What's a Hormone Panel and 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 a birth control pill, patch, or ring you may be able to get pregnant within 1-3 months of stopping a combination pill -- meaning those that have estrogen and progestin. But most women can get pregnant within a year. 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. The panel includes:
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 LH work together in further development of the egg follicle. Ideally this should be below 10.
2. Luteinizing hormone (LH) - stimulates the ovaries to produce estradiol. A mid-cycle a surge of LH causes the ovaries to release an egg during ovulation. Ideally this would be close to your FSH level.
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. Ideally this would be less than 50.
The second test is of progesterone. 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). The ovary produces progesterone after ovulation, and its presence indicates that ovulation has occurred. Adequate progesterone levels are important in maintaining a healthy uterine environment during pregnancy.
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 relatively new marker whose role in assessing a woman’s fertility is still being determined. AMH levels reflect the quantity, but not the quality of the follicles (the protective sac for the immature egg). The level of AMH is dependent on age. As you get older your FSH turns the gas to ramp up growing your follicles to get you to ovulate because it sees you as running out of time. If you're seeing a low AMH and high FSH, it can be an indication that you need to work on follicle 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. Other issues can impact AMH levels as well. For instance, high AMH levels are seen with PCOS.
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, healthy fetal development, and may lead to miscarriage. 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 pre-conception and pre-natal 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. Ideally, Vitamin D levels should be over 30.
Ok, I know my hormone levels, but how can acupuncture help with all this?
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) to get an accurate depiction of your hormones. If you've been using a birth control pill, patch, or ring yyt notou may be able to get pregnant within 1-3 months of stopping, but most women can get pregnant within a year. If you've been using an injectable birth control such as Depo Prevera, 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. nel. ormone panel. rmone panel. mone panel. one panel. ne panel. e panel. panel. panel. anel. nel. el. l. . nel. panel. anel. nel. el. l. . nel. el. l. . anel. nel. el. . .
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.