# FSH and LH what are good levels?



## greatgazza

Hi Guys

I'm sure i have posted this/read this somewhere but i can't for the life of me find it.  

Just wondered if anyone knew what the ranges were for fsh and lh i.e. good, poor, very poor etc so i can get an idea of where i'm at.  i also know they can change quite dramatically is that right?  what do those changes depend on? can you influence them for the better/worse with your lifestyle/diet or something?

thanks

GG x


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## karenanna

There's lots of info in this post from Minxy on levels.



☼♥ Minxy ♥☼ © said:


> Hi
> Obviously I'm not medically trained so really it should only be your consultant who interprets your results and advises you, but this should give you a rough idea....
> Different labs and clinics use varying ranges and unit measurements but this is what I was given when I've had FSH & LH tested between cd2-4/5....often tested on day 3.
> (follicular stage) LH - range 1.9 - 12.5 IU/l
> (follicular stage) FSH - range 2.5 - 10.2 IU/l
> FSH levels to indicate ovarian reserve (all in IU/l):
> under 6 = Excellent
> 6 - 9 = good
> 9 - 10 = fair
> 10 - 13 = diminished
> 13+ = hard to stimulate
> I also found these ranges which someone else was given, so as you can see, the different labs have used slightly different ranges but gives you a rough idea (all in IU/l)...
> Follicular: FSH 2.8 - 14.4 LH 1.1 - 11.6
> Midcycle: FSH 5.8 - 21 LH 17 - 77
> Luteal: FSH 1.2 - 9.0 LH 0 - 14.7
> 
> FSH & LH should be similar and if LH is higher than FSH then this may be an indication of PCOS.
> Assuming your FSH and LH were measured as IU/l then an FSH result of 6.2 IU/l is good and if your LH was 2.9 IU/l then that's still within normal range for follicular phase (which is when you'd have these tested on day 3).
> Check out this website...
> http://www.fertilityplus.org/faq/hormonelevels.html#female (but this is US site so do check the unit measurements as may vary to those your clinic have used & if compare different measurements then takes out of context)
> Take care
> Natasha
> 
> This post contains an unconfirmed link/information and readers are reminded that FertilityFriends.co.uk or its owners are not responsible for the content of external internet sites


In terms of changing levels - this thread from the ARGC board has some tips further down about diet and things link spirulina or wheatgrass - http://www.fertilityfriends.co.uk/forum/index.php?topic=246052.0

Hope this helps

Karenanna xxx


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## ☼♥ Minxy ♥☼ ©

Hi there

Was about to reply and saw Karenanna had already included a link to some info I'd put together about FSH and LH levels 

It's also a good idea to get E2 (oestrogen/oestradiol) tested at same time as high E2 can suppress FSH levels and make the FSH appear lower than it actually is.

You may also want to get your AMH (anti mullerian hormone) level tested. This is a newer test to check ovarian reserve but used in conjunction with FSH, LH and Oestradiol, can help give a clearer picture.

AMH 1 ng/ml is approx 7.14 pmol/l

http://www.sharedjourney.com/test/amh.html

http://www.tdlpathology.com/index.php?option=com_content&task=view&id=201&Itemid=73

http://www.advancedfertility.com/amh-fertility-test.htm

As Karenanna says, there are some things that are thought to be beneficial in reducing FSH levels such as Wheatgrass and acupuncture but overall, your FSH levels indicate how many eggs you have left (ovarian reserve) so whilst FSH levels may lower (and can fluctuate monthly), you're not going to "grow" more eggs.

A woman is born with about 1-2 million immature eggs. By the time a woman reaches puberty there are only about 400,000 eggs left. With each period cycle, around a thousand eggs are lost and usually only one follicle will actually mature and contain an egg.....so as we age our ovarian reserve naturally reduces (some quicker than others).

Good luck
Natasha

/links


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## greatgazza

great thanks girls really useful

had my fsh/fh done when having endocrine appts but not done since dec 09 so they would need doing again wouldn't they?

i know these can be done on nhs so can i just request to be sent for them by my gp?  i believe amh isn't done on the nhs how would i go about getting this if i am having tx abroad, is it possible just to get tests/bloods done privately without having to have private consultations?  And what about E2 etc would a GP do those or are those private?


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## Astral

Hey GreatGazza

I would advise getting your FSH and LH done again, on the right day (FSH is done on day 2, I believe early in the morning). Your GP should do them for you - mine have done them twice, simply because I asked and they know I am having fertility treatment. The fertility clinic did my AMH. But, if you are having difficulties conceiving I am sure that the GP would do it? Otherwise, blood tests can be booked with your local private hospital, afterall, you just need a number, not an appointment with a Con to discuss.

natasha - Thats interesting about the ovarian reserve counting down from puberty from 400,000. I heard that female fertility can be affected by the age you start your periods. I started late at about 15 and I am now 39 1/2 and I was surprised my AMH was 7, so maybe thats why ?


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## ☼♥ Minxy ♥☼ ©

*Hi again GreatGazza* 

FSH, LH & Oestradiol can be done anytime between cd1-6, but best to get done cd2/3 if you can. These can all be done by your GP/NHS. Some places seem to say you can get AMH tested anytime but my consultant advised I get it tested at the same time as FSH etc. at beginning of cycle.

I was under the impression that AMH could only be done privately, which is only way I've been able to get it tested but someone on FF mentioned other day that they'd had it done on NHS so not sure how they managed that or whether it's just lucky. If you can only get it done privately then you could phone up any private clinic and ask about it but you may need to speak with consultant to get the blood forms completed and signed.

If you've not had your hormones tested for a year then it's a good idea to get tested again as they can fluctuate.

*Hi Astral*...We're all different so the some women will find their ovarian reserve drops much quicker than others, the numbers are all just averages. There are some women in their mid 20's who may have higher FSH and lower AMH levels than someone in their mid 30's....our bodies don't work as an exact science.

