🤍 Fertility & Trying to Conceive

What this panel can settle, and by what logic

Only one marker on this list proves anything happened, and it is not the expensive one.

1. Progesterone, drawn 7 days after ovulation, is the only test here that demonstrates an event. A luteal rise means a corpus luteum formed, which means an egg was released this cycle. Everything else on the panel describes a capacity or a risk; this describes a thing that occurred.
2. Anti-Müllerian Hormone (AMH) with day-3 LH & FSH and Estradiol, Sensitive (LC/MS-MS) estimates the size of the pool. The estradiol is not decoration: a raised day-3 estradiol suppresses FSH, so the two together stop a diminished reserve hiding behind a normal FSH. In a meta-analysis of 26 studies, AMH and antral follicle count outperformed FSH and estradiol for predicting ovarian response Salemi 2024.
3. Prolactin and TSH (Thyroid-Stimulating Hormone) with Thyroid Antibodies (TPO + TgAb) cover the two endocrine causes that block ovulation outright. Antibody positivity is prognostic information rather than a treatment target, which is the part usually got wrong — see below.
4. Ferritin and HbA1c (Hemoglobin A1c) are the preconception half. Pregnancy roughly doubles iron requirement against an empty store, and glucose control before conception is one of the few modifiable inputs with a measurable effect on outcome Cancado 2025.

What it cannot settle, and what would

It cannot tell you whether you will conceive, and AMH is the marker most often asked to. The evidence behind AMH thresholds comes from predicting response to controlled ovarian stimulation, where the pooled diagnostic odds ratios are 2.68 for poor response and 2.76 for high response with between-study heterogeneity of 95.65% Salemi 2024. Those are modest numbers about a laboratory procedure. AMH counts follicles; it says nothing about whether the oocytes inside them are competent, and quality tracks age on its own.

An AMH cannot be compared with last year's AMH from a different laboratory. There is no agreed international standard behind it, many methods are in circulation, and the measured spread between them runs to 22.35% on real sera Li 2021 Ferguson 2018 — larger than most of the change anyone is looking for.

Positive thyroid antibodies are a prediction, not a prescription. The 2023 Korean Thyroid Association revision is explicit that thyroid hormone therapy to prevent miscarriage is not recommended in autoantibody-positive women with normal thyroid function Ahn 2023. The same guideline adopts 4.0 mIU/L as the upper limit of TSH in the first trimester and recommends levothyroxine above that, regardless of antibody status — which is a looser threshold than the under-2.5 target this page's own summary quotes, and the discrepancy is worth raising with your clinician rather than resolving from a website.

It reaches only half of a couple, and none of the plumbing. A male factor is present in a large share of infertility and the test for it is a semen analysis with its own manual and its own critique Boitrelle 2021. Tubal patency needs a hysterosalpingogram, the uterine cavity needs imaging, and endometriosis needs a laparoscopy. Ten normal results here exclude none of those.

Draw conditions that decide whether the money is wasted

This panel needs two separate visits to be read properly, and the second one is timed by your own cycle rather than by the calendar.

1. Anti-Müllerian Hormone (AMH) on any day, but always the same laboratory. The growing follicle pool turns over across months, so cycle day genuinely does not matter here — a real property of the analyte rather than a marketing claim. What does matter is the platform, given an inter-method spread of up to 22.35% Ferguson 2018.
2. LH & FSH and Estradiol, Sensitive (LC/MS-MS) on days 2 to 5. Day 1 is the first day of full flow, not spotting. Drawn on day 8 these numbers describe a follicle, not a reserve.
3. Progesterone 7 days BEFORE your next period, not on day 21. Day 21 is only mid-luteal in a 28-day cycle. On a 33-day cycle day 21 falls a day or two after ovulation, before the corpus luteum has produced anything, and a low result there gets read as a failure to ovulate when it is a failure to count. If your cycle length varies, track ovulation and draw 7 days later.
4. No biotin for 72 hours, and note anything containing it. Prolactin, TSH (Thyroid-Stimulating Hormone) and Thyroid Antibodies (TPO + TgAb) are streptavidin-based on the common analyzers, so one prenatal or hair supplement can compromise three of the ten results Li 2020. Prenatal vitamins are exactly what this reader has already started.

How you would know it answered your question, and what each pattern means next

Five patterns, and the intervals below are set by follicular biology rather than by anxiety.

• Progesterone above roughly 3 ng/mL on a correctly timed luteal draw: you ovulated that cycle. A single low value is one anovulatory cycle, not a diagnosis; repeat in the next cycle before concluding anything, because sporadic anovulation happens to people who conceive.
• Low Anti-Müllerian Hormone (AMH) with a raised day-3 FSH: diminished reserve, and the useful next step is a reproductive endocrinologist with an antral follicle count, which the pooled evidence places alongside AMH rather than behind it Salemi 2024. Repeating the AMH inside 6 months measures assay noise.
• FSH above 25 IU/L under the age of 40: stop treating this as a reserve number. That is the premature ovarian insufficiency threshold in the 2024 guideline, where a single elevated value now suffices for diagnosis and AMH is reserved for uncertainty Panay 2024.
• Raised Prolactin: repeat rested, then screen for macroprolactin, which accounts for around a fifth of hyperprolactinemia and needs no treatment at all Sharma 2021. A true elevation blocks ovulation and responds to a tablet within weeks.
• Positive Thyroid Antibodies (TPO + TgAb) with a normal TSH (Thyroid-Stimulating Hormone): monitor TSH through pregnancy rather than starting levothyroxine, and re-test TSH each trimester — the guideline treats the TSH, not the antibody Ahn 2023. If Ferritin is under 30 ng/mL, fix that first and allow 12 weeks Cancado 2025.

Sources read for these sections

• Nelson SM, et al. Anti-Mullerian hormone for the diagnosis and prediction of menopause: a systematic review. Human Reproduction Update 2023 · PMID 36651193
• Salemi F, et al. The best ovarian reserve marker to predict ovarian response following controlled ovarian hyperstimulation: a systematic review and meta-analysis. Systematic Reviews 2024 · PMID 39695880
• Li HWR, et al. Challenges in Measuring AMH in the Clinical Setting. Frontiers in Endocrinology 2021 · PMID 34108942
• Ferguson JM, et al. Towards international standardization of immunoassays for Mullerian inhibiting substance/anti-Mullerian hormone. Reproductive BioMedicine Online 2018 · PMID 30241771
• Ahn HY, Yi KH. Diagnosis and Management of Thyroid Disease during Pregnancy and Postpartum: 2023 Revised Korean Thyroid Association Guidelines. Endocrinology and Metabolism (Seoul) 2023 · PMID 37291743
• Panay N, et al. Evidence-based guideline: premature ovarian insufficiency. Human Reproduction Open 2024 · PMID 39660328
• Sharma LK, et al. Prevalence of Macroprolactinemia in People Detected to Have Hyperprolactinemia. Journal of Laboratory Physicians 2021 · PMID 34975255
• Cancado RD. Defining Global Thresholds for Serum Ferritin: A Challenging Mission in Establishing the Iron Deficiency Diagnosis in This Era of Striving for Health Equity. Diagnostics (Basel) 2025 · PMID 39941219
• Boitrelle F, et al. The Sixth Edition of the WHO Manual for Human Semen Analysis: A Critical Review and SWOT Analysis. Life (Basel) 2021 · PMID 34947899
• Li D, Ferguson A, Cervinski MA, Lynch KL, Kyle PB. AACC Guidance Document on Biotin Interference in Laboratory Tests. J Appl Lab Med 2020 · PMID 32445355