Season 3, Episode 2 – Transcript

Why Fertility Testing Matters

Hello. Welcome back. Today I want to talk about testing. It’s where I start with all of my one to one clients. And it’s where I’ll start with you. Because unless you know what testing you need to do, you really don’t know what direction you need to move into.

And I will say that nine times out of ten people are in my DMs, they’re messaging me, or they’re coming into a discovery call or our first consultation, and I guarantee you the first thing they say is, I’ve had all the tests done and everything’s normal. But I’m going to tell you, if you’re not pregnant, there’s something that’s not normal. And let me explain why.

Why “Normal” Fertility Test Results Can Be Misleading

It’s one of three things. Firstly, I see all the time they haven’t had enough tests done, and the tests that they have had done aren’t telling you the full story. And if everything truly was normal, then you’d be pregnant by now.

And here’s the thing. You will go to a GP or another doctor, and what they test will be completely different to what another doctor will test. So there is some guidelines on what we should be testing with fertility, but in my opinion it’s absolutely not enough.

Conventional vs. Comprehensive Fertility Testing

So the first thing I do when I work with people is talk about the testing. And I’m going to talk to you about this today so that you can get started on this by yourself. Here’s the thing. You’re not doing enough of the test.

So most people will go in and see their doctor and get the basics done. A lot of it tends to be a lot of the STI screenings. Or they might do iron studies, a vitamin D, a basic thyroid. But it really doesn’t tell us enough.

So conventional medicine will do the basics. But what we really need to know is the full story.

Examples of Comprehensive Fertility Testing

And by that I mean a full thyroid panel. We need all of your reproductive hormones done on day two of your cycle. We’re looking at fasting insulin. What’s your metabolic status? How are your nutritional panels looking? How is your vitamin D, your iron studies, B12, folate? What are your zinc levels doing? And the same goes for men as well.

If they’ve just done a sperm test and nothing else, you’re missing a huge part of the story. Because when it comes down to fertility, we need to know what’s happening with your gut, what’s happening with inflammation, what’s happening with your immune factors.

And I think the thing is, is that we get so far down the track that you think everything is normal, and then your next step has to be IVF.

And I’ve just worked with so many women that once we actually look at the real story, we’ve picked up so many things that they didn’t need IVF or they’ve been able to conceive naturally after four years by looking at it from a more holistic approach.

And it’s not always picking between conventional and natural medicine, as I say a lot. It’s really about getting support from all angles.

Functional Medicine and Root Causes

So what I do is really functional medicine. And in functional medicine, we’re looking for the root cause of where the problem is. When we look at the root cause we then are looking at different tests. We’re looking at them in a different reference range as well. So if you’re just within the reference range, it’s often not enough.

The Fertility Blood Test Rundown

All right. So comprehensive testing. You need more testing. I’ll give you the basic rundown of what I generally look at in a fertility patient. Starts with day two hormone panel. And this means you’re doing it on day two or three of your menstrual cycle. And we need to do this because it is the baseline of your hormones. And it’s a good place to measure.

Day 2 Hormone Panel

So day two hormones: we’re looking at FSH, LH, estrogen, prolactin, sex hormone binding globulin. We’re looking at your androgens, DHEA.

Nutritional and Thyroid Panels

And then in terms of a nutritional panel, I look at iron studies, vitamin D, full thyroid panel including thyroid antibodies. If we’re able to get B12, folate, I look at a full blood count.

I like to test celiac because undiagnosed celiac is a big driver of infertility. I also like to check zinc and cortisol when there’s a stress factor, liver enzymes, and electrolyte panel. I need to know what’s happening with your kidneys and everything else.

So it’s pretty well rounded, and it gives us a really good sense of what we need to know about your health.

Mid-Luteal Testing

And when you have that kind of testing done, you know you’ve got enough information. Oh, and I also forgot mid-luteal testing—oestrogen and progesterone. So we need to test your progesterone and estrogen seven days after ovulation to: one, confirm that you have ovulated and progesterone is high enough to hold a pregnancy; but secondly, I always check oestrogen in your mid-luteal, seven days after ovulation.

