Fertility Test

Aspects of fertility

Human fertility is measured by being able to successfully conceive. Infertility is the inability of a woman to conceive after one year of trying to do so. Although infertility is relatively common, those struggling with it are nevertheless confronted with medical, psychological, and financial uncertainty, which can be highly frustrating. But there are actions that can be taken to improve fertility. The Thorne Fertility Test provides an assessment that reflects the convergence of biological, psychological, and social elements. This assessment, when combined with proven methods to improve your diet, nutrition, stress, sleep, activity level, and other factors, can empower you and promote healthy fertility.

Human fertility is a complex process that is affected by a wide variety of factors. Alterations in the biological status of these factors can contribute to infertility. Factors that have been shown to affect fertility include:

• Age

• Diseases or disorders

• Genetics

• Hormones

• Sleep patterns

• Stress

• Nutrition

• Environmental toxins

• Exercise and activity level

• Weight and level of body fat

How the biomarkers we measure impact your health

Fortunately, there are evidence-based steps that can be taken to improve your chances to conceive. The Thorne Fertility Test analyzes three groups of hormones that have been shown to impact fertility ‐ reproductive hormones, thyroid hormones, and adrenal hormones. These hormones work synergistically in the body to promote or impede fertility. And certain biological markers, when they are out of normal range, can contribute to infertility more than others.

The test panels in the Thorne Fertility Test are not intended to be used as diagnostic measures relative to determining your fertility. Instead, this test is intended to be a screening tool, that is within your control, that will reveal patterns in your hormones that might be influencing your fertility. With a knowledge of these patterns, you can then take basic supportive steps and more precisely communicate with your health-care practitioner.

Reproductive Hormones

Estradiol

Estradiol, the most powerful and active form of estrogen, plays a critical role in fertility. Estrogen stimulates maturation of an egg and, after ovulation, causes the uterine lining to thicken in preparation for implantation of a fertilized egg.

Progesterone

Progesterone is released by the ovaries in response to ovulation. After ovulation, progesterone levels rise to prepare the uterine lining to accept and nourish a possible fertilized egg. A low progesterone level can make it difficult to sustain a pregnancy.

Testosterone

Testosterone, typically thought of as the "male hormone," is also needed in a small quantity for good reproductive health in women. Too little or too much testosterone can disrupt fertility. In fact, a high testosterone level is most associated with infertility related to Polycystic Ovarian Syndrome.

Sex hormone-binding globulin (SHBG)

SHBG is a protein produced in the liver that binds to testosterone (and estrogen to a lesser extent). Binding to these hormones reduces their availability and can result in relative deficiencies or excesses that can affect fertility.

Follicle-stimulating hormone (FSH)

FSH is secreted by the pituitary gland in the brain and stimulates the growth of ovarian follicles, the maturation of an egg within the follicle, and the secretion of estrogen and progesterone. It is instrumental in helping maintain the menstrual cycle.

Luteinizing hormone (LH)

LH is the trigger hormone for ovulation. When an ovarian follicle secretes enough estrogen, a surge of LH stimulates the release of an egg and development of the corpus luteum (what the ovarian follicle turns into after ovulation).

Thyroid Hormones

Thyroid-stimulating hormone (TSH)

TSH is produced in the pituitary gland in the brain and moves to the thyroid gland just above the collarbone. In the thyroid gland, TSH activates the production of the thyroid hormones, T4, and to a lesser extent, T3. Abnormal levels of TSH are often the first sign of thyroid dysfunction and can contribute to fertility problems.

Triiodothyronine (T3)

T3 is one of two thyroid hormones. Although the thyroid gland produces some T3, the majority of T3 is made from the conversion of T4 to T3 outside the thyroid gland (referred to as peripheral conversion). T3 is more potent than T4 ‐ meaning it has a stronger action on tissues that have thyroid hormone receptors. T3 influences reproduction ‐ too much or too little of it can interfere with the menstrual cycle and prevent normal ovulation.

