The tests you need when getting pregnant is taking longer than expected

If you have been TTC for over 6 months, you may be starting to get impatient and wondering what you can do next.

While most medical professionals suggest waiting 12 months until doing any further investigations for couples with the female/ egg contributing partner under 35 years, I always like to get the ball rolling from the six-month mark.

This is because while stats say 90% of couples conceive within the first year of trying, 80% of these couples will do so within the first 6 months. So if you haven’t conceived by 6 months, it is less likely you will have conceived by 12 months (but definitely still possible).

For couples with the female/ egg contributing partner 35 years and over, the 6-month mark is agreed by all as the time to investigate things further. However, having most of these tests done even before you start trying may be the way to go.

So if this is you, hopefully you just need some more patience and time (which feels excruciating – I know!). But if there is something impacting your fertility, getting onto it earlier will hopefully bring you that one step closer to baby sooner.

Here are the tests I like to organise for my lovely fertility clients after 6 months of trying with no luck. This is a general list only, and investigations will always be personalised for the person/ couple I am seeing.

Usually you can’t get all of these tests ordered through your GP, which is why I help my clients navigate this tricky process quickly with ease and confidence.

Cycle tracking education/ assessment

I had to start off here as although this is not a ‘test’, this is the number one essential component of conceiving without medical intervention, because if you don’t get the timing right you literally cannot get pregnant!

Many of the people/ couples I see for fertility are relying on apps to tell them when to have sex. Apps are great for collecting information but cannot tell you when you ovulate because this is based on so many variables that apps simply cannot measure – stress, diet, weight changes, travel, illness, exercise etc.

It is so common for couples who haven’t fallen pregnant yet to fall pregnant quickly once I teach them how to interpret their own unique fertile signs.

Hormone testing

Hormones co-ordinate the whole intricate process that leads from egg growth, to ovulation, to implantation, and then the maintenance of pregnancy.

Cycle Day 2 (i.e. second day of your period) FSH, LH, Oestrogen, Prolactin – this is when our hormones are at their lowest, and so gives us a good idea of what is happening at baseline.

Androgens (Testosterone & DHEAs) - androgens are typically thought of as ‘male type’ hormones, but they so important for all aspects of female and male fertility.

Luteal phase progesterone and oestrogen (ideally timed 7 days after ovulation) – oestrogen and progesterone help to prepare the endometrial lining for implantation. If these hormones are out of balance, we may not have a friendly environment for an embryo to implant and grow. Progesterone is our pregnancy hormone and adequate levels are essential for pregnancy.

AMH – ovarian reserve

This gives an indication of egg count in the ovary. Very low levels may be indicative of early ovarian ageing, and very high levels can be indicative of PCOS. While low/ high AMH don’t necessarily impact chances of a natural conception, it’s always good to see where this is at.

Full thyroid panel – TSH, T4, T3, Thyroid antibodies, reverse T3

The thyroid gland releases hormones involved in energy, temperature control and fertility.

 Most people will be offered the thyroid test ‘TSH’ which measures the signals going from the brain to the thyroid gland. Unless this measure is way out of range, most doctors will not assess actual thyroid hormones produced by the thyroid gland (T4 – inactive thyroid hormone & T3 – active thyroid hormone) and thyroid antibodies (white blood cells that attack the thyroid gland). However, even small changes in thyroid hormone production and a slight elevation of antibodies can impact fertility, so having a full thyroid assessment is an absolute must. 

Blood sugar studies - fasting glucose, fasting insulin, HbA1c

 High blood sugar can prevent ovulation, and low blood sugar can be associated with stress induced cycle changes. Sometimes it is not just enough to measure our fasting blood sugar, and we also need to look at the hormone that helps balance our blood sugar – insulin. HbA1c is a measure that gives us an idea of long term blood glucose levels.

Blood lipids (fats) - cholesterol and triglycerides

Our eggs and sperm are coated in a beautiful outer layer of nourishing fat. Our blood lipds can tell us if fat is being utilised inappropriately in our body, or if there is an increased risk of the fat in our body being transformed into more harmful types that can impact egg and sperm quality. Cholesterol also impacts blood flow to the reproductive area.

Liver function testing – ALT, AST, ALP, GGT

Our lovely liver has a pretty important job when it comes to fertility. It helps eliminate toxins from the body, helps to activate some of our main hormones, is essential for blood sugar balance and nutrient absorption.

Full blood examination and iron studies

If our red blood cells aren’t functioning properly, we can’t deliver beautiful nutrients to our eggs and sperm and to the endometrium (baby palace) to help it grown. Looking at the size and composition of our blood cells helps to determine if there is anything suss we need to address.

Iron studies are essential as both low and high iron levels greatly impact fertility, and iron is essential for red blood cell production.

Other Nutritional assessment

Vitamin D – both low and very high levels can impact fertility. Over 70% of Victorian’s are vitamin D deficient in winter.

Plasma Zinc – absolutely essential for male and female fertility and not typically offered as a standard test by GPs.

Plasma selenium and urinary iodine - if thyroid problems suspected as both these nutrients are key in thyroid health.

Methylation assessment – B12, folate, homocysteine, MTHFR gene

 Methylation refers to the cycle that transforms vitamin B12 and folate into various compounds that are essential for fertility (and many other areas of health). Both of these nutrients are crucial for fertility and a healthy pregnancy, and if levels are low, or they aren’t being used effectively through the methylation cycle, this can greatly compromise chances of pregnancy.

In some cases we will also tests for variants of the MTHFR gene. This is having a version of a gene that compromises your ability to use vitamin B12 and folate effectively.

Semen analysis

The male/ sperm contributing partner does not get off easy at this point, and most of the above testing is relevant to them as well. We know that having healthy sperm not only increases the chance of pregnancy, but also leads to better health outcomes in pregnancy for the mother, and better lifelong health for the baby and their babies in generations to come. COOL RIGHT!

Ideally semen analysis is performed at a specialised lab (usually connected to fertility clinics) to get an expert eye to assess for any abnormalities.  

Want to get started on assessing your fertility? Book a complementary 20 minute introductory consultation here

References:

We’re having trouble conceiving, 2005, Australian Family Physician

Extent of the problem, 2003, British Medical Journal

Impact of thyroid disease on fertility and assisted conception, 2020, Best Pract Res Clin Endocrinol Metab

MTHFR (methylenetetrahydrofolate reductase: EC 1.5.1.20) SNPs (single-nucleotide polymorphisms) and homocysteine in patients referred for investigation of fertility, 2021, J Assist Reprod Genet

The Value of Anti-Müllerian Hormone in the Prediction of Spontaneous Pregnancy: A Systematic Review and Meta-Analysis, 2021, Front Endocrinol (Lausanne)