The Top 10 Labs I Order for Fertility (And Why They Matter)
What Your Lab Work Can Reveal About Hormones, Nutrients, and Your Path to Conception
When it comes to fertility, there's often a lot more going on beneath the surface than just whether or not someone is ovulating. Hormonal health, inflammation, nutrient status, adrenal function, and even how well your liver detoxifies can all impact your ability to conceive and sustain a healthy pregnancy.
In my practice, I use lab testing not to label or pathologize, but to understand. To see the patterns. To help patients connect the dots between symptoms and underlying physiology. Here are the top 10 labs I most frequently order in the fertility space, along with why they matter, what they reveal, and how they connect to nutrient needs.
1. Progesterone (Tested ~7 Days After Ovulation, Typically Day 19–21)
What It Measures: Progesterone is the hormone that dominates the second half of your cycle (luteal phase) and is critical for preparing the uterine lining for implantation and sustaining early pregnancy.
Why It Matters: Low progesterone can lead to spotting before your period, shortened cycles, difficulty sustaining a pregnancy, or outright infertility.
Nutrient Links: Low progesterone is often associated with deficiencies in vitamin B6, zinc, and magnesium—key players in hormone synthesis and stress resilience.
2. FSH and LH (Tested on Day 3 and Day 19–21 respectively)
What It Measures: These pituitary hormones help regulate the menstrual cycle and ovulation. FSH tells the ovaries to grow follicles (one of which matures into the egg you’ll release that month); LH triggers ovulation.
Why It Matters: High FSH can signal diminished ovarian reserve; low LH might suggest anovulation. The ratio between FSH and LH can also hint at PCOS.
Nutrient Links: Zinc and vitamin D support healthy pituitary function and hormonal communication.
3. Estrogens (Estradiol + Estrone, Tested on Day 3 and/or Day 19–21)
What It Measures: Estradiol is the primary estrogen during the reproductive years. Estrone becomes more dominant post-menopause.
Why It Matters: Low estrogen can prevent ovulation and thin the uterine lining; high estrogen may lead to PMS, fibroids, or endometriosis. Elevated Estrone:Estradiol ratio due to genetic mutations and/or poor detox, can influence ovulation and cycle regularity.
Nutrient Links: Estrogen metabolism relies heavily on B vitamins (B2, B6, B12), choline, and liver function.
4. Thyroid Panel (TSH, Total T4, Free T3, Anti-TPO, Anti-TG)
What It Measures: Full thyroid function, including autoimmune markers.
Why It Matters: Even mild thyroid dysfunction can disrupt ovulation, increase miscarriage risk, and contribute to fatigue or low libido.
Nutrient Links: Iodine, selenium, iron, and zinc are essential for healthy thyroid function.
5. Inflammation Markers: hsCRP and Ferritin
What It Measures: hsCRP is a sensitive marker for systemic inflammation; ferritin is the body’s iron storage protein that we consider an “acute phase reactant” meaning when high, it also signals inflammation.
Why It Matters: Chronic inflammation can impair implantation, ovulation, and egg quality. Ferritin is also a double-duty marker—too low and you may have iron deficiency; too high can indicate inflammation.
Nutrient Links: Iron, vitamin C (for absorption), and antioxidants like vitamin E and selenium play a role here.
6. Iron Panel
What It Measures: Serum iron, ferritin, TIBC, and transferrin saturation.
Why It Matters: Iron is essential for oxygen delivery to your ovaries and uterus. Low iron can lead to fatigue, poor egg quality, and anovulation.
Nutrient Links: Vitamin C enhances absorption; copper, B12, and folate are iron cofactors.
7. Adrenal Function (Morning Cortisol, DHEA-S)
What It Measures: Cortisol and DHEA-S are adrenal hormones that reflect your stress response and your body’s ability to mitigate daily stressors.
Why It Matters: Chronic stress can suppress ovulation, lower progesterone, and contribute to irregular cycles.
Nutrient Links: Vitamin C, B5, magnesium, and adaptogens like rhodiola or ashwagandha support adrenal resilience.
8. Liver Function (Comprehensive Metabolic Panel)
What It Measures: Kidney function, Liver enzymes (ALT, AST), albumin, and bilirubin.
Why It Matters: Your liver metabolizes and clears excess hormones. If sluggish, it can contribute to estrogen dominance and higher overall toxic burden.
Nutrient Links: Choline, B vitamins, NAC, and antioxidants like milk thistle or glutathione precursors support liver detoxification.
9. Blood Sugar and Insulin (HbA1c, Fasting Glucose, Fasting Insulin)
What It Measures: Glucose metabolism and insulin sensitivity.
Why It Matters: Insulin resistance can block ovulation and contribute to PCOS-like symptoms. Balanced blood sugar is foundational for hormonal health.
Nutrient Links: Chromium, magnesium, omega-3 fatty acids, and fiber all help regulate blood sugar.
10. Homocysteine
What It Measures: An amino acid that, when elevated, indicates poor methylation typically due to low B vitamin status.
Why It Matters: High homocysteine is linked to miscarriage, poor egg quality, and implantation issues.
Nutrient Links: B12, folate, and B6 are needed to keep homocysteine in check—especially if there's an MTHFR gene variant involved.
Bonus Labs for Those Struggling to Conceive
MTHFR Genotyping: Determines how well you methylate folate, which is critical for early pregnancy and DNA replication.
Factor II & Factor V Leiden: Clotting mutations that can increase risk for early miscarriage.
Celiac & Gluten Sensitivity Testing: Undiagnosed celiac disease can impair nutrient absorption and affect fertility.
AMH: Anti-mullerian hormone, a marker of ovarian reserve or the number of eggs remaining in the ovaries.
Final Thoughts
Fertility isn't just about ovaries and sperm—it's a reflection of whole-body health. These labs help us understand what your body needs support with so we can take targeted, personalized steps to improve your fertility outcomes.
Whether you're just starting to think about getting pregnant or you've been trying for a while, getting a comprehensive lab workup is a powerful, clarifying first step.
If you're interested in working together, I offer a fertility-focused lab review package that includes a thorough intake, personalized lab recommendations, and an action plan based on your results.
Let’s decode what your body is telling you—because your fertility is worth listening to.