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Fertility Tests- Day 3 Hormone
Evaluation
Predicting Ovulation, Endometrial Development
Cycle Day 3 Hormone Evaluation- FSH, LH, Estradiol
Blood is drawn on day 3 of the menstrual cycle and levels of estrogen, FSH, LH, and other hormones are measured. The FSH level is used to predict ovarian reserve and a level greater that 10 mIU/ml may indicate diminished ovarian reserve or poor quality eggs. Your fertility specialist will discuss your test results with you in detail.
When the ovaries begin to loose their ability to develop “good eggs,” the pituitary produces more FSH to try and “push” the ovary to recruit follicles.  Hormones including thyroid, androgens, inhibin, and others may be measured. At some point, prolactin levels will be measured to rule out hyperprolactinemia.
Predicting Ovulation
Nowadays, the vast majority of patients predict ovulation using urinary LH test kits (commonly called ovulation predictor kits which are obtained at any pharmacy). They accurately measure the surge in LH that occurs prior to ovulation. The LH levels are assessed using urine because this is where LH is excreted and it is easy to obtain a sample.
Clomiphene Citrate Challenge Test (CCCT)
Candidates for IVF may have the Clomid Challenge test which predicts the likely success of an IVF cycle, especially if her day 3 FSH level is elevated. In general, those who fail the CCCT have a poor IVF prognosis because the ovaries are not likely to respond to FSH fertility drugs . The test is performed as follows:
- FSH, E2 levels are measured on day 3 of the menstrual cycle.
- The patient begins Clomid at 100 mg on day 5.
- After 5 days, the FSH level is measured again.
A level > 10 mIU on day 3 or day 10 indicates a poor prognosis for ovarian stimulation with FSH fertility drugs (Gonal-F, Follistim, Repronex, Bravelle, Menopur).
The lining of the uterus is known as the endometrium and it must thicken and become more vascular to support a developing embryo. Endometrial development is stimulated by estrogen and progesterone. Progesterone is initially produced by the leftover follicle (the corpus luteum) and later by the placenta.
An endometrial biopsy may be taken to learn if the endometrium is “in phase”. When it is “in phase” the stage of endometrial development coincides with the expected development for that cycle day. The development of the endometrium is also assessed with vaginal probe ultrasound, which can measure the endometrial width. Another way the fertility specialist can assess the quality of the luteal phase is to obtain a blood level of progesterone roughly 1 week after ovulation.
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