Puberty is classed as when you start developing which will include when you start your periods. I started developing at the age of 10 (sorry TMI  pubic hair, boobs  ) and started my periods at 12. I've been lucky with good hormone levels....low FSH and high AMH. My last hormone bloods were done last September when I was 40 (a few months shy of 41) and my FSH was 7.9 IU/L and AMH was 16.3 pmol/l. Previously my FSH had ranged between 6.3 and 6.9 IU/L between age 34 and 39....and that's despite very good response, sometimes too much, to IVF stimms drugs with lots of follicles and eggs.

I'm not sure exactly how fertility will be effected by age you start periods  but obviously the older you get, the less eggs you'll have (and quality also drops) and there is also the opinion that as you age, you may release more than one egg naturally sometimes too.....consultant actually mentioned this to me 5/6 years ago as my progesterone levels were naturally high following ovulation and on one of my natural FET cycles the sonographer thought I was on fertility drugs as I had several dominant follicles (I don't have PCOS/PCO).

Good luck and take care
Natasha


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## Astral

Thanks Natasha so much for another comprehensive answer   

Thats interesting about the leading follicles. I've only had one scan done so far (natural few days before ovulation). I believe I had 2 eggs at 11mm and one at 12mm and maybe one other the nurse said, so 4 in all. I wondered at the time if this was 'normal', although she said the 12 was the leading follicle and I ovulated 4/5 days later I believe. So perhaps I did only release one afterall. I am on IUI stimming now and am scanned on Monday, so fingers crossed.


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## ☼♥ Minxy ♥☼ ©

Yes it is normal to have a few follicles develop but only one would usually mature and release an egg, the others just die off (hence why we lose so many more eggs than we actually release through ovulation).

If you had 2 follicles of 11 and 12mm then they were both similar size so it's possible that they both matured and released eggs....the smaller ones probably wouldn't have matured in time before the other dominant ones popped.  If you release more than 1 egg then it will be within a single 24 hour period as once ovulation has happened, the release of progesterone prevents further maturation of follicles and hence ovulation.  Did you have your progesterone blood tests done ?

Good luck with the IUI   
Natasha


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## Sacha75

Hi Everyone

I also have a question regarding high FSH levels and I hope that you'll be able to help please?

On Friday 13 August 2010 I went for my usual appointment with my Gynaecologist regarding my Fibroids and I mentioned that I hadn't had a period for a month. She sent for a blood test  and my FSH came back as 125. I then had another test six days later and this time the level came back at 101! 

I'm not sure what to do now as my only option seems to be donor eggs and HRT  . I just wondered if there was anyone that my levels will ever return back to normal.

I have done lots of research on the internet and I am taking the following supplements:

Agnus Castus capsules
Raspberry Leaf capsules
Co-Enzyme Q10
Royal Jelly
Well Woman one a day capsules
Wheatgrass Juice
Flaxseed oil capsules

I have also consulted a herbalist so she has given me some medicine to compliment the vitamins. I have also had 2 sessions of acupuncture! 

I'm getting married next year and I'd love to have a baby. Just wondered if anyone has any advice really.

Thanks for listening.

Sacha75


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## Mistletoe (Holly)

Sacha - I am so sorry hunni. Your ovarian reserve is as good as your worst FSH I am afraid. I don't believe that it is reversible - but please discuss with a fertility specialist. It needs to be done on day 2-3 of a cycle ideally. Over 100 is post menopausal, usually 50 is regarded as the cut off.

This must be a shock for you and I hope you come to terms with it. The good news is that with donor eggs the success is as good as the woman the eggs came from - the womb is receptive to pregnancy if prepared correctly.

As for ovarian reserve and when the menarche was - I started my periods when I was 11, I have always had regular cycles and my FSH at the age of 39 was 3.7, my antral follicle count is about 20 and I got 22 eggs on my last cycle.
My doctor tells me not to panic as my biological clock is ticking extremely slowly. I have never really drunk alcohol, never smoked and I eat tons of fruit and veg.
It could be genes - my mum had me at 39.
Who knows?

Unfortunately, even if there is good ovarian reserve at my age, the eggs are still old and will be more likely to have problems. As you can see from my profile


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## ♥JJ1♥

Just to add some NHS clinics are doing AMH's on NHS pts.  Some clinics aren't concerned with AMH, I have asked for it before when cycling using OE and was told that a previous cycle of IVF tells them more about response and calculating drug doses and so refused to do it for me at ARGC

Lx


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## greatgazza

I have requested some blood forms from my doc to get my FSH/LH oestradiol, prolactin and whatever else he'll allow me to tested for before my next tx so the results are more up to date and then hopefully the clinic can make a better decision as to whether i go med or unmed (as last time Dr Stepan thought my results were pcos like and i should go unmed), but if there isn't a risk and going med would help then i'd like to try anything i can to improve my chances)

we were just speaking on the phone and i said 'what else should i get done' he added progesterone to it (to see if i'm still ovulating he said?) but said that should be day 21.  So i asked whether i should be getting two lots of bloods done LH/FSH on day 3 etc then prog on day 21.  He said that LH and FSH stayed at similar levels throughout cycle but with progesterone it was important that it was on day 21 

the upshot is that he's leaving me 1 form to pick up to do all the tests on day 21.....what do you guys think  of that?  i didn't want to question him as he's not my assigned gp (who has washed her hands of my situation) and he's being so helpful and sympathetic that i didn't want to come across like i knew more or was questioning his judgement and alienate him in anyway but i'm concerned as everything i read on here you guys all say it should be day 3 for the other tests etc....

GG x


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## greatgazza

oh, i think he's doing testosterone as well which has been raised for me before but then came back into the normal range? i have also had high DHEAS but that also went down to the normal range but i have no idea what that is to be honest


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## suitcase of dreams

GG - you DEFINITELY need the FSH/LH on day 2-3 of your cycle, then the progesterone on day 21....can you get him to give you 2 sets of forms so you can do the 2 on different dates?
The FSH/LH results will be meaningless if not done at the right time in your cycle

Good luck - glad you've found a GP to help out, 
Suitcase
x


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## greatgazza

ooh blimey.  i did say to him shouldn't the fsh/lh be done on day 3 but he said the levels didn't change that much but it was important to do the prog on day 21....i don't know what to do now.  i've picked up the form and he's ticked fsh, lh, prolactin, prog, oestradiol, testosterone....on day 21 of cycle...

how can i get round this? i really don't want to p**s him off but how do i say i don't agree with him and that the knowledge i have regarding testing on day 3 is better than that of a doctor (which i believe it is)??! yikes..


