When you walk into a fertility appointment, you deserve to walk out with real information. Not a summary of normal findings. Not a wait-and-see recommendation. Actual data about what is happening in your body and what it means.
Here is the testing I consider foundational for any woman trying to conceive.
The Core Fertility Panel
Request cycle day 2 or 3 bloodwork, with cycle day 1 being the first day of full bleeding. This should include FSH, LH, estradiol, and AMH. Together these give you a baseline picture of ovarian reserve and hormonal activity at the start of your cycle. Never interpret FSH alone. Estradiol and FSH are inversely proportional, meaning high estrogen falsely lowers FSH and low estrogen falsely elevates it. They must be read together.
Take the Fertility Hormones 101 Masterclass here.
Add progesterone testing at multiple points in your luteal phase, not just day 21. A single mid-luteal progesterone misses the full picture of how your progesterone rises and stays elevated.
What Is Usually Missing
Thyroid testing beyond TSH. The standard panel checks TSH, but thyroid antibodies, specifically TPO and TgAb, are what connect to miscarriage and implantation failure. Many women have elevated antibodies with a normal TSH. These will not be found unless you ask.
Get the Miscarriage Panel here.
Vitamin D. Optimal for fertility is 50 to 70 ng/mL. Most women in clinical practice are well below this. Fasting insulin alongside fasting glucose. Insulin resistance is one of the most common hidden contributors to ovulation dysfunction and hormonal imbalance. CRP and homocysteine are markers of systemic inflammation and methylation function respectively. Both have documented effects on egg quality and implantation.
How to Use Your Results
Request your actual numbers. Not a summary of normal. Write them down or photograph the report. Bring them to a practitioner who understands optimal ranges, not just reference ranges. A TSH of 3.8 may be within the lab’s range but is not optimal for fertility. Vitamin D at 31 ng/mL is technically above the deficiency threshold but not sufficient for follicle development. Know the difference.
In the revised edition of Yes, You Can Get Pregnant, I include a detailed fertility testing breakdown and a Fertility Lab Reference Range that compares “typical” laboratory ranges with functional fertility ranges, so you can better understand the difference between what is considered “normal” and what may be more optimal when trying to conceive. I also walk you through the additional fertility testing to ask for help to give you a more complete picture of your hormones, thyroid health, inflammation, blood sugar regulation, nutrient status, and overall reproductive health.
Get the revised edition of Yes, You Can Get Pregnant here.
Learn more about One-on-One Fertility Coaching here.
Don’t wait for your next appointment to get answers like this. Subscribe to my Substack, The Fertility Authority, and get this kind of information delivered every week—not just when you remember to ask.
This post is for educational purposes only and is not a substitute for personalized medical advice. Please consult your own doctor before making changes to your care.