# Whole host of blood test



## alittlenervous (Apr 28, 2014)

So my GP is concerned about my erratic cycle, huge pms and fact me going it alone via sperm donor at £800 ago she wants to make sure I am ok and nothing bad going on because she said right now I don't stand any chance of getting pregnant with my ovulation so far apart 

I have just picked up my blood form, she wants me to get all the bloods done on day 25 of my cycle because my cycle is around 35 days other months 23 other months 37.    So on 22nd Feb I have to get them done then I see her a fortnight later for results and where to go from there.

Can someone shed some light on the bloods I am having done please?    The ones requested are:

Biochemistry profile (includes U+Es and LFTs)
Cycle Day (CYC)
Full Blood Count/Differential
Progesterone 
Prolactin
Thyroid Function Tests (TSH) (T2)
Female Testoserone

I know the thyroid one as had one before as had a borderline result 3 years ago so being monitored and progesterone I know usually done day 21?  I will it be reliable day 25?  I usually ovulate around day 19/20 on  a35 day cycle but sometimes day 14 if a shorter cycle.  Just worried won't be accurate enough results?


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## Calluna (Jun 14, 2012)

Hi ALN,

You want to have the progesterone test approx. 7 days after you ovulate. You could use ovulation test sticks to detect your LH surge - assume you will ovulate the day after you first detect the surge. Then book the blood test for 7 days later.  

Did you see the actual numbers for your thyroid or did they just tell you it was borderline? The NHS's idea of 'borderline' is often a significant thyroid issue. For fertility you need your TSH to be below 2 (ideally around 1). If you have a thyroid issue that can cause prolactin to be raised and progesterone to be low but thyroid treatment would sort that out.

Testosterone can be too high (suggestive of PCOS) or too low (can be associated with low egg reserve/quality). 

The other tests are just basic health checks I think.

Have you had FSH, LH and oestrogen checked on day 2-3 of your cycle?

Good luck! x


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## alittlenervous (Apr 28, 2014)

Calluna said:


> Hi ALN,
> 
> You want to have the progesterone test approx. 7 days after you ovulate. You could use ovulation test sticks to detect your LH surge - assume you will ovulate the day after you first detect the surge. Then book the blood test for 7 days later.
> 
> ...


Thank you for your reply Calluna. I thought I had to get the progesterone test 7 days after ovulating as well so day 21 of my cycle to but my GP said day 25 as I have around a day 35 cycle so she told me to go on the 22nd February to the local hospital and get my bloods done but if my day 25 falls on a weekend go the Friday or the Monday.

The Cycle Day test I am assuming is my FSH levels? Not had any other tests done fertility wise. My GP just said as my cycle all over and I turn 36 in a couple of months she wants to run these bloods to see if any issues going on.

My thyroid I didn't get results last time but got told it was 11 but not sure what she meant was 11? If TSH or T4. Had several thyroid tests since the borderline one and all been told are normal but don't know the score. I am very fatigued though and my periods are all over the place. I've been off the pill 8 coming up 9 months and still only a 1 day period but horrendous PMS! I turn into a psycho woman when due on lol


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## Calluna (Jun 14, 2012)

Hi ALN,

Your doc will be guessing where your day 21 equivalent might be based on your cycle length but the only way to make sure the test is in the right place is to know when you ovulate on that particular cycle. 

If your TSH was 11 you definitely have a thyroid problem (NHS treats anything above 10 usually). If it was your FT4 that was 11 that sounds pretty low so could also suggest a possible issue. There are some NICE guidelines on hypothyroidism which you can download from the internet, which may help if you need to convince your GP to treat you but it's not easy to get the NHS to take thyroid-related fertility issues seriously. I had to get my fertility clinic to write to my GP to advise that TSH should be below 2 to get them to treat me (although I later ended up seeing someone privately to get my thyroid properly sorted). If you have symptoms as well it sounds like this will be a key issue for you to address. I had a short luteal phase and low progesterone until I sorted my thyroid. 