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## greatgazza

doing a bit of reading on this to see if i can find stuff i can quote so i can talk to him and most do actually call it the 'day 3 fsh test' so i really don't know why he's not going with that but i also read this:

http://infertility.about.com/od/infertilitytesting/p/day3_fsh_levels.htm 
What Is The FSH Levels (Day 3 FSH) Test:
As part of a basic fertility work-up, your doctor will likely order blood work to check yourFSH levels, specifically on day 3 of your menstrual cycle. Sometimes called the Day 3 FSH test, it is a simple blood test meant to measure the amount of FSH in your bloodstream.
FSH, otherwise known as follicle stimulating hormone, is a hormone that tells oocytes, or premature eggs, to begin growing. Each oocyte is contained within a follicle, or little fluid sac. The growth and development of the oocytes is the first part of the process that will, ideally, lead to ovulation.
You can read more about ovulation here.
When Are FSH Levels Checked:
The test is usually given on day 3 of your menstrual cycle, though most doctors are OK with the test being done on any day between days 2 to 4 of your cycle. (The first day of your cycle is the day your period begins.)
*FSH levels may also be checked at another time during the menstrual cycle, but this is uncommon.*

so if he's of this school of thought he might not waiver.....like i said i really don't want to fall out with him in any way but like you say don't want a meaningless test so i really don't know what to do...i wonder if i could try and speak to another doctor when this doctor isn't there (so it doesn't seem like i'm going over his head) and just request a day 3 fsh/lh blood form and don't really go into detail about it....

gees why are things never straightforward...

GG x

This post contains an unconfirmed link/information and readers are reminded that FertilityFriends.co.uk or its owners are not responsible for the content of external internet sites


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## greatgazza

maybe i could say that my 'clinic' have insisted that fsh/lh are performed on day 3 for them to consider my situation and make an assessment?? would still rather speak to a different doctor tho so i can keep this one on side...


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## Mistletoe (Holly)

My GP did my FSH on day 21 the first time, before I knew better to argue and it came back 1.2. My clinic freaked out saying it was too low, before they found out it was a day 21 level.

My day 3 level has been 3.3 and 3.7, which is fine.

You can get your clinic to fax a request to the GP.
You want to get a true picture of your ovarian reserve and likely response to treatment.


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## Sacha75

Hi Hazel

Many thanks for the response to my post.

It now seems that all of the vitamins, TCM and the acupuncture etc are just a waste of time and money. I've done so much research on the Internet and I could see where other women had conceived naturally, even with a high FSH. I guess I was just clinging onto a last bit of hope!  

Sacha


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## ♥JJ1♥

FSH and LH should be done days 1-5, some clinics say 1-3 better, progesterone is usually done on day 21, or 5-7 days after you have ovulated

L x


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## greatgazza

ok, so i'm gonna call the surgery and make sure i get a form for prog on day 21 and a separate one for fsh/lh on day 3 (or thereabouts).  Which of those two should i also do the prolactin, oestradiol and testosterone on, or does it not matter what days those are done on?

GG x


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## Mistletoe (Holly)

Oestradiol must also be on day 3 as this will tell them whether the FSH is being suppressed by a high oestrogen level and so whether the FSH level is a true reflection of ovarian reserve.

Prolactin and testosterone I don't think matter.
It is important that the body is not stressed by starvation or illness when the prolactin is done as these will increase it.


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## ☼♥ Minxy ♥☼ ©

Hi there

Agree with the other ladies.

FSH, LH, Oestradiol, Prolactin and Thyroid should be done at the beginning of your cycle between cd1-6, ideally around cd2/3. FSH & LH do change througout cycle, no idea what your GP/consultant is talking about saying they don't ! I remember years ago my GP sent me for FSH, LH and Progesterone on cd21....my consultant couldn't understand why and said FSH and LH on cd21 was completely pointless. Thing is, GPs are just that, "general practitioners" and some just don't have a full in depth understanding of fertility and when hormones should be tested.

As per my original post, Oestradiol should be tested same time as FSH as a high Oestradiol level can suppress FSH levels and make FSH appear lower than it actually is.

Prolactin is the hormone that stimulates breast development & milk production when pregnant. If your prolactin levels are higher than normal (when not pg) then your body can "think" its pregnant or breastfeeding so can effect and prevent ovulation and subsequently effect chances of conception.

Prolactin can be raised due to stress, amongst other things. Here's some info which may help...

http://en.wikipedia.org/wiki/Prolactin

http://www.fertilityplus.org/faq/hormonelevels.html#female

http://www.sharedjourney.com/define/prolactin.html

Progesterone should be tested at 7 days past ovulation as this is when it peaks. Having it tested on cd21 assumes ovulation on cd14.

Have a look at this graph...it shows how the hormone levels vary throughout the month...

http://en.wikipedia.org/wiki/File:Estradiol.Cycle.jpg

Hope you manage to sort it out and get hormones tested on correct days.

Good luck
Natasha

This post contains an unconfirmed link/information and readers are reminded that FertilityFriends.co.uk or its owners are not responsible for the content of external internet sites


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## greatgazza

thanks girls

waiting for the duty doctor at my GPs to call me so i'll be getting it sorted shortly hopefully.  It is frustrating/difficult when you can't get done what you need/want.  But it's really hard to question a doc's judgement when you genuinely know different isn't it? And i really don't want to alienate the current one who's helping me in any way and lose his support.  So the duty doc is a different doctor to the nice one and i'll just be very matter of fact and say i need two forms and the clinic need FSH/LH etc on day 3.

