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FSH/LH/E2
A cornerstone of the female fertility evaluation is the measurement of day three hormone levels of FSH, LH, and estrogen. When a woman has decreased ovarian reserve, or impending ovarian failure, her FSH level will be elevated. An FSH level above 12 miu/ml is usually an indication of diminishing ovarian reserve and poor chances for conception (usually predicts at best a 5% delivered pregnancy rate per treatment even with the use of IVF). 
An FSH level should be accompanied by an estradiol (E2) level and should be performed on day 3 of the cycle. Normal ovarian function is indicated when the FSH is <10 mIU/mL (ideally less than 8) and the estradiol is <65 pg/mL. If the FSH is >20 mIU/mL, the patient will usually require egg donation or they should consider adoption.
Women with elevated FSH levels, especially if they are older, are often candidates for our donor egg program. IVF success rates using an egg donor match the donor’s age group and are typically high.
For women with unexplained infertility, recurrent miscarriages or over the age of 34, we usually recommend a clomiphene citrate challenge test (CCCT). This test is an even more sensitive way to screen for decreased ovarian reserve. In addition to the day 3 blood tests for FSH and estradiol, clomiphene citrate (Clomid®) 100 mg (2 – 50 mg tablets) is taken orally every morning days 5 through 9 of the menstrual cycle. An FSH is repeated on day 10 of the cycle.
Androgens
Elevated androgens (male hormones) can lead to irregular or no ovulation. Polycystic ovarian syndrome (PCOS) is a common cause of female infertility marked by irregular cycles, androgen excess, and an increased number of antral follicles (small cysts on the ovary). A severe excess of androgens leads to the expression of male characteristics such as increased body hair, male pattern baldness, lowering of the voice, and acne. In many PCOS patients, excess androgens are a result of chronically elevated insulin levels, a condition known as hyperinsulinemia or insulin resistance.
Thyroid Hormones
Thyroid hormones are produced by the thyroid gland and levels are measured with blood tests such as Thyroid Stimulating Hormone [TSH]) and/or free T4. Hypothyroidism (low levels of thyroid hormone (T4) but usually high levels of TSH) can cause anovulation and early pregnancy loss. Hyperthyroidism (high levels of thyroid hormone (T4) but usually low levels of TSH) is associated with many abnormal conditions including irregular ovulation, fetal abnormalities, and premature labor.
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