Female fertility tests

Female fertility hormones control the menstrual cycle and are involved in the development of eggs, including when they are released, and how well your womb lining prepares for pregnancy. By measuring these hormones, you’ll be given valuable insights into your fertility and find out why you may be having difficulty conceiving.

Key hormones measured in a female fertility panel

You can choose from a range of female fertility tests. Depending on which one you choose, or which one your doctor recommends, they can measure one, some, or all of the key hormones involved in your reproductive cycle.

The main female fertility hormones that are measured are:

• follicle-stimulating hormone (FSH) – stimulates the development of ovarian follicles, which contain eggs, and high levels can suggest a low or reduced ovarian reserve (remaining number of eggs)
• luteinising hormone (LH) – triggers ovulation, and high LH levels compared to FSH may be a sign of polycystic ovary syndrome (PCOS)
• oestrogen – regulates the maturing of your eggs and thickens the womb lining
• Anti-Müllerian hormone (AMH) – measured to assess your ovarian reserve (the number of eggs remaining in the ovaries), and high AMH suggests a good ovarian reserve, while low levels may be a sign of a low reserve
• prolactin – prepares the body for breastfeeding, but high levels can suppress ovulation and cause irregular periods
• thyroid stimulating hormone (TSH) – regulates thyroid function, and both an underactive and overactive thyroid can impact ovulation

The menstrual cycle

It’s essential to understand how the menstrual cycle works when looking at your fertility levels, as having sex at the right time can improve the chances of fertility. Changes to your norm or differences from a regular 28-day cycle can also be a sign of female reproductive conditions.

The cycle is divided into 4 main phases:

1. Menstrual phase – This typically spans days 1 to 5 of your cycle, when oestrogen and progesterone levels are at their lowest, and is when your period occurs.
2. Follicular phase – Usually takes place on days 1 to 13 as an average. During this time, FSH rises to stimulate egg development.
3. Ovulation – The release of an egg from an ovary happens around day 14 or mid-cycle. Here, LH surges, resulting in the release of a mature egg.
4. Luteal phase – This is the last phase of your menstrual cycle. When an egg is released from the ovary, the follicle it came from develops into a structure called the ‘corpus luteum’, which produces progesterone and increases oestrogen levels to thicken the womb lining in preparation for pregnancy. If an egg is not fertilised, then hormone levels fall, which triggers your period.

Around 1 in 7 couples have difficulty conceiving in the UK.

There are many different causes for this. For example, studies show that:

• ovulatory disorders affect 25% of couples, which includes conditions like PCOS
• a lack of ovulation or irregular ovulation causes infertility in 21% of women

Female fertility testing is a good way to help you understand why you may be having difficulty getting pregnant.

Some of the common symptoms that suggest testing may help are:

• irregular or absent periods
• very heavy or unusually light periods
• difficulty getting pregnant after 12 months of trying (if under 35) – if you are over 36, you should see your GP or consider testing sooner
• signs of PCOS, including acne, excess hair growth, and weight gain
• miscarriages

Common risk factors for female infertility

Some of the common risk factors for infertility include:

• age – in women, fertility declines in your mid-30s and more rapidly after the age of 35 because the number and quality of your eggs declines
• ovulation issues – conditions like PCOS, thyroid problems, and premature ovarian failure can stop an egg from being released or can make ovulation irregular
• endometriosis – a condition that affects 10% of women worldwide, where tissue similar to the womb lining grows in places outside the womb, damaging the ovaries or fallopian tubes, causing fertility problems
• medications – some medications like non-steroidal anti-inflammatory drugs (NSAIDs), chemotherapy, antiepileptics, and spironolactone can impact fertility
• lifestyle factors – activities like smoking, excess alcohol, stress, and poor sleep are all linked to reduced fertility

If you have any of these symptoms or risk factors, female fertility testing may be beneficial for you and provide answers to any concerns you may have.

An at-home fertility test measures the levels of various hormones that regulate the menstrual cycle and play a role in reproduction. You will need to collect a small sample of blood using a finger prick, a simple and almost painless procedure that can be performed at home.

