fertility assessment

Assessing Fertility Through Western Medical Diagnostics​

As a fertility acupuncturist, I find conventional medical diagnostics can help refine and enhance traditional Chinese medicine diagnosis and treatment. For example, with a diagnosis of diminished ovarian reserve, it is important to treat Kidney Jing. Another example, with a diagnosis of luteal phase defect, it is important to build yin in the follicular phase to nourish yang in the luteal phase. Last example, with a diagnosis of thin endometrial lining, it is important to build blood, especially in the follicular phase. 

Further, one of my responsibilities as an acupuncturist specializing in fertility is to ensure that my patients are screened properly by their conventional medical care providers, as this could make a difference in their treatment plan and outcome. In some cases, appropriate tests are not ordered, or tests are interpreted incorrectly. In other cases, patients may feel rushed into in-vitro fertilization (IVF), not made aware of other treatment options that may be tried before IVF, or counseled in ways to prepare their body (and mind) for conception and pregnancy…  or the inevitable stress of trying to conceive.

While my acupuncture practice is located in Oakland, CA, through my articles, women and couples from all over the world frequently reach out to me for fertility advice – at the end of this article, there is information about scheduling phone consultations.

Basic Fertility Assessment...

The following tests are typically ran through a blood draw, unless otherwise noted. Test reference ranges can vary between different laboratories. All information, content, and material offered here is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or other healthcare provider.

Follicle Stimulating Hormone (FSH) stimulates the growth of ovarian follicles in the follicular phase, and influences estradiol production. Testing FSH levels is one method used by doctors to gauge ovarian reserve. For this purpose, it is ideally ran on Day 3 of the menstrual cycle (with E2, see below). FSH levels tend to increase with age, as ovarian reserve naturally diminishes. Do note: FSH levels tend to fluctuate from cycle to cycle, therefore it can not be relied upon as a sole measure of fertility.

  • <10 IU/L “normal range” = adequate ovarian reserve
  • 10-20 IU/L suggests diminished ovarian reserve
  • >20 IU/L may signify a shift towards menopause

Estradiol (E2) levels, in combination with FSH, are helpful in establishing baseline ovarian reserve. For this purpose, E2 levels are ideally checked on Day 3 of the menstrual cycle (with FSH). If FSH is within “normal range,” raised E2 may be artificially suppressing FSH, thus giving a false FSH level. 

  • <50 pg/mL “normal range”
  • >50 pg/mL may be artificially suppressing FSH

Luteinizing Hormone (LH) triggers ovulation and the development of the corpus luteum, which produces the hormone progesterone. This test is typically ran on Day 3 of the menstrual cycle, in conjunction with FSH and E2. 

  • 1.4 – 7.8 IU/L “normal range”
  • High LH + normal FSH = further testing for Polycystic Ovarian Syndrome
  • High LH + high FSH suggests diminished ovarian reserve

Anti-Mullerian Hormone (AMH) is a substance produced by granulosa cells of primary, preantral, and antral ovarian follicles – a higher number of early follicles, correlates with higher AMH levels. It is valued as an important marker of ovarian reserve, and considered more reliable than FSH levels. This test may be ran on any day of the menstrual cycle.

  • >1.0 ng/mL suggests fertility
  • <1.0 ng/mL suggests diminished ovarian reserve
  •  > 6.7 ng/mL = further testing for Polycystic Ovarian Syndrome

Progesterone (P4) is a hormone produced by the corpus luteum that prepares the endometrium, the lining of the uterus, for implantation. This test is typically ran in the mid-luteal phase, both to confirm ovulation and to ensure adequate progesterone production to support a potential pregnancy. 

  • >3 ng/mL confirms ovulation has occurred
  • >10 ng/mL suggests good corpus luteum function

Prolactin (PRL) levels are best checked during the follicular phase, and a few hours after waking, as levels tend to be higher in the luteal phase and the early AM. High prolactin levels may contribute to ovulatory dysfunction by lowering estrogen levels. 

  • 2 – 29 ng/mL “normal range”
  • < 20 ng/mL preferred by most doctors in a fertility assessment

Thyroid Stimulating Hormone (TSH) has a direct effect on the body’s metabolism. Suboptimal levels have been implicated in cases of unexplained infertility, ovulatory disorders, irregular periods, miscarriage, preterm birth, and impaired fetal development.

