Medical tests standards in pregnancy planning, infertility diagnostics and treatment

Please remember that the standards depend on the test method and the device the test is conducted with and therefore they may be slightly different from one another. The best is to compare your results to the standards set by the laboratory where the test was performed.

In the following section of the article you will find information about the testing standards for:

1. Gonadotropins FSH and LH,
2. Prolactin PRL,
3. Estradiol and progesterone,
4. Thyroid hormones,
5. Androgens,
6. Human chorionic gonadotropin HCG,
7. Anti Müllerian Hormone AMH,
8. Endometrial evaluation,
9. Cycle (ovulation) monitoring with ultrasound,
10. Sperm,
11. Karyotype.

1. Gonadotropins FSH i LH

FSH - follitropin (follicle-stimulating hormone) stimulates the  growth and maturation of ovarian follicles containing an egg.
The aim of the test: to determine the ovarian reserve and the pituitary gland efficiency, the diagnosis of the menstrual cycle disorders.

Term	Standard
2 – 4 day of cycle	3-12 mlU/ml
ovulation	6-21 mlU/ml
luteal phase	1,2-9 mlU/ml
after menopause	22-153 mlU/ml

LH - lutropin (luteinizing hormone),  its sudden increase causes the end of the egg maturation and it is essential for the rupture of the Graafian follicle; after the  ovulation it stimulates the corpus luteum to produce progesterone.
The aim of the test: a detection of the  preovulatory LH peak.

Term	Standard
2 – 4 day of cycle	2-13 mlU/ml
LH peak day	17-77 mlU/ml
ovulation	6-21 mlU/ml
luteal phase	0-15 mlU/ml
after menopause	11,3-40 mlU/ml

The relation between the concentrations of gonadotropins FSH and LH should be close to 1. In the case of pituitary insufficiency it reduces below 0.6, and in the case the polycystic ovary syndrome it rises above 1.5.


2. Prolactin PRL

PRL - prolactin, the pituitary hormone; when its concentration is increased, the level of gonadotropins lowers - what interfere with the mechanism of an ovulation. It can also lead to the luteal (postovulatory) phase insufficiency. The level of prolactin is relatively constant during the menstrual cycle, but it changes during the day – it is higher at night when you sleep. The prolactin level also increases due to  stress, physical exercise, after a meal,  during pregnancy and breastfeeding. Therefore the test should be carried out in the morning, on an empty stomach or at least 3 hours after a meal and after a few minutes rest.
The aim of the test: the diagnosis of   ovulation mechanism disorders and luteal phase disorders.

Standard	Interpretation of the test result
3-5 ng/ml	perfect result
15-20 ng/ml	proper result (treatment only in exceptional cases)
20-25 ng/ml	mild hyperprolactinemia
>25 ng/ml	hyperprolactinemia

Converter: 1 ng/ml=20 mlU/l


3. Estradiol and progesterone

E2 – Estradiol produced by the maturing Graafian follicles or more exactly by the granulosa cells. Its level varies significantly during the cycle.
The aim of the test: the ovarian reserve estimation (the test of  FSH is carried out as well), the evaluation of  follicles growth and  corpus luteum activity,  the ovulation monitoring (additionally).

Term	Level	Interpretation
3 day of cycle	under 75 pg/ml	Increased E2 may indicate an ovarian cyst or decreased ovarian reserve
about 2 days before ovulation	≥200 pg/ml	Standard for one matured follicle
6-8 days after ovulation	≥100 pg/ml	Post ovulatory corpus luteum produces  progesterone as well as estradiol

Converter: 1 pg/ml=3,67 nmol/l

Progesterone is secreted by the corpus luteum formed from the follicle ruptured duringthe ovulation, by the placenta during pregnancy and by the adrenal glands but only a small amount. Progesterone is responsible for the preparation of the endometrium for implantation of the embryo, it maintains appropriate conditions for the development of pregnancy and the decrease of  its concentration causes the menstruation. Progesterone level begins to increase 40-16 hours prior to the LH peak and the peak of its release is about 8 days after the ovulation.
The aim of the test: the evaluation of corpus luteum functions, the  early pregnancy monitoring.

For the test to be accurate, it should be  repeated three times, because  progesterone is not secreted constantly  and its concentration in blood changes every few hours up to 50%. Progesterone level does  not fully reflect the degree of  endometrium preparation. In order to determine any deficiencies we need to take the endometrium clipping on a fixed day of the second phase of the cycle or perform an ultrasound.

