takes over at approximately 10-12 weeks gestation.
Progesterone lab range:
> 3ng/mL ovulation has occurred
< 3ng/mL ovulation has not occurred
Many practitioners prefer to see progesterone at >10ng/mL or higher showing better quality luteal function
Are there any other lab tests I might get?
There are other fertility labs that are not always part of a standard workup with a gynecologist, but are considered part of a fertility workup and will be run by a reproductive endocrinologist. They include:
1. AMH - Anti Mullerian Hormone
AMH is a hormone produced by the cells of your follicles and this hormone can be tested on any day of your menstrual cycle. AMH levels naturally decline with age and assessing the value relative to your aage is a useful tool when deciding if your follicle pool and quality of eggs are declining prematurely. If you're seeing a low AMH and high FSH, it can be an indication that you need to work on egg quality. If your FSH is below 10 and within the normal range, but your AMH is on the low end, then the issue is more about quantity of follicles rather than quality. More follicles equals more opportunities for conception. More healthy follicles puts the odds even more in your favor.
2. TSH- Thyroid Stimulating Hormone.
The thyroid gland controls the metabolism in the body and is important in maintaining the hormonal balance between the pituitary gland and the ovaries. Both hyperthyroidism (an overactive thyroid) and hypothyroidism (an underactive thyroid) can interfere with normal ovulation and healthy fetal development. The optimal range for hormone balance, conceiving, and for most people overall wellness levels are 1-2.5 ng/mL.
3. Vitamin D
Vitamin D exerts a wide variety of positive biological effects. For preconception and prenatal care, vitamin D enhances the body’s sensitivity to FSH, stabilizes the function of the immune system to support implantation, and helps build a healthy skeletal system. Vitamin D also contributes to better moods and an overall sense of well-being.
Ok, I know my hormone levels, but how can acupuncture help with all this?
Acupuncture can regulate and balance your reproductive cycles, and the hormones that drive them. Acupuncture increases blood flow to the uterus and overall pelvic region, helping with the growth of the endometrial lining, follicular growth and correcting any period issues that might be preventing implantation. It doesn't force the body to do anything, but rather redirects energy so that it is able to heal itself.
Regular acupuncture also reduces stress, thereby reducing cortisol, which helps to balance progesterone, an indicator of ovulation. Traditional Chinese Medicine can incorporate herbs, dietary changes, exercise, and supplements to address restore balance to your qi and your endocrine system, and address egg quality. Be prepared to allow sufficient time for your endocrine system and hormonal levels to achieve overall balance. Imbalance doesn't occur in a day and our bodies aren't designed to regulate them in short order either. Work with your acupuncturist to design a plan specific to your needs.