Because when that’s higher than we like it to be, that can interfere with how you implant. So it’s a really big clue of what’s going on. And I often find that it’s missed years down the track. And when we correct that, really amazing things happen.

Fertility Testing Conditions: Getting It Right

The next thing you need to know with testing is testing conditions. And I see this not communicated very well most of the time.

For your test to be the most accurate, they need to be done in the morning, ideally fasted. That means no exercise, no coffee beforehand, and about an hour after waking up.

I know it sounds like a lot, but if you’re testing AM cortisol or you’re testing testosterone for men, that really needs to be done an hour after waking up, and that’s where it’s going to be the most accurate.

We also need some tests done on specific days. So your reproductive hormones need to be on day two or three of your cycle, progesterone a week after ovulation. And the same goes with AMH testing—that is going to be the most accurate if you do that on day two or three of your cycle, and we’ll talk a little bit more about AMH as well.

So testing conditions are really important. I often find that if you haven’t fasted before tests or they’re done on the wrong day—especially hormones—they’re just very hard to interpret.

And I know that doctors have said, well, it doesn’t matter, hormones change all the time, you can test them anywhere in your cycle. But really, to get an accurate reading for your fertility, they should be done on these specific days.

Why Reference Ranges Aren’t Always Fertility-Friendly

If you’ve been to your doctor and they said everything looks normal, but you’re still suffering with a lot of the symptoms that come with low iron or low vitamin D, or your thyroid doesn’t feel right, it’s probably because you’re sitting somewhere in the reference range that isn’t optimal.

Being within those reference ranges is not optimal for fertility. Those reference ranges are basically meaning that you’re not in a really bad way with your health. They’re not measured for your optimal health. And when it comes to fertility, we really need those levels in an optimal range.

For example, your TSH—your thyroid stimulating hormone—the reference range goes from 0.3 to 5. So if you’re sitting at 3.8 or higher, you’ll probably be told that it’s normal. But for fertility, we like your TSH to be 2.5 or lower.

And then if it is in the higher range, you’re at a higher risk of having a miscarriage or other problems with your thyroid. Same goes with iron, B12, folate, especially your hormones. I’ll be looking at completely different reference ranges to put you in that optimal health range.

So having normal blood tests doesn’t always mean it’s normal.

And if you are in a position where everything feels normal but you’re still not getting answers, you should definitely be getting another opinion or another set of eyes on it. Maybe seeing a naturopath, or seeing someone like me who works in functional testing to really help you get a clear idea of what is going on.

Because interpretation is the second part of it, and it matters so much. Because you can have all the testing done, but if you don’t know what to do with it, then that’s the hard bit.

Male Fertility: The Other 50%

Let’s not forget the guys as well. I see this time and time again—and I mean years into a fertility journey—where men have done a sperm test and it’s been ticked off. Really minimal other tests done. Just, you know, maybe they’ve had sperm antibodies checked if they’re seeing a fertility specialist. But often that sperm also doesn’t get rechecked. And if it’s more than three months old, you know, things can change in a really big way.

The thing that gets me the most with male fertility is that they’re just so disregarded in the fertility journey. And really, they’re fifty percent of the equation. So we need to be checking the guys more.

If you’re in a position where you’re doing egg collections and you’re getting low fertilization, or you’re having a huge drop off of your embryos, or you’re trying naturally and everything’s looking great and your blood tests are amazing but you’re still not implanting—you need to do more comprehensive testing with the guys.

Comprehensive Male Fertility Testing

And when I do comprehensive with the guys, I check everything. I check liver function, I check their iron, vitamin D. Super high iron in men can affect their fertility. Same with low vitamin D. If they have high homocysteine, then we’re talking about issues with methylation. So there’s a lot more to their health story.

