Whether you’re in the process of trying to conceive or plan on trying in the next 12 months, it can be helpful to know whether you need to be tested, which tests to have done to check your fertility, and at what point you should be having these fertility tests.
PCOS is one of the most common causes of infertility in women however, just because you have PCOS does not mean you will struggle to conceive. If you do struggle there are plenty of treatment options available. The hormonal imbalances common in PCOS interfere with the maturation and release of an egg from the ovaries (ovulation). Correcting these hormonal imbalances can help improve your chances of conceiving but knowing where your hormonal imbalances lie can be tricky without the correct testing.
When should I get tested?
In an ideal world everyone who is thinking about trying to conceive in the next 12 months should be offered a full panel of bloods to ensure their body is ready (free of any deficiencies) to support the growth of a baby. This will hopefully pick up any fertility issues you may have been unaware of, enabling you to address them immediately.
However, in the UK the NHS usually only request tests when you have been having regular (every 2-3 days) unprotected sex for 12 months and have not been able to conceive. If you are over 36, they will request tests after six months or if you have any medical conditions that impact fertility (PCOS), irregular periods, received cancer treatments, or have a history of sexually transmitted disease/s.
What testing is currently offered?
The NICE guidelines (usually followed by the NHS) recommend doing a ’21-day progesterone’ test to assess whether or not ovulation has occurred. The problem with this is that it makes the following assumptions:
- You have a regular cycle that is 28 days in length.
- That you ovulate on day 14 of your cycle.
- That you ovulate every month.
Most of us who are trying to establish whether we ovulate will also be experiencing irregular cycles, which means testing on day 21 - or knowing when in your cycle you ovulate - is going to be almost impossible.
If your cycle is irregular then please ensure you ask your GP to request gonadotropin (FSH & LH) tests alongside progesterone. This will help give you a slightly clearer picture of what is going on.
What tests should be done?
Gonadotropins (LH and FSH) and progesterone alone are very seldom enough to give us a clear understanding of what is going on. There are many other nutrients and hormones which impact fertility, which should therefore be tested at the same time. Here is a list of other markers which should be looked at:
Testosterone: this is typically elevated in PCOS and causes many of the more common PCOS symptoms. It’s important to request both serum and free testosterone to get a true picture of your levels.
Vitamin D: often those with PCOS are deficient in vitamin D and there is more and more evidence to support the role of vitamin D in fertility.
Iron: especially important if you have heavy periods. Iron plays a role in fertility and it’s important that your stores are adequate to support a healthy pregnancy
Sex hormone binding globulin: this is associated with insulin resistance and the abnormal metabolism of blood glucose and lipids.
Vitamin B12: (for those taking metformin) metformin interferes with the absorption of B12, therefore if you take metformin your B12 levels should be tested annually.
HbA12: PCOS increases your risk for developing type 2 diabetes. It is important to assess whether your blood glucose levels are elevated or not.
Lipid profile: heart disease risk is elevated in those with PCOS, therefore testing your lipids is important in managing long term health.
Cortisol: our stress hormone is often elevated in those with PCOS and can exacerbate symptoms of PCOS.
Thyroid hormones: an underactive thyroid (hypothyroidism) is common in those with PCOS so it’s good to be able to rule this out.
FSH & LH: the ratio of these is often slightly out in those with PCOS and can indicate that there is an issue with ovulation.
Prolactin: these levels are usually normal in those with PCOS but it’s important to test levels to rule out other conditions that cause similar symptoms to PCOS.
Progesterone: testing can help indicate ovulation, although please be mindful of how difficult it can be to test this at the right time for accurate results.
DHEA-s: this is another androgen (male hormone) and tends to be elevated in PCOS.
*Take this list with you to discuss blood test with your GP.
What about males?
The saying ‘it takes two to tango’ has never been truer. All too often women are left feeling like fertility is solely their responsibility. As soon as a female begins with any fertility investigations, her partner should start too. This can sometimes be challenging when relying on the NHS, but you should make the request and if your GP does not oblige, there are options to go private.
If you are not having any luck getting tests done through the NHS, there are other options. Here are a few companies who provide accurate tests from the comfort of your own home:
.png)