While i'm here, do any of you happen to know if Factor V Leiden can be tested by a blood test and requested by a GP?  If so, i'll ask for that too.  Or is it a more specialised test?

GG x


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## ☼♥ Minxy ♥☼ ©

Hi again

Factor V Leiden is a more specialist blood test.  I've had countless blood tests for blood clotting disorders (of which Factor V Leiden is one) plus immune blood tests.

These are not standard blood tests.  Some can be done on NHS but most have to be done privately.

During all the blood tests I've had for immunes and blood clotting problems I was not tested specifically for FvL but due to having Low Activated Protein C, haematologist said I had high chance of FvL, alongside the other blood clotting and immunes I was already diagnosed with.

You'd need to ask separately for these type of tests.

Good luck
Natasha


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## greatgazza

oh ok, that's interesting.

whilst i was speaking to the duty doctor i asked if he could put me down for a FvL test and he said yes  as if it's not that complex and can just be added to the blood tests already being done?

i also asked him about amh to see if i could sneak it in there but he'd never even heard of it....

GG x


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## ☼♥ Minxy ♥☼ ©

Hey hun

Don't forget, some of my tests were done 5+ years ago so things may have changed as to what they do as "standard"...also different clinics/consultants are able to push through different tests.

As far as I'm aware, even now, FVL is not a standard blood test....standard blood tests are the very basic hormone bloods to check for ovarian reserve, possibility of PCOS, ovulation etc......once you start into blood clotting disorders (such as FVL) and immunes, these are not standard blood tests....they're further investigations.  

The NHS does seem to cover for some blood clotting disorders because some are known to cause implantation failure and/or early miscarriage and the treatment for them, such as 75mg aspirin and clexane injections can be prescribed on NHS......but immunes is a whole different story as many consultants don't agree with the theories and treatment.  If you can get your consultant to test for FVL and anything else then go for it !

As for AMH, whilst it's not a new blood test, again, it's not seen as a standard blood test like having FSH, LH etc is.  18mths/2yrs ago I asked my GP for AMH and they wouldn't do it on NHS so I had to pay privately whereas I've read recently (here on FF) that some areas will now test AMH.

Are you seeing a GP/doctor or are you seeing a fertility consultant ?

TC
N x


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## greatgazza

at the mo i'm just seeing GP.  although my regular GP has just turned super unsympathetic and has washed her hands of my case but i've been speaking to another GP at my practice who's been very sympathic and understanding so i'm going to deal with him from now on.  I've just been asking him for more recent blood tests so i can let the Copenhagen clinic know (if that's where i decide to go next) so they can advise whether i do unmed diui or medicated.  I did unmed for my first one as Stepan at Reprofit said my results were 'pcos like' (which i have been told i am and then told i'm not over the years...).  

Because of going abroad  i'm kinda going it alone with regards to a 'fertility' consultant as such but i am in the process of being referred to a consultant who deals with recurrent mc.  apparently i can get investigations done on nhs, despite my age, but obviously no tx e.g iui, ivf, and being single would have probably put the kybosh on that anyway.  

So i'm just hoping that at least talking to a consultant in that field will be useful as there may not be any underlying issues preventing me getting pg (apart from my age and egg quality) but i'd like to rule anything else out before i switch from IUI and spend thousands on IVF.

Maybe the duty doctor i spoke to on the phone didn't really understand about FvL....and said he can put it down on the form but maybe he can't...he had no idea what AMH was when i asked about being tested for that

GG x


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## daisyg

Hi,

Just to let you know that FVL is a standard part of the clotting panel that your GP can easily order for you from any hospital lab.  They are testing for activated protein C resistance and the factor V Leiden gene and this should be standard.

I would ask your GP to run some basic tests which should be no problem to organise.  These would be TSH and antithyroid antibodies, a basic thrombophilia (clotting) panel which would include FVL and APS and anticardiolipins, full blood count, Antinuclear antibodies.
I have never had a problem with this.  You may want an expert to look over results for second opinion.

I would strongly advise you to check out your thyroid levels as Thyroiditis (Hashimoto's) is associated with PCOS and miscarriage and this is treatable.  

You really would be advised to ask to be referred to a recurrent miscarriage specialist as well (e.g.St Mary's Paddington).  Sorry not sure exactly of your history or current status.

Other tests which are important ref.miscarriage are karyotyping for you, uterine checks, infection, autoimmune issues and finally rarer immune issues such as NK Cells and cytokine levels.

Daisy
x


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## ☼♥ Minxy ♥☼ ©

hello again 

If you have managed to find an understanding and sympathetic GP then I would push for as many tests as you can on NHS....if he says he can do FvL then I would get him to put it on the form.....also, even if he doesn't know what AMH is, if you can get him to write it on your blood form then go for it !!

Different GPs/consultants/clinics will have varying ideas and procedures....push for as much as you can get on NHS.....why not ?! I got my GP, well the nurse, to put down a whole load of blood tests, including AMH, but when the results came back they'd only done a few of them and GP told me that they couldn't (wouldn't ?!) do some of them as not available on NHS but there was no harm in me trying. As it turned out, I had to pay privately for the rest......

I genuinely wish you so much luck.....I've never been for tx abroad so not sure how that works but I know I've been very lucky that my private consultant also works for NHS so he always tries to get as much for me done that way, if he can....he even writes to my GP directly and "insists" for some things such as the additional blood tests and medications I need for recurrent miscarriage....it's so bloody expensive otherwise.

TC  
N x

*PS*......just posted my message after *daisyg*......listen to her, she's a wealth of knowledge and I've learnt so much from her over the years.....and her twins are testament to the experience and knowledge she has !!


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## ☼♥ Minxy ♥☼ ©

Apologies for hijacking thread but....

Hey *daisy*

Long time no speak....hope you and your little family are doing ok ? Often think of you 

Love n hugs
Natasha xx


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## daisyg

Also apologies!  

Natasha - I sent you a PM some time ago but not sure whether you got it??  We are all v. well thank you.

I may PM you again in more detail soon to catch up.