And I see this a lot. I see stress in a really big way with guys that’s not being addressed and it’s affecting their fertility.

So what we see with high levels of stress is that their cortisol is raised, it’s driving up their fasting insulin. So they’re having lots of insulin resistance and it’s lowering their testosterone. So to get a whole picture of what’s going on—that’s what we really need to be looking at as well.

Why “Good Eggs Fix Bad Sperm” Is Misleading

It’s just I’ve heard it so many times from doctors that good eggs fix bad sperm. But why should we be dealing with that? Why wouldn’t we be looking at men as well, and looking at their overall health and helping them to get healthier so that we’re getting better fertilization with embryos, more eggs that are frozen, and getting better results?

Because this is the thing, right? When an egg and sperm fertilize, it’s then the egg’s job to fix damaged DNA of the sperm. And when there’s too much damaged DNA of the sperm, it either won’t implant, it won’t fertilize, or it may end up in a miscarriage. So we need to be looking at the other fifty percent of the equation, because a pass on a sperm test doesn’t tell us everything.

What a Sperm Test Really Shows

So in my masters, we learned that—and this is a medical masters—that a sperm test doesn’t tell us directly about the fertility potential of a man. What that tells us is essentially it’s a snapshot in time. So it tells us what the sperm looks like at that time.

And yeah, there’s lots of things we need to tick off. We need to know that there’s enough sperm. We need to know that they’re swimming in the right direction and they’re moving forward. And it tells us about how many of them are a normal shaped sperm and the pass rate.

So what the reference ranges are on a sperm test are actually the bottom fifth percentile of the fertile population. So the World Health Organization sets the parameters of what normal sperm is. And what they did is they tested how fertile men were in Western countries, and they tracked that over a year. And then they put that data into a bell curve. So the pass rate has dropped significantly over the years.

You need three to four percent normal shaped sperm to be considered normal. But what that means is that the eggs are having to work harder to get the right sperm. So a pass rate is not always off the hook.

Working With Couples, Not Just Women

And honestly, with my clients that I’m working one to one with—and now I’ve changed how I’m working with couples in the sense that if he’s not on board, I don’t take them on—because for too long I worked with women and not really worked with men.

Yes, I would check their sperm test and I would give them supplements, but I wasn’t really working with him on that deep level. And now that I’m working with couples and addressing both of their health, I cannot believe the results we’re getting.

Where normally it might take six months or so for them to get pregnant, and it’s now happening within two to three months. And I really feel like this is a missing piece of the puzzle, and it will be a huge part of the future as well, because male fertility is in a really bad way. We need to be addressing that.

And, you know, we’re smoking less. We’re doing other things. Although, having said that, vaping is something that’s definitely ruining your sperm quality. So if your partner is vaping, tell him that’s something that he needs to come off straight away.

AMH Testing and Fertility

And lastly, I want to talk about an AMH test because so many of you are getting this done and then freaking out about the results—which is understandable.

I also saw there was a company that was promoting at-home AMH testing, sort of like an egg timer test. And really that frustrates me because they’ve got all these influencers talking about how they’re so worried about their fertility, and now they feel okay knowing that they’ve had this test done. But interpretation matters so much.

What AMH Actually Measures

And this is the thing—the AMH test was designed for the IVF space. It doesn’t tell you how many eggs you have left. What happens is when you do the AMH test, if you have a low AMH test, it will change how much of the drugs your doctor would give you to stim up your eggs for an egg collection. Same if you have a high AMH, then they will give you less drugs so you’re not overstimulated.

And somewhere along the line, this became a fertility test. But there is no such thing as a fertility test. It’s a collection of a whole lot of different tests that we then use to get a really good idea of what’s going on for you. Because there was some research that came out that said a low AMH doesn’t dictate how fertile you are. So that means that if you have low AMH—still try naturally. Because I’ve seen it so many times where women have really low levels and have still been able to conceive naturally.

