I got the rest of my bloodwork back last week, and let me tell you…I’ve been stressing out about it ever since! The internet is so great at times, and so terrible at others. All this technology at our fingertips is not always a good thing! When my results came back, I had no idea what they meant or even what it was that they were testing for. My RE just gave me a huge list of bloodwork that I needed to have drawn and told me to fax over the results once I had them. So, I did what I was told and went and had all the labs drawn. Eleven vials of blood later…and it was a waiting game for the results. The results took about a week. Once they were all in I was able to view them online. Unfortunately, none of the labs had “normal range” listed…so all I was looking at was a bunch of tests (half of which I couldn’t even pronounce the names), followed by a bunch of numbers. Anyone that knows me, knows that I love to research things. Plus, I’ve always been fascinated by medicine, so the natural thing to do was to look up the results and see 1) first what the tests were for, and 2) what the numbers meant. BAD IDEA! I should have just faxed them off to the RE’S office as instructed and went on with my day. That would have been the smart thing to do. If I’d done that, I’m pretty sure I’d have a lot less grey hairs right now! It is never good to self diagnose…it always ends that you are going to die or have a super rare disease that in incurable. For me, I was pretty sure I was in pre-menopause after my bout of “research”.
Without further adieu, here are my blood test results and what they mean:
Estradiol – 25.8 / Normal range – 25 to 75 mIU/ml
Research: Normal Estrogen levels for on CD3 (cycle day 3) is between 25-75. Estrogen is the predominant female hormone; estradiol is the predominant form of estrogen produced in the ovaries. It acts as a growth hormone for tissue of the reproductive organs, supporting the lining of the vagina, the cervical glands, the endometrium, and the lining of the fallopian tubes and prepares the lining of the uterus for implantation. Estradiol is necessary to maintain healthy eggs in the ovary. Levels on the lower end tend to be better for stimulating, where as abnormally high levels on day 3 may indicate existence of a functional cyst or diminished ovarian reserve.
Notes: This looked good. I was in the “normal” range and I learned that lower estradiol was better for stimulating, which would mean less medication to get my body to respond. I was a little worried that it may be too low though. I mean, it was at the very bottom of normal. After talking to Dr. Kolb, he assured me that the level was perfectly normal for me, especially when you factor in my size. He said that thinner women on average have lower estradiol, and with me only being 100 lbs…it was nothing to be concerned about. Yippee!
Luteinizing Hormone (LH) – 4.9 / Normal LH – 7 mIU/ml or less
Luteinizing hormone increases right before an egg is released from the ovary. Baseline levels are less than 7 international units per liter (IU/L) on day three of the menstrual cycle and the hormone level rises to 20 IU/L or higher as the egg matures and is released from the ovary.
Notes: This looked good too! Well within “normal” limits!
Thyroid Stimulating Hormone (TSH) – 1.46 / Normal .4 – 4.0.
Research: If the thyroid malfunctions, then either too much (hyperthyroidism) or too little (hypothyroidism) of these vital hormones are released. In pregnancy, these conditions may lead to miscarraige, premature birth, or pre-eclampsia.
Notes: Another one that looked “normal”. Woo Hoo!
Follicle Stimulating Hormone (FSH) – 13.0 / normal under 10
Research: FSH is produced in the ovaries and stimulates egg maturation. Levels of FSH on days two to three should be less than 9 mIU/ml, according to the Advanced Fertility Center of Chicago (AFCC). A higher level of FSH indicates peri-menopause, and a level higher than 40 mIU/ml means that a woman is menopausal. FSH levels indicate a woman’s potential ability to become pregnant. AFCC states that FSH levels of 11 to 15 mIU/ml indicate decreased egg reserve and a reduced chance of pregnancy, while levels of 20 mIU/ml relate to a very low chance of pregnancy and live birth. If the ovary doesn’t have any eggs, or if it can’t release them, the pituitary sends out more and more FSH in an attempt to get the ovary to respond. For the woman who is found to have a very high FSH level, it’s a sign that the pituitary is trying stimulate the ovary but the ovary isn’t responding at all or very well.