Post your results when you have them if you want help interpreting them.


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## alittlenervous (Apr 28, 2014)

Thank you so much for your help Calluna  

Right I'm tracking my ovulation each month anyway so as soon as I get a positive go 7 days after that?  On my form it says go 7 pre menstruation so wasn't sure if to go 7 days after ovulation or 7 days before period due to be more accurate.

Yeah I've read a lot about thyroid issues and I have a lot of the symptoms including the overwhelming fatigue.  Our GP surgery won't treat until TSH is over 10, say they aren't allowed to even though there range goes upto 5.5 and then classed as over.  Really hope my thyroid is ok as going it alone I only have enough for 3 cycles of insemination, that's it so trying to get everything ready to go.

I will post my results when I get them, thank you so much for your help x


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## Calluna (Jun 14, 2012)

Yes, just go 7 days after ovulation (in theory that is also 7 days before period based on a 14 day luteal phase but not everyone has a 14 day luteal phase, especially if there is a thyroid issue).

It's appalling that they have moved to only treating above 10 when other countries are moving to treating anything above 2.5. I would definitely get your thyroid sorted before having any fertility treatment because even if it worked the risk of miscarriage is much higher if your TSH is above 2-2.5. Have you been tested for thyroid antibodies?

x


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## alittlenervous (Apr 28, 2014)

Calluna said:


> Yes, just go 7 days after ovulation (in theory that is also 7 days before period based on a 14 day luteal phase but not everyone has a 14 day luteal phase, especially if there is a thyroid issue).
> 
> It's appalling that they have moved to only treating above 10 when other countries are moving to treating anything above 2.5. I would definitely get your thyroid sorted before having any fertility treatment because even if it worked the risk of miscarriage is much higher if your TSH is above 2-2.5. Have you been tested for thyroid antibodies?
> 
> x


No on the NHS they don't test for antibodies unless your thyroid comes back abnormal. As mine was borderline they just did a repeat test 6 months later and told me it was now normal. My GP did say that I would need thyroid treatment years down the line as my thyroid has shown to be struggling but they aren't allowed to treat until it reaches 10 and the range here for normal is 5.5 on TSH. I'm really hoping it won't effect my fertility as at almost 36 and only 3 chances to get pregnant with money for fertility treatment so expensive I am pinning my hopes on these blood tests being ok


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## alittlenervous (Apr 28, 2014)

So I am supposed to go for these blood tests on Monday but I still haven't ovulated.

I got 2 lines for 2 days last week but the second line was lighter than the test line so says that means negative and to be on safe side did a clearblue too incase it was positive but got a blank circle.  So do I still go for the test Monday or wait for ovulation?  I am on day 20 now and ovulation test negative


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## Calluna (Jun 14, 2012)

Hi,

There's no point testing progesterone until you know you've ovulated or the test won't be accurate (unless you think you're not ovulating and then it helps to demonstrate that you're not). Have you detected your LH surge on previous cycles? If so, I would just keep testing until you detect it and then make the appointment for the blood test (and cancel the current appointment). If your cycles are sometimes 35 days or longer then you could ovulate in the next few days.


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## alittlenervous (Apr 28, 2014)

Thanks Calluna, yes usually I get a positive usually between day 19 - 21.  On day 21 today and just done a test when i got up and again negative.  Been testing twice a day since day 12 of my cycle.  So frustrating as already nervous about these blood tests and the results and now worrying I won't ovulate in time for the tests.  I have the bloods next Monday and booked in to see my GP on the 4th March for results and where to go next.

Thank you again for your help, really appreciate it x


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## alittlenervous (Apr 28, 2014)

So today day 25 of cycle I got what looked like a positive on my opk so to check I did a clearblue and got a smiley face.  I am supposed to get my bloods tomorrow but should I put them to the following Monday?