Best
Daisy
x


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## greatgazza

thanks girls

wish i'd waited a bit and seen these posts before i spoke to my docs again today.

unfortunately i've got the forms done now and they are requesting fsh/lh, prolactin, progesterone, oestradiol, testosterone and then i requested to add on FvL over the phone today which the duty doctor agreed to so i just need to pick up the form.

when i asked about amh he said that they won't request tests which they wouldn't be able to deal with the results for (if that makes sense)

i am in the process of being referred to a recurrent miscarriage specialist.  my god it's been a nightmare.  my gp said she would refer me to St mary's and i rang them last thursday just to find out their general wait times so i could possibly arrange another tx in the meantime (in case there are no underlying issues) but they told me i'm outside their gp catchment area and need to go via a specialist. that in itself isn't a huge problem but they also mentioned their cut off age at first referral is 42 (i will be 42 on the 20th of this month).

this sent me into a complete panic and i have had a most unbelievably stressful week trying to get gp to change letter to send me via a local consultant etc..she said she'd done her bit, became completely unsympathetic said i should 'just leave it now' and i'd left it too late for any help on the nhs....but i wasn't prepared to give up. spoke to another doc at my surgery who, thank god, listened, was understanding and said i had as much right as anyone to find out if i was fertile (as my regular gp is referring to the fact that i'm too old and i'm single so there's nothing she can do and it's kinda tough. ironically she's from cz rep and thought i should complain about the treatment i got at reprofit).  anyway he did everything he could to try and get me to st marys but no consultant would just forward on a letter without seeing me and if i have to do that i'd miss their cut off.

anyway the long and short of it is, a nice consultant from my local hospital actually called me when my letter landed on his desk and after i'd nearly been in tears to his secretary and said they can do all the stuff st marys would do so i'm now getting referred to him.  Also, the coordinator at st marys who i'd been close to tears talking to called me back and said don't worry about the cut off, to see local consultant and she would look out for my referral....she was lovely so it sounds like the door is still open there for a while

i don't want to push my luck with the docs at my gps as i've now got one onside so i think i'll stick with the tests they've agreed to send me for and hopefully once i get to see consultant he will request these for me.... altho time is obviously of the essence but i don't want to p**s some of these docs off and alienate them cos i feel like i'm already becoming a bit of a pain in the butt...but maybe we have to be to get things done??

just curious, at what age did you start investigating/having tx?

GG x


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## daisyg

GG,

Just to let you know my history.  I got pg at age 37 but had a termination (and a breakdown shortly afterwards - it was the single worst thing I have ever done).

After this had not met anyone and decided to go it alone.  Went straight to own egg ivf one month before my 44th Birthday.  Got pregnant and miscarried.  2nd own egg ivf at age 44 - pg but miscarried.  3rd own egg ivf at Cornell NYC - pg but miscarried.  Tests revealed Factor V Leiden.  Moved to DE at IVI Valencia. - pg but miscarried.  More tests revealed autoimmune issues and MTHFR.  De ivf - pg but miscarried.

Final cycle - added ivig, steroids in addition to clexane and high dose Bvits and finally gave birth to twins at age 46 from Donor embryo at IVI Valencia.  They are now nearly four years old.

This is why I go on and on about testing as everyone told me it was my age, but it turned out to be other issues as well and by the time they found out, too late for my eggs.

BUT I now couldn't imagine my story ending any other way - I am so incredibly lucky to have ended up with two beautiful, wonderful children who are the wonder and love of my life.


Daisy
x


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## ☼♥ Minxy ♥☼ ©

apologies as this is a very quick reply as I'm about to log off (got to be in office to for 7am tomorrow so early start !)....

It does sound like you've got some GP/consultants on your side so get these tests done and just push push push for anything else, do not let them fob you off....I'm same age as you, well, 42 in January so only just behind you...not old at all   

As for when did I start getting tests done...well, slightly different situation....I've had endometriosis since 12...diagnosed at first laparoscopy at 19 and told would have difficulty conceiving as so bad....shock got pg at 21, didn't even know for several months but didn't continue with pg, for reasons won't go into detail on here      Also have septate uterus (found during hysteroscopy about 12+ years ago), so GP and various gynae consultants already knew I had things that could cause fertility issues.....started ttc at 34 (boyfriend 6 yrs younger) but didn't get referred to fertility consultant until ttc over a year (GP at time wasn't particularly nice or understanding), despite my medical history....finally saw fertility consultant when I'd just turned 36 (and was pg at time of appt although didn't realise at time...first mc    )....and it went from there.....initially on NHS but then private (same consultant) almost immediately as quicker.

Anyway, gotta go cos I knackered, sorry, but feel free to PM me anytime   

TC
N xx


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## greatgazza

Wow.

Everyone's got a story haven't they.  It's amazing how much people have been through.  Like you daisy i also had a termination.  Many years ago and it's bringing back so many feelings of guilt now about what right do i have to be even going down this road.  I've been loathe to mention it on here for fear of being judged and knowing how much people go through to have a child but i was a lot younger and in a a lot less stable state and relationship.  However, it also brings up the question of whether i would have been able to continue the pg anyway and i'll never know that.  Finding out from my sister last night that there's Factor V Leiden in the family has really surprised me (not that i had any idea what is was) as i never knew and i'm kinda gutted i didn't know before as i may have considered asking to be referred for tests before now if i'd known there might be issues.

Sadly i spent way too long still waiting and hoping mr right would come along and thinking i'd have a fairytale ending.  i so wish now i'd started things sooner but i can't do anything about that now so have to get on with it and hope it's not too late.

curious daisy, you seem to have been all over the world??!  ok, well USA and Spain, but even so, what made you do that?

Also, were you advised to switch to DE due to FvL and other issues or was is because of your age? Do you think if you had found out about your issues earlier you may have been able to continue with your own eggs?  It's just that i know that realistically (well from what i'm hearing from the world and his wife) there's probably not much hope for my own eggs and i should be seriously considering DE (so i'm told).  I'm not quite ready to get my head round that yet i don't think as i've only just embarked on any kind of tx and never thought i'd even be in this situation so i'm kinda hoping i might still have some time.  No one can really answer that i know but it's a tough switch to make... how did you find it?