In general, under 6 is excellent, 6-9 is good, 9-10 fair, 10-13 diminished reserve, 13+ very hard to stimulate. In PCOS testing, the LH:FSH ratio may be used in the diagnosis. The ratio is usually close to 1:1, but if the LH is higher, it is one possible indication of PCOS.
Notes: Here is where I freaked out! My FSH is really high, especially for my age. I mean, I am at the top of the “diminished reserve” category and at the bottom of the “very hard to stimulate” category. As I researched more, I found phrases like, “bad eggs” and “pre-menoposal” and “donor eggs needed” and “some clinics won’t even take you”. I was a mess. Picture me bursting out crying at timed intervals throughout the day. And the most frustrating part, I couldn’t get ahold of either of my doctors to discuss these results. So, for the past week I pretty much thought I was going into menopause. Thanks stupid internet!
Today I finally talked to my RE and I feel a ton better. He made me promise not to do any more internet research or anything that will stress me out. He agreed that the number was high for my age and he had expected it to come back at less than “10”, however, he said that this is just one piece of the puzzle and you can’t only rely on this number alone to make a prediction on the outcome for us. He said that all my other numbers looked good and the most important factors they look at are 1) age and 2) follicle count during ultrasound. At age 32, he said I am at a perfect age for IVF and I should still have plenty of good quality eggs. Now, if I was 42 and had a 13 or higher FSH, then he’d be a lot more concerned. Really he said we sought out assistance at he perfect time. I mean, wow, who knows where my number could be in 6 months or a year. The higher it gets, the less likely a successful pregnancy (with your own eggs) is. As for my follicle count, during the 1st ultrasound I had with him, there were 14 resting follicles which he said was a great number. The thing with FSH, is it doesn’t tell you anything about the quality of the eggs, just the reserve. My body is producing way more FSH than it should to get an egg ready to go, which probably means that I may not have a ton of eggs left (we are born with hundreds of thousands though, so who knows how many are considered “low”)…but the ones I do have are probably (hopefully) good quality.
Anti-Mullerian Hormone (AMH) – 1.18 / normal 1 or higher
Research: Anti mullerian hormone is one potential test of ovarian reserve. AMH is a substance produced by granulosa cells in ovarian follicles. Since AMH is produced only in small ovarian follicles, blood levels of this substance have been used to attempt to measure the size of the pool of growing follicles in women. Research shows that the size of the pool of growing follicles is heavily influenced by the size of the pool of remaining primordial follicles (microscopic follicles in “deep sleep”). Therefore, AMH blood levels are thought to reflect the size of the remaining egg supply – or “ovarian reserve”.
Notes: This is a fairly new test that is performed and there is still lots of controversy whether it really gives a snap shot of ovarian reserve. It was nice to see that I was in the “normal” range, however, I was a little alarmed that I was in the very bottom of this category that also may indicate fewer remaining eggs. Dr. K said that he was not concerned about this, and anything over 1 was a good sign.
Although I don’t like the outcome of some of my bloodwork, I am glad that I know. And as Dr. K said, we are seeking help at just the right time. I guess that’s a silver lining in this crazy journey. And I have to keep reminding myself…it only takes one. We only need one perfect egg and one perfect swimmer to make our precious baby. I have to remember, focus on, and trust in that! Bottom line, he said that our odds may be a little more compromised than he originally thought and he may have to be a little more aggressive with the medication (which translates to more injections, which translates to more $$$) but he still thinks we have a pretty good shot at this. After the past week of freaking the heck out and thinking I was heading into menopause…even though it wasn’t all good news, it was news from a reliable source and it made me feel prepared knowing what we are heading into. This road may be a little tougher than we originally thought, but we’re not giving up!
Side note: If you are in your 30’s and haven’t had children yet, or are waiting to have children, request to get your FSH and AMH tested on CD3 (cycle day 3). It could tell you a ton about how much longer you can/should wait before fertility potential starts to decline. I sure as heck know that if my daughter decides to wait and have children later in life, I will have her check these things every couple years just to stay informed. Before this week, I never knew there was a way to scientifically measure your fertility and give you a snapshot of how many fertile years you could possibly have left.