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## Calluna (Jun 14, 2012)

Hi. Sorry - just seen this. Yes, you should ovulate today or tomorrow so if you book the test for next Monday that should be fine for progesterone. If the 'cycle day' one is a hormone profile that includes oestrogen, LH and FSH, that is best done on day 2-3 of your cycle so you would want to do that separately. The rest should be ok anytime x


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## alittlenervous (Apr 28, 2014)

Thanks Calluna for your help.  She's put all the bloods on the same form to be done at the same time strangely enough so I'll go next Monday.    Really appreciate your knowledge and advice x


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## alittlenervous (Apr 28, 2014)

Well tomorrow I get my results.  Really really hoping it's good news.  Feel so sick about my appointment.  I rang to check results back today and got told only one on the system for the FBC meaning it's normal but all the fertility ones and thyroid one GP held back.  Hoping doesn't mean bad news


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## Calluna (Jun 14, 2012)

Good luck! Make sure you get a copy of all your results x


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## alittlenervous (Apr 28, 2014)

Stupid me forgot my test results! Asked for copy then forgot to pick them up!!

I know my TSH she said was fine, was 4 and normal range anything under 5.5.  My progesterone she said was very low and looks like this month I have not ovulated despite a positive ovulation test.  My prolactin she said was elevated too.  She said all the others were normal.  I've been booked in for a repeat of progesterone and prolactin for this months cycle to see if any better as she thinks it could be because I didn't get surge till day 25 and blood test day 32.  It could just be because it was a long cycle.  I am on day 37 now and not started yet.  Going off when I got the surge 2 weeks is day 39, this Sunday, Mothers Day lol. 

I am not panicking, yet!!! I'll wait and see what this months tests show then panic.  She said if still showing the same I will be referred to gynae as they can do more blood tests than she can and look deeper into it


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## Calluna (Jun 14, 2012)

Ok, a TSH of 4 is not normal and is much too high for fertility. You want it around 1 and no more than 2. Treating your thyroid will be key to getting your prolactin down and sorting out your ovulation/ progesterone levels. You could try reading up on it and taking the NICE guidelines on hypothyroidism and some research papers to your GP and see if you can convince your GP to prescribe thyroxine. Have a look at Agate's FAQ on here (under diagnosis - immune issues) for info and links. If your GP won't help you could see someone privately (an endocrinologist or a doctor from Thyroid UK's list or a fertility clinic). On the plus side, it's a relatively straightforward issue to fix once you get the right advice/treatment from a medical professional with experience of fertility and thyroid issues x


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## alittlenervous (Apr 28, 2014)

They won't treat if your TSH under 10 on the NHS unless very lucky I've found and anything under 5.5 they class as normal. My t4 was 11 a couple of years ago, normal range 11 - 23 and she said can't treat.  I can't afford to go private as currently out of work so have to put all my trust into the NHS.  I'm hoping TSH won't effect things as can't do anything about it as have no funds to go private and pay for sperm      If I get referred to the hospital after next cycle tests maybe they will know more about it than GP.    

I'm day 1 of this cycle now so I'm starting a fertility diet as well to see if I can my ovulation any better and my progesterone up.  I am suspecting prolactin was up because had a very stressful 2 months and I know that can effect prolactin and menstrual cycles.  Just fingers crossed for things to have improved this cycle.  Hope I went the right time too as got the surge day 25 on a 2 line opk and smiley face on pink clear blue which was a Sunday so went the following Monday day 33.  My GP said I should go 7 days before my period but my period came today 5 days after I had the blood test so maybe I went at the wrong time?


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## Calluna (Jun 14, 2012)

It's very unlikely to be stress that is responsible for your raised prolactin when you have an obvious thyroid problem. Raised prolactin, late ovulation/LH surge, low progesterone and short luteal phase are all classic hypothyroid symptoms. You've found the problem, now you just have to find the right help to fix it (which is not to say there might not be other problems you don't know about but all the issues you've described could be explained by the thyroid issue). If you can't get this sorted there's really no point wasting money on fertility treatment/donor insemination with a TSH of 4. Even if it worked, the miscarriage rate is substantially higher even with a TSH of 2/2.5 (compared with 1), never mind 4. With limited funds it's even more crucial to do the relatively cheap things that will give you a much better chance of getting and staying pregnant. 

