5 Commonly Missed Tests for Preconception, Fertility and IVF

If you have been trying to get pregnant for a while, you may have consulted your doctor about your fertility challenges. Chances are your doctor ran a blood test on the second or third day of your cycle, and maybe they looked at a few general labs too. Lab results that come back normal or that feel incomplete can be frustrating when you still aren’t pregnant.

Or, perhaps you are beginning to try to conceive and you just want to be proactive. Conventional providers don’t typically investigate fertility until there is a problem. Women under the age of 35 are told to wait one year before seeking a broader fertility evaluation and women over the age of 35 are told to wait 6 months. For many, this is a long time to wait!

There is no reason to wait for a comprehensive blood test, in fact, sooner is better in order to address anything that needs attention. Whether you are thinking about getting pregnant, faced with challenges or are in an IVF cycle, labs can be enormously helpful as one part of a thorough evaluation and treatment plan.

5 Most Missed Lab Tests for Fertility

Most basic fertility workups check FSH, LH, and estradiol on cycle day 2 or 3—but there’s much more to uncover. These additional tests are often overlooked and can provide valuable insights:

# 1 Progesterone

Progesterone is a hormone that is drawn about seven days after ovulation. Since progesterone is not produced in abundance before ovulation, any progesterone reading before ovulation (like on cycle day two or three) is not helpful. This hormone is essential for preparing the uterus for implantation and maintaining a healthy pregnancy. Here are some key points about progesterone:

• Thickens uterine lining to support implantation and pregnancy

• Regulates immune system for implantation

• Blood test 7 days after ovulation

• Basal body temperature charts and at-home urine testing can be useful

• Low levels may show up as spotting before the period or a short luteal phase (< 10 days)

• Ideal levels are at least 10-12 ng/mL

#2 Fasting Insulin

A fasting insulin, along with hemoglobin A1c and fasting glucose can help us understand if insulin resistance or a blood sugar imbalance is influencing the hormonal landscape. Key points about insulin:

• Glucose can look normal even when insulin is high

• Often tied to polycystic ovary syndrome (PCOS), endometriosis and thyroid disease

• Impacts egg quality, implantation, and risk for gestational diabetes

• Affects blood flow and immune health

• A lipid panel and liver enzymes add to the picture

#3 Complete Thyroid

Thyroid stimulating hormone (TSH) is often run as part of a general lab panel, but there are several other important thyroid markers. A full panel, including thyroid antibodies like TPO, gives a clearer picture of how well your thyroid is supporting fertility.

• Thyroid hormones influence cycle length and ovulation

• Essential for uterine receptivity, implantation, and fetal development

• Thyroid hormones and progesterone support each other

• TPO antibodies can raise miscarriage risk, even with normal TSH

• Healthy maternal thyroid levels are vital for baby’s thyroid health

• Autoimmune thyroid issues can often be supported with integrative medicine

#4 Iron and Ferritin

Iron status is about both circulating iron and stored iron (ferritin). Heavy or frequent periods can easily deplete both. Even “borderline” levels can impact fertility.

• Ferritin above 30–40 ng/mL supports ovulation, egg quality, implantation, and pregnancy

• Adequate iron lowers miscarriage risk and supports fetal development

• Consume iron rich foods or supplements with vitamin C (avoid with calcium)

• Supporting digestion often helps with absorption

#5 Vitamin D

Vitamin D is an essential nutrient and hormone. It’s famous for helping our bones but it does so much more.

• Improves egg and sperm quality

• May enhance implantation

• Supports thyroid, immune, and blood sugar health

• Levels above 30 ng/mL are linked with higher conception and IVF success rates

• Optimal levels may be even higher (40 – 60 ng/mL)

• Most prenatal vitamins don’t provide enough vitamin D

Affordable Comprehensive Lab Testing

I offer an affordable, cash-based lab panel for $167 that includes over 60 markers—including all of the ones above—plus many more. While you may be able to request some of these through your doctor, insurance can make that process challenging.

In addition to looking at a comprehensive lab panel, we also want to consider that lab result ranges are usually pretty wide. When we apply a narrower optimal range for lab results vs. a standard range we may see the reason behind symptoms and fertility challenges. 

Lab testing is just one piece of a personalized fertility plan. All recommendations are made in the context of your full health history and a comprehensive intake. And when labs are normal—or don’t fully explain what’s happening—acupuncture and herbal medicine, guided by a Traditional Chinese Medicine (TCM) diagnosis, can be enormously supportive.

Getting Started

When you book a New Patient Fertility appointment we will request any lab results from the last two years. At your initial appointment we will discuss which outstanding tests are recommended and give you the option to request these tests from your provider or test through our clinic with our cash-based option.