GG x


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## greatgazza

also just curious minxy, your signature says your last tx was dec 09, just wondered what you're up to at the moment, are you currently having tx?

GG x


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## Bethany915

Hi ladies

Hope you don't mind, I'm just bookmarking - just found this thread and there are lots of interesting-looking links I want to come back to!

Good luck, GG, with your tests.

B xx


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## Bethany915

Hi again girls

Just had a look at the graph posted earlier by Minxy:

http://en.wikipedia.org/wiki/File:Estradiol.Cycle.jpg

I know that Day 3 FSH is the standard test, but if you look at this graph (red line), it appears that FSH only really increases at ovulation (which I didn't know) and the rest of the month it is fairly uniform. So maybe GG's GP wasn't so way off after all. I must say I am surprised to see that - I had thought it peaked at Day 3. Unless the scale of the graph is too small to really see the variation....

As for estradiol, my NHS gynae got me to do that without any mention of when in my cycle it should be - and from the graph (blue line) it seems to vary considerably throughout the cycle. Will have to go back and work out which day they did it.

Final comment - I had a NHS u/s of my pelvis at the beginning of August on Day 15 of my cycle and told the sonographer I had just had my LH peak that morning (coincidentally) and asked her if she could look for follicles. She said she couldn't see any (which I was slightly concerned about). Anyway, when I finally received the results (after 2 phone calls to my GP, about 6 phone calls to the Gynae Dept and one trip to the hospital - why can't they do you the courtesy of sending you your results without you having to chase them?  ) it said that I had a 16mm cyst on my right ovary ("probably a haemorrhagic cyst"). I was rather upset by this as the sonographer had not mentioned it at the time. Anyway, when I next went to my fertility clinic and showed these results to the nurse, she said - "Day 15, LH surge, 16 mm, it was most probably either a follicle or the corpus luteum" (I should have thought of that myself!). And I'm sure she's right because she couldn't see any cysts when they were scanning me prior to my IUI this month. But just an example to show you can't always rely on what the NHS "experts" tell you  .

B xx

This post contains an unconfirmed link/information and readers are reminded that FertilityFriends.co.uk or its owners are not responsible for the content of external internet sites


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## ☼♥ Minxy ♥☼ ©

greatgazza said:


> also just curious minxy, your signature says your last tx was dec 09, just wondered what you're up to at the moment, are you currently having tx?
> GG x


Hi again 

Yes, our last IVF was end of Nov/Dec. Unfortunately, all the IVF drugs and my response to them (lots of follicles/eggs) has aggravated my endo and meant I've had more ops to remove it (had one last year and another this year as it's coming back quicker, more aggressively).

We've decided to start drawing a line under ttc as it's been over 7 years, lots of treatment, quite a few early miscarriages and a huge amount of heartache, we just can't keep on putting ourselves through it. We do still have 6 frozen embryos which we'll use at some point in the not too distant future and never know, both our previous FETs resulted in BFPs, albeit short lived and we did manage a natural miracle pg last summer, but sadly resulted in our 5th early mc  So it's almost the end of the line for us.

Don't beat yourself up about the termination you had when you were younger  I can completely empathise with you as when I had mine when I was 21 I already knew that because of my endo I may be limiting my future chances, it wasn't an easy decision but I also know it was the right choice to make for me at the time. I too prefer not to go into too much detail about it on here but I know we're not alone and that choice we made back then, however much we may sometimes wonder about it, certainly wasn't the cause of what we're going through now...if that makes sense ?

Anyway, good luck to you  
Take care
Natasha


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## greatgazza

Yes it does make sense minxy and i just need to keep reminding myself of that fact.  sorry to hear you've been through so much and might be calling it a day,  really hope your frozen embryos bring you the much needed outcome you deserve and it won't have all been in vain.

bethany yes it's quite alarming really when you come across so many different answers and opinions.  As if we weren't stressed enough with all this and then to top it all it seems so blooming difficult to just get a definitive answer to help us to know where to go next. quite frightening really especially when we're in a difficult position if we disagree with what they say and want to dare question their judgement...who are we to know any better??  although from the advice i've got from here, with so many women on here having been all over the world and spoken to every specialist on the planet i'd trust what i find out on here quite a bit more than from many doctors.

GG x


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## bluepumpkin

Hello, does anybody have any idea if there is anything you can do to reduce your estradiol levels? Mine came back high, I'm hoping it was because of the timing of the test (supposed to be day three, and count the first day of full bleeding as day one, unless it's after 5pm - I started spotting on the wednesday, came on on the friday night so counted saturday as day one and had the test done on Monday afternoon) FSH and LH were normal (6 and 4) but estradiol was high. I'm hoping to egg share so need to get better results! Am planning to have them taken again next cycle, but was wondering if anyone has any advice (dietary etc) to reduce the levels or is it just a case of hoping and praying?   Thanks.


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## Mistletoe (Holly)

It could be timing, but also high oestrogen levels suppresses FSH levels and can be indicating the body is making more for a reason.
Try having the test done on day 3 of any bleeding and see what it is like.


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## bluepumpkin

Yes, I'm going to try having the tests again and hope that next month I don't have the spotting for quite so long - normally it's only a day or so rather than two whole days of spotting. In the meantime I am thinking positive and trying to do as much as possible to maximise my fertility! Lots of leafy green veg, nuts and seeds and dairy products. Any more ideas are very welcome!

Thanks Hopeful Hazel!


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## greatgazza

i just had my fsh and lh levels done on day 3, i also had them done on day 21 ( i didn't cross them off the blood form as i'm intrigued to know if my gp was right to send me for them and whether they will vary wildly).  but on the report i have from my day 21 tests it has the following reference ranges (which do show variations between clinics and labs ideas of ranges, which is kinda scary...who actuallly knows a definitive range for cliff's sake!!)