I put my raised prolactin down to stress when it first came back high (I had the test the day after we found out we couldn't use my husband's sperm) and I tried all sorts of things to lengthen my luteal phase, but lots of tests/ treatment/ research/ expense later, I now know these were classic signs of a thyroid problem and they have all resolved with thyroid treatment. There are multiple mechanisms involved and it isn't fully understood yet but to give you some idea of what's going on - there are TSH receptors in developing ovarian follicles and raised TSH causes more follicles to develop, which produce higher oestrogen levels and it takes longer for one follicle to assert its dominance to mature and ovulate or there may be no clear 'winner' but the oestrogen levels from multiple follicles get high enough to trigger your LH surge even though there is no one follicle mature enough (so your LH surge is delayed and you may not produce a mature egg). Lack of a mature follicle at the time of your LH surge means you don't end up with a decent corpus luteum (so your progesterone levels are low). Also T3 (the active thyroid hormone) acts directly on the corpus luteum to cause progesterone release. When there isn't enough T3, progesterone production is further reduced and the luteal phase ends prematurely (so your period comes earlier than expected and what should be the mid-point of your luteal phase - 7 days after ovulation and 7 days before your period starts - ends up being 7 days after ovulation and only 5 days before your period starts on this occasion). It can be a vicious circle because the elevated oestrogen levels from abnormal follicle development make thyroid hormone less available and so increase the body's requirement for thyroid hormone - so the less thyroid hormone you have, the higher your oestrogen levels, and the more thyroid hormone you need (and it isn't clear which comes first - elevated oestrogen levels or low thyroid hormone levels - but both contribute to each other). If you manage to get your oestrogen, LH and FSH tested on day 2/3 of your cycle I would expect your oestrogen levels to be mildly raised (probably not enough to concern your GP but maybe 200 or so).

Hopefully you will get a more helpful response from the hospital. If not, you may only need to pay for one private appointment to get a letter sent to your GP instructing them that your TSH needs to be below 2 (aiming for 1) for fertility and then your GP should be happy to treat you (or you can always change GPs if they won't). My GP said she couldn't go against the guidelines unless a consultant took responsibility for it but once she had the letter from my fertility consultant she was very happy to help. In the meantime, have a read of the thyroid board (under diagnosis - immune issues) to get an idea of others' experiences x


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## alittlenervous (Apr 28, 2014)

Oh thank you for all that information, really helped explain a lot!

I'll get this next test done 7 days after the surge and if still showing I didn't ovulate I will be referred to the hospital and hopefully at the hospital they know better RE the TSH levels than my GP?      I was thinking if I get referred after next cycle results maybe doing a private thyroid test that checks not just TSH but also T4 and T3 but also looks for antibodies?  I've looked into it and it costs £89.  So I could do that before the referral to gynae comes through?  Are private thyroid tests any more reliable?

Sorry for all the questions.  Just so hard to know which way to turn when right now I have limited finances and if I use them on going private I couldn't afford to buy sperm but it I buy sperm I have no money for tests if I don't get pregnant.    A lottery win about now would be good lol


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## alittlenervous (Apr 28, 2014)

So today I have ovulated day 14 which means I need to go next Friday but being Good Friday Easter everywhere is closed!!! Will it hurt if I went the Thursday afternoon?  Just worried to soon.  I got 2 lines last night but one a little paler so negative and clearblue blank circle, had a niggle of period type pain and heavy discharge this morning so tested around 11.30am and got a dark 2 line positive and a smiley face clear blue so definitely ovulated today.


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## Calluna (Jun 14, 2012)

Yes that will have to do as it's the closest you can get it. And yes, testing T3 and T4 privately sounds like a good idea to get a fuller picture x


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## alittlenervous (Apr 28, 2014)

Thanks Calluna, appreciate all your advice x


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