And I’ve seen people have really low levels who have absolutely freaked out, and the next thing they’re in that whole IVF cycle, they’re doing egg collections because they’re worried that they’re going to run out of eggs.

Understanding Egg Reserve and AMH

But here’s the thing. You’re born with all the eggs you will ever have in your life. They’re trapped in a type of—I call it like a reproductive vault. So they’re locked in there and nothing can access that. But then every month, eggs are released from that vault. And I mean quite a few eggs. And they’re all coming out for the job of ovulation. So in that pool of eggs that come up out of the vault, up for the job of ovulation, only one of them will make that job, and then one egg will be picked for the egg, and the rest of them will die.

It’s actually a natural process in the body where we’re continually releasing eggs, and then they’re dying, releasing them, and they’re dying.

So what happens is the AMH test tests the fluid and the hormone signaling from those eggs that are released out of the vault. So the idea really is that the more eggs that are released means that there’s more left in the reserve, in the vault, and there’s less that’s released is actually meaning that there’s less in the vault.

So there is some research to say that a low AMH also means that we have poorer egg quality. But here’s the thing—there’s some things that can influence your AMH levels. Really low vitamin D can bring back a lower AMH level. And also the day that you test it. So it’s always going to be more accurate if you do it on day two or three of your cycle.

It’s also quite an expensive test. It’s not something you want to be testing all the time, but making sure you get the testing conditions done right is really important.

When Low AMH Might Be a Concern

I will say one thing though. If your AMH is really, really low and there is a history of early menopause in the family, and your hormones also look like you’re in early menopause—that’s something you don’t mess around with. So that’s why interpretation is important. Because if you are in that category of poor ovarian reserve and early menopause, that’s something that you want to be actioning pretty fast. And by that I mean taking out your eggs and freezing them.

And that situation doesn’t come around that often. And I think what’s happening now is a lot of women are pulled into that. As soon as we see a low AMH, we start freaking out. But it’s not true poor ovarian reserve. Because I’ve seen too many people in that situation go through enormous stress and then go on to have children naturally. And I don’t even mean in their early thirties—I mean in their late thirties and early forties.

So fertility is nuanced, and it’s just a lot more complex than one test. Don’t weight everything on that test. And also, don’t freak out if it’s low. There’s still lots and lots of options. And it might not mean that you will struggle to conceive because you’re never going to run out of eggs. Not until you go through menopause. And that’s not anytime soon for most of you.

Fertility Testing as the Foundation for a Plan

So we’ve talked about testing conditions. We’ve talked about more comprehensive testing—that the tests you’ve already had done are probably not enough. And then we’ve also talked about getting your partner checked in a really big way, and what AMH really means.

When you have all of this done, that’s your foundational work. From that data, that’s where I create plans for people. Because when you have that data and someone’s interpreted that and told you what’s going on, you know what your next steps are. And it’s really clear. And that takes you out of the waiting zone—wondering what’s happening, feeling powerless because you don’t know what’s going on with your fertility journey. It gives you the power back.

And that’s why I love functional testing. And I love then going—this is the type A in me really going—here are the missing pieces. Let’s put the puzzle back together. Because once we have a really clear strategy, that’s when you go, it’s going to be six to eight weeks of doing this, and then we’re going to be in a better place. We can retest it, we can track your progress, and then we can map out what your next steps look like.

So really, testing is where it begins—at the same time of doing all of the lifestyle stuff. But honestly, sometimes this can be the kick you need to know what lifestyle stuff you need to be working on, especially with the guys. I really find that once they see the data in front of them and we can put it together, that’s when they’re really motivated and that’s when they’re really on track to make those improvements.

And I honestly think that’s where the magic happens. And that’s how I’m seeing people getting pregnant faster and faster.

Closing Thoughts

Okay. Thanks for listening. I hope that was helpful. Send me through any topic ideas that you would like to hear about. I’d love to dive into what you’re actually wanting to hear. Send me an email or send me a DM on Instagram.

See you in the next episode.