Guest blog by Dr. Rachel Corradetti-Sargeant, ND, a fertility-focused naturopathic doctor.
In the fertility clinic where I work, we often run a panel of tests called THE BIG 5. These are conducted on Cycle Day 3. Each of these provide critical information about what’s happening with your hormones. Results from these tests can help your care team determine what types of treatments you may or may not need.
This series of tests are run on cycle day 3 for a particular reason. Cycle day 3 is the 3rd day of full bleeding during a period. Day 1 is considered the first day of full bleeding. It’s the kind of bleeding where you actually have to do something about it – you know what I mean. This is the time in the menstrual cycle when hormones are at their quietest, which means it is the best time to test them out to understand where your body is at.
The Big 5 – The Top 5 Hormones to Test when TTC
Here is a detailed breakdown of The Big 5 and why they matter:
Estrogen – This is the top fertility hormone to investigate. Estrogen is produced as the follicle matures within the ovary during the early luteal phase. It will reach its first peak before ovulation and it will reach a second smaller peak in the middle of the luteal phase. Testing estrogen on day 3 can help your care provider understand if your levels are abnormally high, which might indicate a cyst, or abnormally low, which might indicate any issue with how many follicles are available to stimulate.
TSH – Thyroid Stimulating Hormone – This hormone is a marker of the communication between the brain and the thyroid gland. The thyroid is responsible for setting the metabolic rate of the body. This means it can impact how well your reproductive system is functioning. If TSH is depressed or elevated it can put you at risk of issues with how well a stimulation cycle might go. It can also put you at risk of miscarriage if certain antibodies are similarly elevated. Your doctor will look to this test to see if medications may be required to support your thyroid function.
LH – Luteinizing Hormone – This hormone is responsible for ovulation. It should not be elevated in the early part of your luteal phase. If it is elevated, especially if it is three times higher than LH, it can indicated fertility-impacting conditions like PCOS.
FSH – Follicle Stimulating Hormone – This hormone is released by the brain at the start of the menstrual cycle in order to get a follicle engaged in the maturation process. If the number is too high it can indicate that there may not be many follicles left to call upon. This can indicate that it might be harder to get pregnant, or that you may not do as well with certain fertility treatments.
Beta HCG – This is the pregnancy hormone. It is tested in the early luteal phase at the start of fertility treatment cycle to ensure the patient isn’t pregnant before starting any treatments. If the patient is pregnant, no treatments are needed, of course.
Extras: These are sometimes included on a baseline BIG FIVE for extra detail.
Progesterone – Progesterone is a hormone that should not be elevated in the follicular phase. If it shows up as elevated then something else is going on that needs to be investigated.
Prolactin – This hormone is produced by the pituitary gland within the brain. It is meant to stimulate milk production by the mammary glands. If it is elevated in someone who isn’t lactating it could mean it’s impacting ovulation.
The BIG FIVE are crucial for understanding your fertility status and predicting outcomes for your success.
Dr. Rachel Corradetti-Sargeant, ND is a fertility-focused naturopathic doctor practicing at Conceive Health @ Niagara Fertility in Stoney Creek, Ontario, Canada. She studied at the National College of Natural Medicine in Portland, Oregon and the Canadian College of Naturopathic Medicine in Toronto, Ontario. She is licensed through the College of Naturopaths of Ontario, and is a professional member of the Canadian and Ontario Associations of Naturopathic Doctors, as well as the Endocrinology Association of Naturopathic Physicians. She treats her patients with personalized, functional, and integrative medicine.
After her own difficulties with pregnancy loss she is passionate about empowering her patients to make healthy changes that help them conceive and maintain healthy pregnancies. When Dr. Corradetti-Sargeant is not seeing patients, she’s running triathlons, contributing to magazine articles (look for her in Clean Eating and Elle magazines), or making a giant mess in the kitchen whipping up the latest healthy desserts!
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