Term	Standard	Interpretation
7-8 days after ovulation	≥10 ng/ml	Proper function of corpus luteum
II (late) phase of cycle	≤3 ng/ml	No ovulation

Converter: 1 ng/ml=3,18 nmol/l

4. Thyroid hormones

TSH - thyroid stimulating hormone, it stimulates the production of T3 and T4.
T4 - thyroxine, the main thyroid hormone.
T3 - triiodothyronine, produced in small amounts by the thyroid gland, the majority of it comes from the conversion from T4.
FT4 - free thyroxine.
FT3 -  free triiodothyronine.
The test can be done any day of the cycle. However, it  is usually performed on the third day of the menstrual cycle.

Hypothyroidism significantly reduces fertility. With a slight deficiency of thyroid hormones it is possible to conceive a child but the pregnancy is associated with a risk of miscarriage and premature birth. Furthermore, hypothyroidism of a mother  can adversely affect both the function of the child’s thyroid and  the development of his central nervous system.
Hypothyroidism (high TSH) indirectly promotes the overproduction of prolactin, which also adversely affects fertility.
Hyperthyroidism does not inhibit fertility directly, but the excess of thyroid hormones can block the estrogen receptors and reduce their effectiveness even in the preparation of the endometrium for implantation. Hyperthyroidism can also cause complications in pregnancy associated with hypertension, preeclampsia, or the changes in the cardiovascular system.
The aim of the test: the detection of hypothyroidism or hyperthyroidism.
 

Hormone	Standard 1	Standard 2	Converter
TSH	0,4-4,0 mlU/l	-	-
FT4	11-23 pmol/l	0,8-1,8 ng/dl	1 ng/dl=12,8 pmol/l
FT3	2,25-6 pmol/l	1,5-4,1 pg/ml	1 pg/ml=1,53 pmol/l
T4	54-150 nmol/l	4,2-11,6 ug/dl	1 ug/dl=12,8 nmol/l
T3	1,3-2,9 nmol/l	85-190 ng/dl	1 ng/dl=0,015 nmol/l

5. Androgens

Testosterone,  an androgen with a strong biological activity.  It comes mainly from androstenedione (60%).  The rest is produced directly by the ovaries and adrenal glands (20%).
The aim of the test: to confirm hirsutism, PCOS (Polycystic ovary syndrome), be helpful in the search for the causes of the excessive testosterone in the body.
Androstenedione, a weaker androgen, it is produced by the ovaries and adrenal glands.
The aim of the test: the diagnosis of PCOS and adrenal dysfunction.

DHEA - Dehydroepiandrosterone and its sulphate (DHEAS)  are weaker androgens produced almost exclusively by the adrenal glands (above 90%), some small amount is produced by the ovaries.
The aim of the test: it indicates the adrenal or ovarian source of testosterone excess.

SHBG,  sex hormone-binding  globulin.  It is involved in the transport of hormones (testosterone, estradiol) in the blood.
The aim of the test: the  confirmation of the biologically active testosterone excess, the confirmation of PCOS or hyperthyroidism.

17-OH progesterone, in the first phase of the cycle is produced only by the adrenal glands, and in the second phase by the corpus luteum as well.
The aim of the test: to diagnose the congenital adrenal hyperplasia.

The  androgens level is relatively constant except for the periovulatory period when their concentrations increase. However, the test is usually performed on the third day of the menstrual cycle.
 

Hormone	Standard 1	Standard 2	Converter
Testosterone	15-84 ng/dl	0,4-3,0 nmol/l	1 ng/dl=3,47 nmol/l
Androstenedione	0,7-3,1 ng/ml	2,5-10 nmol/l	1 ng/dl-3,49 nmol/l
DHEAS	40-390 ug/dl	-	1 ng/ml=2,7 umol/ml
17-OHP	0,2-1 ng/ml	0,6-3 nmol/l	1 ng/ml=3 nmol/l
SHGB	18-114 nmol/l	-	-

6. Human chorionic gonadotropin HCG

HCG - human chorionic gonadotropin is a hormone produced by the placental component syncytiotrophoblast, and thus is produced by blastocyst after the implantation in the uterus, and by the villi. The chorionic gonadotropin maintains the corpus luteum function in early pregnancy (8-10  weeks). If there is the implantation of fertilized egg (usually between 6-8 days after ovulation), the detectable concentration of HCG (> 1 mIU / ml) appears in the blood 48 hours later.
The aim of the test: an  early pregnancy detection, a monitoring of  the ectopic pregnancy treatment effectiveness with methotrexate and the control of the molar pregnancy or choriocarcinoma treatment.

Week of pregnancy	Level of beta HCG
3	5-50 mlU/ml
4	5-430 mlU/ml
5	19-7340 mlU/ml
6	1000-56000 mlU/ml

More important than the absolute HCG values ​​are its increases of concentration in time. In the case of a normal pregnancy HCG level increases by at least 66% within 48 hours and by 114% within 72 hours. HCG level reaches its peak in 8th-10th week of pregnancy, then its level lowers and remains lower until the end of pregnancy.