FSH ranges  (IU/L)
follicular              2.5 - 10.2
mid cycle peak    3.4  - 33.4
luteal                  1.5  -  9.1
post menopausal 23.0  - 116.3

LH ranges  (IU/L)
follicular                1.9  -12.5
mid-cycle                8.7  - 76.3
luteal                      0.5  - 16.9
post menopausal  15.9 - 54.0

My FSH taken on day 21 was 3.2 and my LH was 2.5 so according to these i'm still in range looking at the luteal bit so maybe it's not so critical to have it taken on day 3 (or 2 to 4) but even when you google it  it acutally says 'day 3 FSH test'.  I'll have my results next thursday hopefull so i'll be really interested if there's much difference  and how they actually measure it if one of my GPs didn't think it mattered when it was done in the cycle.


Bluepumpkin what was your oestradiol level and what day was the test done on?  the levels i have on my report forms are:

Serum oestradiol level (pmol/l)

follicular  69 -905
mid cycle  130-2095
luteal      83-940
post menopausal  <163

that doesn't make sense to me. how can post menopausal be less than 163 when in quite a few of their 'correct ranges' you could have a figure of 69 to 163 and that should seem ok shouldn't it??

i haven't got my head round these tests and how they affect/can be affected by other levels at all so i'm trying to keep it simple for myself at the mo and concentrate on my FSH/LH.  That's about all i can manage to intepret.  I'm blonde.

GG x
GG x


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## bluepumpkin

Hi greatgazza,
I'm assuming that the reason that the estradiol 'normal ' range is so wide is because the follicular phase lasts for days 1-14, so levels rise dramatically between those days. Day three should be much lower than day 13 for example. My GP had a similar normal range listing to the one you've got, and so was not at all concerned about my levels. When I had my blood taken for day 3 hormones, I'd been spotting since the Wednesday, came on properly on the Friday evening so I counted Saturday as day one and had the blood tests done on the Monday afternoon. Now I'm wondering if I was further through my cycle than day 3 (by Monday I'd all but stopped bleeding too). My levels were 230, and the clinic likes them to be less than 180 for egg-sharing.

So! I'm crossing my fingers and being very positive, and reading the 'Fertility Diet' book, I've bought some apimist and a whole ranges of herbal supplments and vitamins which WILL bring my hormones into perfect order ready for my re-test which I will probably do in a couple of cycles time.   

With regards to the post-menopausal range, I don't really know much about it but I'm assuming that in a menopausal woman you would not see the kind of swings that you see in a healthy cycle. Levels would be lower generally. Does that make sense? I could be wrong though, it is all new to me and seems pretty complicated!   And my GP clearly didn't have a clue - she didn't know why the clinic would care what my estradiol levels were, whereas when you look on the internet there is loads of information about how relevant the results are!


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## greatgazza

Yep it's all pretty new to me too and yep it's pretty complicated!!

From what i've read on here GPs really don't know an awful lot about this.  One doctor at my surgery hadn't heard of AMH test when i asked about it (but maybe i'm being unfair as it is a fairly specialised field and i only know from reading about stuff)  and the other doctor sent me for my FSH/LH on day 21 saying it didn't matter what day they were done on as it 'doesn't vary very much throughout the cycle' er, doc so why's it often called 'the day 3 fsh test'  that's why i wanted to still have it tested on day 21 AND day 3 cos i'll be interested to see if it's way different.  If i wasn't asking questions on here i could have been sent on a right wild goose chase and getting useless tests done cos they're done at the wrong time.  Quite concerning really...

GG x


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## bluepumpkin

It is really isn't it? My GP had never heard of AMH either, and a lot of NHS surgeries/clinics don't test it apparently. But you'd think your GP would know the importance of testing the FSH/LH on day 3 really wouldn't you? I'm pretty sure that they vary a lot throughout the cycle so I'll be interested to see your day 3/21 comparison!

Is the AMH much more accurate do you know? And can it be affected by environmental factors as well like weight/diet etc?


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## greatgazza

i recently got zita west's book and she says the level of AMH

"correlates to ovarian reserve, which declines with age.  This test can be used in combination with an ultrasound scan measuring antral follicles.  IVF clinics are now using this test to give them an idea about how a woman will respond to IVF tx and how many eggs she is likely to produce.  This test tells us about the egg reserves but not the quality'......'altho it may give some indication of your natural fertility potential, there has not been enough research into this and we have seen women with extremely low levels (almost off the bottom of the scale) getting pregnant naturally.  As ever, the woman's chronological age is still the most significant factor.'  

It does say it can't measure the actual quantity or quality, not sure if you can change it yourself with lifestyle etc.  It says a lot of IVF clinics are now using it.

It seems it's only available privately and i think i've seen someone mention on here the lister do it at £62 i think which seems cheaper than other clinics.

GG x


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## bluepumpkin

Thanks GG, I've just bought that book too! I think I'll stick with my hormone balancing protocol for now and get my retest done in a couple of cycles time. At least it's free for me!


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## Mistletoe (Holly)

With these tests they will be looking at the whole picture and pattern - if you had an FSH of 23 and an oestradiol level of 100 this would be post menopausal. Plus if the woman had hot flushes and vaginal dryness the clinical picture would correlate with the blood tests.

Doctors do not only look at one thing when making a diagnosis - they fit all the pieces of the puzzle together, make a differental diagnosis and then narrow down the required tests to find the answer.


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## greatgazza

Bp what's your 'hormone balancing protocol'?  Something you've been advised about or something you've devised yourself and what does it involve?

GG x


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## bluepumpkin

Well it's a bit of a mixture of advice from on here, and advice from the book 'The Fertility Diet'. I'm trying to eat as healthily as possible, focusing on my fertility rather than my waistline (I'm a bit of a weightwatcher normally). Lots of fresh veg and fruit, and very little caffeine/alcohol/refined foods. I looked at the thread 'AngelBump's Fertility Protocol' which has lots of great advice about which foods to eat (lots of high protein foods) and some advice about good supplements to take such as Co-Enzyme Q10 which I've ordered.

