Blood Test

Blood test is performed to measure the levels of different reproductive hormones in the serum. These include the levels of follicular stimulating hormone (FSH), luteinizing hormone (LH), progesterone, prolactin, oestradiol and human chorionic gonadotropin (hCG) hormones. The purposes of monitoring these hormone levels are as listed below:

1.
FSH is an important indicator of women's ovarian reserve. Abnormally elevated FSH levels are associated with poor ovarian reserve. This means the chances of getting good quality eggs from the ovaries are reduced. At level above 9 mIU/ml, the ovarian reserve is reduced. When a woman menopause, the FSH levels are very high, more than 20 mIU/ml.
2.
The normal LH levels are 0.5 to 76.3 mIU/ml. When the levels of LH are high in relation to FSH, it indicates that the patient has polycystic ovary suyndrome (PCOS). In PCOS, the ratio of LH:FSH is more than 3:1.
3.
Oestradiol will rise as the follicles develop, above 20 pg/ml. In woman who has menopause, oestraogen levels will be less than 20 pg/ml. In woman who has many follicles developing, the levels can be as high as 4000pg/ml.
4.
After ovulation has occured, the progesterone levels will raise to more than 9 ng/mL. So, by measuring the serum progesterone level, we can determine whether the present ovarian cycle is ovulatory or not. At the end of menstrual cycle, the progesterone levels will fall dramatically to less than 2 ng/ml. So, by measuring the progesterone levels at the beginning of menstrual cycle, we can determine whether the patient is ready for controlled ovarian hyperstimulation (COH).
5.
Prolactin is produced by the pituitary gland of the brain. Its function is to stimulate the breasts to produce milk. Abnormal high levels of prolactin will inhibit follicular developement and egg maturation. Patient with high levels of prolactin will have spontaneous breast milk production and absence of egg developement.
6.
hCG levels will start to rise after implantation has occured. The hormone is detectable in the blood 5 days after implantation. After 10 days of implantation, the hCG levels are detectable in the urine. By meansuring the hCG levels in the blood or urine, we are able to determine the early pregnancy.

Please refer to the table below for the normal value of these hormones:

 
Follicular Phase
Mid-cycle
Luteal phase
Postmenopausal
FSH ( mIU/ml)
2.5-10.2
3.4-33.4
1.5-9.1
23.0-116.3
LH (mIU/ml)
1.9-12.5
8.7-76.3
0.5-16.9
15.9-54
Oestradiol (pg/ml)
21-251
38-649
21-312
<10-28
Progesterone (ng/ml)
0.15-1.40
NA
3.34-25.56
ND-0.73
Non-pregnant
Pregnant
Postmenopausal
Prolactin (ng/ml)
2.8-29.2
9.7-208.5
1.8-20.3

NA - Not Available, ND - Not Detectable

Other non-hormone blood tests that done for infertile couples include haemoglobin, blood group, haemoglobin electroforesis for thalassaemia, hepatitis B antigen, human immunodeficiency virus (HIV) and VDRL.