There are 5 female fertility tests available from ZAVA. They are:

1. AMH test, which tests your AMH levels to give you a better picture of your ovarian reserve.
2. Progesterone test, which measures your progesterone levels.
3. AMH and progesterone tests, which measure both your progesterone and AMH levels.
4. Pituitary profile test, which checks your FSH, TSH, and prolactin levels.
5. PCOS test, which checks for specific hormones that may indicate PCOS, including testosterone, sex hormone binding globulin (SHBG), and free androgen index (FAI).

Both the pituitary and progesterone tests need to be taken on specific days of your menstrual cycle to give you an accurate result. The pituitary profile and PCOS tests can be taken on any day during your cycle. You can also retake the tests as many times as needed.

Once your sample has been analysed by our partner lab, one of our doctors will review your results and provide you with further guidance and advice.

If you’re not sure which test you need, you can book a fertility consultation with a ZAVA doctor to help find the right test for you.

You can get an at-home fertility test from ZAVA. The process is simple, easy to use, and has a quick turnaround, allowing you to receive your results and treatment promptly if needed.

There is also no need for a face-to-face consultation, so you can avoid NHS waiting times.

To request an at-home fertility test from ZAVA, you will need to:

1. Choose the test you require or book a fertility consultation if you’re not sure.
2. Complete a short online health questionnaire.
3. One of our doctors will review your request to make sure it is suitable for you.
4. Once approved, your test will be delivered to your home address in discreet packaging to maintain confidentiality.

Once you have received your test, read the enclosed instructions carefully to collect your sample. You may have to wait to collect your sample on a specific day in your cycle. Once you’ve collected your sample, post it back to our partner lab for analysis. When they have received it, you should get your results within 72 hours in your patient account. For more guidance on delivery windows, check out our information page.

When you receive your results, a ZAVA doctor will have reviewed them and provided you with a detailed report explaining their meaning. Some of the possible next steps our doctors may suggest include:

• referral to a fertility specialist or gynaecologist
• lifestyle changes to improve fertility, such as weight management, a healthier diet, stopping smoking, or increasing exercise
• additional testing, such as ultrasound scans or male fertility testing (for partners)
• advising on fertility treatment options

Emotional support is also important, so if reduced fertility is suspected, then counselling or referral to support groups may also be suggested.

There are several treatment options available for female infertility, depending on the cause. In many cases, lifestyle changes, medication, or assisted reproductive techniques can help.

If not, then there are 3 main treatment types available:

Medication

Medications can be given to help deal with some of the underlying causes of fertility issues. Common fertility medications include:

• clomifene or tamoxifen to stimulate monthly ovulation in women who are not ovulating or are ovulating irregularly
• metformin if you have PCOS to help regulate your blood sugar levels
• gonadotrophins to stimulate ovulation
• gonadotrophin-releasing hormone and a dopamine agonist to promote ovulation

Medications are not suitable for everyone. For example, if the cause of your infertility is unknown, they may not be beneficial. They can also cause side effects, like feeling or being sick, headaches, and hot flushes, so it is important to discuss these with your doctor.

Surgery

Some surgical procedures can help to identify the cause of fertility issues or improve them, such as:

• fallopian tube surgery if they have become blocked or scarred
• laparoscopic surgery to treat endometriosis, remove fibroids, or treat PCOS

Assisted conception

The most common assisted conception techniques are:

1. Intrauterine insemination (IUI) is where sperm is inserted into the womb via a thin plastic tube that’s passed through the cervix. It’s also commonly known as artificial insemination, and some studies show a cumulative pregnancy rate of 19.4% with IUI.
2. In vitro fertilisation (IVF) is a procedure in which an egg is fertilised outside the body and then returned to the womb to grow and develop. The average IVF pregnancy rates in the UK in 2022 were 31% per fresh embryo transfer.
3. Egg and sperm donation involve using an egg or sperm from a donor to help you conceive. It is estimated that 1 in 153 children born in the UK are conceived through egg or sperm donation.