The Fertility Diet talks a lot about having as organic a diet as possible, avoiding the use of chemicals (even trying to avoid drinking out of plastic bottles) but also has a great section on the herbal supplements and vitamins which can improve fertility. I've ordered Black Cohosh which is a herb "used extensively by Native Americans as a hormone balancing herb" and Wild Chasteberry (Agnus Castus) which "helps in the formation and balancing of our hormones....... balancing excess oestrogen". Apparently is has been used to lower FSH in women who were considered unsuitable for IVF, according to a study cited by Sarah Dobbyn in the Fertility Diet. I'm hoping that this will help lower my estradiol.

Also she talks  about vitamins such as zinc being very important, and apparently Vitamin B6 is "a key player in oestrogen/progesterone balance .....B6 can correct abnormalities caused by excess oestrogen and balance out oestrogen-to-progesterone levels."

So I've ordered both of these vitamins, and have started taking Apimist, which is a honey-based supplement (there are a few threads on here about it) with Royal Jelly, pollen and propolis. Apparently this can improve the quality of your eggs.

I'm also doing lots of positive thinking, visualisation and I've even ordered a 'hypnoconception' CD from the fleamarket forum to help me with this. So all in all I am hoping and praying that my eggs will be plentiful and my fertility will be in abundance! I am planning to follow this as closely as I can for a couple of cycles and then get retested. Fingers crossed! (Wallet a little bruised and battered after all this spending but never mind, it will be worth it!)

Hope this helps!    

Bluepumpkin


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## greatgazza

Wow, well done for being so good about it.

Makes me feel tired to think about being so good!!  Really hope it helps  

GGx


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## bluepumpkin

I know, it is a bit much isn't it?! But it's making me feel more positive, and that's half the battle I think so I will persevere! Taking the supplements etc will be easy, and I am enjoying the avoidance of artificial sweeteners (sugar instead) and the healthy (but calorific) avocados and nuts, butter etc!   But I have been having a cup of tea a day, and had some wine last night. Plus quite a lot of naughty food at a friend's house. So I'm not being that good!    But it's all an improvement so at least I'm moving in the right direction! (albeit making a rattling noise from all those pills......   )


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## greatgazza

hi girls

well i've not got my day 3 results and also i had the tests done on day 21 as well to see how they differed.

                          Day 3                              Day 21

FSH                    8.6                                    3.2
LH                      4.2                                    2.5
Testosterone    1.4                                    2.1
Progesterone                                              61 (only done on this day and shows i ovulated apparently)
Oestradiol          162                                  461 (this also looks ok with the cycle phases)
Prolactin            108                                  187 (this seems in the ok range)


But i'm so glad i checked on here about day 3 and made sure i insisted on having it done then cos if i'd just gone with day 21 numbers and thought that was the  right day i would have been pretty pleased with those figures i think as the FSH looks pretty good on day 21 so glad i have the true picture. 

Also i've read that 'FSH and LH should be similar and if LH is higher than FSH may be an indication of PCOS",  I have been told  i'm pcos like so i'm surprised my numbers are the other way round.  Does anyone know what it means if it's that way round?  if the LH is lower (in my case half) the FSH figure. Also i don't really know what the other figures mean/what impact they have but i have an appt with a recurrent miscarriage specialist in november so hopefully will get some interpretations, but any thoughts welcome in the meantime.

Thanks

GG x


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## ☼♥ Minxy ♥☼ ©

Hi there

Assuming your FSH and LH were measured in IU/L then those levels look fine. It doesn't "mean" anything that your FSH is higher than your LH....looks perfectly normal to me and not indicative of PCOS.

When comparing any hormone levels you need to include the unit measurement used otherwise takes out of context.

What was your Oestradiol measured in ? Was it pg/ml or pmol/l ?

1 pg/ml = 3.67 pmol/l

100 pg/ml = 367 pmol/l (pg/ml to pmol/l = 3.67)
100 pmol/l = 27 pg/ml (pmol/l to pg/ml = 0.272)

Different labs do use varying normal ranges so you'd need to check your results to see what your clinic/lab use.

different clinics ranges for FOLLICULAR PHASE - oestradiol (E2)
37-539 pmol/l
40-606 pmol/l
75-250 pmol/l

I'm not too clued up when it comes to Prolactin but have a read of this...

http://www.fertilityplus.org/faq/hormonelevels.html#female

1 ng/mL = 2.6 mU/L for Prolactin level

As for your progesterone....any level of 30 nmol/l or over indicates ovulation so your level of 61 is good (again, assuming it was measured in nmol/l) 30 nmol/l is approx 10 ng/ml

Good luck
Natasha

/links


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## greatgazza

Thanks so much Natasha.  God this is all like being back in a maths lesson for me - just looks like scary gobbledy **** that makes no sense whatsoever!!

I should have put the measurements in but it didn't occur to me.

                          Day 3                                Day 21

FSH                    8.6                                      3.2  IU/L
LH                      4.2                                      2.5  IU/L
Testosterone    1.4                                      2.1  nmol/L
Progesterone                                              61    nmol/L (luteal range is 11-81 so i'm ok)
Oestradiol          162 (follicluar 69-905)      461  pmol/L  (luteal 82-940)
Prolactin            108                                  187  mu/L

see my lab even has different ranges to the ones you've quoted, it's so confusing.  How can they vary so much when they're the same measurements and still be ok? it doesn't make sense to me.

I will look at that prolactin link thanks.  What i don't get from the levels for that is that it says

male:                      45 - 375 mu/l
female:                    59 -  619 mu/l
post menopausal    38  - 430 mu/l 

so the female range and the post menopausal range overlaps quite a lot and i could be in either category!! need to look into this more but i don't want to get myself too het up over 1 hormone when the others that seem to be the ones everyone says are so important, FSH and LH, are not too bad.

Thanks again

GG x


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## bluepumpkin

Hi GG - think you should go and show your GP those results next time you go in, and stress the importance of the day 3 testing!


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