7. Anti Müllerian Hormone AMH

AMH - Anti Müllerian hormone, is secreted by Sertoli cells of ovaries and testes. The level of this hormone in blood allows to assess the woman’s fertility, to estimate the chances for conceiving a child and to confirm the woman’s menopausal stage.
The aim of the test: the ovarian functions and the ovarian reserve assessment.

Standard	Interpretation
>3,0 ng/ml	High level of hormone (usually PCOS)
>1,0 ng/ml	Proper level
under 1,0 ng/ml	Low level of hormone (usually menopause)

8. Endometrial evaluation

The endometrial evaluation is possible thanks to the ultrasound scan. Decidua cells and EMJ zone (endometrial-myometrial  junction) make a functional unit which determines the proper implantation and maintenance of pregnancy.
The aim of the test: the evaluation of the changes taking place within the endometrium and
the chances to carry a baby to full term.
 

Endometrium essential for implantation	Standard
Minimal level of endometrium	5-7 mm
Optimal level of endometrium	8 mm
Maksimal level of endometrium	14 mm

9. Cycle (ovulation) monitoring with ultrasound.

Cycle (ovulation)  monitoring is an ultrasound test which allows to evaluate the growth of ovarian follicles containing an  egg and to control an ovulation and the moment of its occurrence. The test is carried out several times during the follicular,  periovulatory and postovulatory phase to confirm the ovulation.
The aim of the test: To evaluate the growing follicles and to confirm the ovulation and the endometrial development.

 

Phase of cycle	Dominant follicle	Endometrium	Other features
follicular	up to 18-22 mm (about 3 mm per day)	Increases from 0,5 up to 8,0 mm (min. 5-7 mm)
ovulation	20-26 mm	about 12-14 mm
luteal	Corpus luteum is formed from ruptured follicle, then slowly disappears in next cycle, transforming into the corpus whitish	8-12 mm, endometrium soft in secreted phase	Fluid from ruptured follicle in rectovaginal pouch
menstruation	-	exfoliation of endometrium up to 0,5 mm

10. Sperm test.

The semen analysis includes an assessment of basic parameters such as: the total number of sperm in the ejaculate, the concentration of sperms, their mobility and vitality. Before the test the periodic sexual abstinence (3-5 days) is needed.
The aim of the test: to control the quality of sperm.
 

Parameters tested	Recommendations 1992	Recommendations 1999	Recommendations 2010
Ejaculate volume	≥2 ml	≥2 ml	≥1,5 ml
Ejaculate ph	≥7,2-8,0	≥7,2	≥7,2
Concentration of sperm (numbers in ml of sperm)	≥20 mln/ml*	≥20 mln/ml*	≥15 mln/ml*
Total number of spermatozoids in ejaculate	≥40 mln*	≥40 mln*	≥39 mln*
The percentage of sperm of progressive motility	≥25% of fast progressive motility or ≥50% of fast and slow progressive motility	≥25% of fast progressive motility lub ≥50% of fast and slow progressive motility	≥32% but there is no differentiation on fast and slow progressive motility
The percentage of live sperm	≥75%	≥60%	≥58%
The percentage of proper morphology sperm	≥30%	≥14%	≥4%

* To assess the tested semen as proper one it was enough to achieve only one of these values.

These WHO recommendations are based on the examination of the reference group consisting of more than 4.5 thousand men aged 30 years (± 5) whose partners became pregnant in less than one year effort to conceive a baby. It should be noted that the semen sample analysis is to be confirmed by carrying out the test  at least twice, as the quality of sperm can vary under the influence of different kinds of external factors and diseases.
In addition, these standards should not be taken entirely clear, due to the fact that the patients whose results are below the standards can also conceive the child naturally.


11. Karyotype genetic test

The karyotype (cytogenetic) test one of the tests  used in the infertility or recurrent miscarriages treatment. It is done for both women and men. It is based on determining the number and structure of a given person chromosomes. As a result, the cytogenetic karyotype is obtained, which is  the picture of chromosomes that are found in every cell of our body. In the case of a healthy person each cell must contain a set of 22 pairs of autosomes and 2 sex chromosomes. In total, every healthy person has 46 chromosomes in a single cell.
Any change in the karyotype image is a cause of serious genetic diseases ( aberrations of autosomes or sex chromosomes) and due to disturbances in the gametes production it can be a cause of infertility.
The aim of the test: to find out whether the  fertility problems are genetic ones.

Who should do the karyotype test?
• the women after miscarriages, especially recurrent ones,
• the women with amenorrhea or the problems of puberty,
• the couples struggling with infertility,
• the women who already have children with genetic defect,
• the men with possible sex chromosome abnormalities,
• the people who have relatives with genetic disorder.