Looks Can Be Deceiving…We Recommend a Double Take!

At least once a day we get a call from a friend, a friend of a friend, or a friend of a friend of a friend (say that three times over) asking us to review their results and give them our advice. Inevitably, they are overwhelmed, frightened and often confused. “FS something, I’m not sure” and “mobility of sperm okay but appearance abnormal.” After we sort out some of the details, we are ready to break it down for them in the most basic of terms. Here are some of our tidbits from girls in the know.

1. FSH means NOTHING without Estradiol. FSH and Estradiol are like Bert and Ernie or Bonnie and Clyde. You can’t test one without the other; they don’t make sense when analyzed alone. FSH is a hormone made in the brain (pituitary gland) that signals the ovaries to ovulate (and make estrogen measured as estradiol in your blood).  When FSH is measured early in your cycle, if elevated, it may indicate a decline in ovarian function (meaning your egg quality is declining, making pregnancy more difficult).
2. FSH is falsely lowered by a high estradiol. A normal FSH level with a high estradiol level means that the FSH is NOT normal. Estrogen from the ovaries sends a signal back to the brain to make less FSH in the brain. When estrogen levels in the body are high, the brain makes less FSH. While abnormal levels don’t mean you’re down for the count in terms of baby making, it does make us question whether your ovaries are the cause of your fertility struggles.
3. FSH and Estradiol MUST be sent to the lab on days 2-4 of your cycle. They are not accurate (in all cases except for women with very long, irregular cycles) if sent at other times. Don’t have the blood work done on the wrong day just to check it off your list; you will be re-writing it on your To Do list for the next month.
4. The ranges on the lab report are not always right. Yes, we know that this may sound confusing and totally contradictory but levels need to be interpreted by a physician. Make sure that if you get your levels you speak to a licensed professional before shedding too many tears.  Don’t go straight to Dr. Google with your FSH level until you understand what it means for you specifically!
5. The “dye test” (or the HSG, as we call it) must be done in the early part of your cycle. It cannot be done after you ovulate (you could be pregnant!)
6. An HSG is not meant to be torture. While it can hurt, in most cases it’s pretty tolerable. Take some Ibuprofen before…You should be fine!
7. A “luteal progesterone” test is not equivalent to a day 21 progesterone test. Luteal means “post-ovulation.”  Physicians often test a progesterone (blood test) on “day 21” to confirm an elevation, indicating ovulation.  A day 21 progesterone test is only appropriate for women who have (approximately) 28 day menstrual cycles. If your periods are 35 days, your progesterone on day 21 may be negative (low indicating no ovulation), but that doesn’t mean you won’t ovulate or didn’t JUST ovulate. It just means that it is  (approximately) 7 days too early to check the levels. Make sure to share how long your cycles are with your doctor before diving into the blood work.  If you have longer cycles, then going in after day 21 may be better to confirm whether or not you are ovulating.
8. Not all fibroids are created equal. Fibroids can be a big deal. They can cause pretty bad bleeding, pretty significant pain and pretty real infertility. However, the caveat to the infertility issue is location, location, location. Whether or not a fibroid causes infertility depends on the location of the fibroid. Fibroids located within the uterine cavity are WAY more likely to cause infertility than those in the muscle. Make sure you have a road map of where your fibroid is before you undergo surgery.
9. Motility (a.k.a. mobility in the words of many patients!) is how sperm swim. It is reported as a percentage (% of sperm moving in the sample). Old school normal was 50%. Now that number has been knocked down to 40% (and only 32% need to be moving forward). While no one wants to fail at anything, take it easy on your guy if his “mobility” is off—chances are if you use the newer guidelines things won’t be too bad.
10. Sperm shape has really taken center stage recently. It has become one of the most debatable, doubtable and don’t-know-what-to-do-about-it issues. While it is still unclear as to what abnormal morphology means (impaired fertilization potential currently tops the list), the level of normal to abnormal has been reduced significantly. The new normal is 4% or above. Make sure that you are aware of the new numbers and are aware of what the information means before you start any treatment (some centers are still using the old reference values and therefore are calling anything <14% abnormal rather than <4%). Additionally, while low morphology does mean your partner needs more testing, it does not mean that he needs IVF (in vitro fertilization)!

There are a lot of myths circulating out there. Make sure to ask a reliable source before counting yourself out. While we may not be a friend of a friend of a friend, we are certainly your professional pals!