  •  ≤ 2.5 mIU/L pre-conception and during pregnancy

Other diagnostic blood/serum tests may be recommended based on your signs and symptoms. For example, if Polycystic Ovarian Syndrome (PCOS) is suspected, your doctor may additionally order lab tests for Total Testosterone (Total T), Free Testosterone (Free T), Dehydroepiandrosterone Sulfate (DHEAS), Sex Hormone Binding Globulin (SHBG), 17-hydroxyprogesterone (17-OHP), Cortisol, and Glucose tolerance testing. 

Pelvic Ultrasound can be used to measure the size and shape of the uterus and ovaries, and to determine if there may be structural abnormalities such as fibroids or ovarian cysts. Pelvic ultrasound is also used to assess the thickness of the endometrium, the lining of the uterus. 

Antral Follicle Count (AFC) is considered the most important predictor of ovarian reserve. An AFC is performed via pelvic ultrasound, ideally between Days 2-5 of the menstrual cycle.

  • >10 total antral follicles suggests good ovarian reserve
  • <10 total antral follicles suggests diminished ovarian reserve
  •  ≥ 12 follicles per ovary = further testing for Polycystic Ovarian Syndrome

Semen Analysis (SA) is the most common test performed in the assessment of male fertility; a physical exam is also recommended. In heterosexual couples experiencing infertility, approximately 35% is attributed to male factors, 35% is attributed to female factors, 20% of cases have a combination of both male and female factors, and the last 10% are unexplained cause.

Advanced Physical Assessment...

The following tests are commonly ordered for advanced assessment of the fallopian tubes and uterus. Possible fallopian tube pathology noted on these tests include: scarring, swelling, and blockage. Possible uterine pathology noted include: structural abnormalities, and the presence of polyps, fibroids, or scar tissue. 

Hysterosalpingogram (HSG) is a procedure that uses X-Ray and iodine to evaluate the fallopian tubes and uterus. It is typically done on Days 6-12 of the menstrual cycle. A thin tube called a cannula is inserted into the cervix and is used to gently fill the uterus with a liquid dye containing iodine; the iodine contrasts with the fallopian tubes and uterus on the X-rays. *HSG is considered the frontline test for tubal pathologies, but more sensitive tests should be performed if uterine pathologies are indeed suspected.

Saline Infusion Sonohysterography (SIS), aka Sonohysterogram (SHG), is a procedure that uses ultrasound and saline to evaluate the fallopian tubes and uterus. It is performed in a similar fashion to the HSG, also on Days 6-12 of the menstrual cycle. Doppler ultrasound, which provides information about blood flow, may be used to enhance the procedure. *SIS/SHG is considered a more sensitive test for uterine pathologies, but its assessment of tubal pathologies is limited. 

Hysterosalpingo-Contrast-Sonography (Hy-Co-Sy) is a procedure that uses effervescent fluid and ultrasound to assess the fallopian tubes and uterus. One advantage of this test is that it does not require the use of X-ray (i.e., radiation exposure). While this test has not yet become the standard of care, Hy-Co-Sy appears to be the most comprehensive screening available in the evaluation of infertility, allowing for adequate evaluation of both the fallopian tubes and uterus.

Schedule a Consultation...

Perhaps you are newly trying to conceive, and feel you could benefit from fertility coaching… or have been trying for a few cycles without success, and feeling discouraged… or have been trying for countless cycles, and feeling VERY discouraged. Perhaps you are facing known fertility challenges, and feel unclear about next steps, or your potential treatment options. Perhaps you feel you could benefit from some guidance in optimizing your diet, lifestyle, and supplement choices. 

I may be able to help.

If  you would like to schedule a phone consultation – please email me at hello@ravenandwrenwellness.com to share some key aspects about your fertility journey. If I feel I may be able to help – I will ask you to complete intake paperwork, as well as email me copies of your most recent lab diagnostics  (for your partner too, if available), your cycle history, and basal body temperature charts (if available). Once I receive your complete file, we will look ahead 1-2 weeks to schedule a 30-minute phone consultation to talk in depth about your case, and together, help you plan your next steps.

Here are links to a couple of my articles to help you get started:

Basal body temperature charting can be helpful in assessing fertility and confirming ovulation – learn more: Optimizing Fertility Part I: Basal Body Temperature Charting

Ovulation predictor kits can be helpful in identifying ovulation – learn how to effectively use them: How to Use Ovulation Predictor Kits


Dr. Jules Bogdanski, DAOM L.Ac.