Tetraiodothyronine; Thyroxine (T4)

T4 is the primary thyroid hormone produced in the thyroid gland. Of the two thyroid hormones, T4 is made in the greatest quantity in the thyroid gland. Although T4 has the same actions as T3, it is not as potent as T3. T4 can be converted to T3.

Thyroid peroxidase antibodies (TPOAbs)

TPOAbs are proteins that can attack thyroid peroxidase (TPO), an important enzyme for thyroid hormone production. The presence of TPOAbs can (but not definitively) indicate an autoimmune-related thyroid dysfunction. TPOAbs are an independent risk factor for having an increased difficulty in becoming pregnant and for loss of pregnancy.

Adrenal Hormones

Cortisol

Cortisol, often referred to as the "stress hormone," normally has a daily rhythm that peaks 30-60 minutes after waking up and then gradually falls throughout the day. When you have a healthy cortisol level, it helps wake you up in the morning, regulates your energy and hunger, and modulates your normal response to physical and emotional stress throughout the day. The level of cortisol naturally increases during pregnancy and is important for maintaining a normal pregnancy because it helps regulate immune functions that are important for the fertilized egg to implant in the uterine wall. On the other hand, a persistently elevated cortisol level can alter levels of reproductive hormones and inhibit normal ovulation.

Dehydroepiandrosterone (DHEA)

DHEA is a hormone made in the adrenal glands ‐ and in small amounts in the ovaries and testes. Because DHEA is a precursor to both testosterone and estrogen, either too high or too low a level can significantly impact fertility. In a woman, her DHEA level tends to peak during late adolescence and begins declining naturally around age 30. A low level of DHEA can make it difficult to become pregnant because DHEA promotes healthy eggs and embryos. In fact, studies show that a healthy level of DHEA improves fertility in women with diminished ovarian reserves. On the other hand, because DHEA is easily metabolized to testosterone, a high level can be associated with PCOS-related infertility.

The Science

• Collins G, Rossi B. The impact of lifestyle modifications, diet, and vitamin supplementation on natural fertility. Fertil Res Pract 2015;1:11.

• Lan L, Harrison C, Misso M, et al. Systematic review and meta-analysis of the impact of preconception lifestyle interventions on fertility, obstetric, fetal, anthropometric and metabolic outcomes in men and women. Hum Reprod 2017;32(9):1925-1940.

• Toledo E, Lopez-del Burgo C, Ruiz-Zambrana A, et al. Dietary patterns and difficulty conceiving: a nested case-control study. Fertil Steril 2011;96(5):1149-1153.

• Vujkovic M, de Vries J, Lindemans J, et al. The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy. Fertil Steril 2010;94(6):2096-2101.

• Faghfoori Z, Fazelian S, Shadnoush M, Goodarzi R. Nutritional management in women with polycystic ovary syndrome: A review study. Diabetes Metab Syndr 2017;11 Suppl 1:S429-S432.

• Andrews M, Schliep K, Wactawski-Wende J, et al. Dietary factors and luteal phase deficiency in healthy eumenorrheic women. Hum Reprod 2015;30(8):1942-1951.

• Orouji-Jokar T, Fourman L, Lee H, et al. Higher TSH levels within the normal range are associated with unexplained infertility. J Clin Endocrinol Metab 2017 Dec 19. doi: 10.1210/jc.2017-02120.

• Azziz R, Black V, Hines G, et al. Adrenal androgen excess in the polycystic ovary syndrome: sensitivity and responsivity of the hypothalamic-pituitary-adrenal axis. J Clin Endocrinol Metab 1998;83(7):2317-2323.

• Li T, Spuijbroek M, Tuckerman E, et al. Endocrinological and endometrial factors in recurrent miscarriage. BJOG 2000;107(12):1471-1479.

• Mastromarino P, Hemalatha R, Barbonetti A, et al. Biological control of vaginosis to improve reproductive health. Indian J Med Res 2014;140 Suppl:S91-S97.

• Fan D, Liu L, Xia Q, et al. Female alcohol consumption and fecundability: a systematic review and dose-response meta-analysis. Sci Rep 2017;23;7(1):13815.