Episode 05 Transcript

[00:01:00] labs are concrete information that you have to then create a fertility plan based on what's going on in your specific body that helps open up your chances of getting pregnant.

[00:01:14] And that is why I'm so excited to be here talking with you about these 7 important, do not miss these PCOS fertility labs. So this is going to be an episode where you're going to want to sit down and have a piece of paper and be jotting a lot of notes. All right. So get that together while you're listening, or, you know, if you're in your car or walking, be sure to bookmark this post so you can come back to it later and write down the notes.

[00:01:43] All right. So the benefits of having PCOS Fertility Labs are that it's this concrete information in front of you that can be used to then create this really amazing fertility plan moving forward.[00:02:00]

[00:02:00] It is also really helpful to share with your partner. because sometimes partners don't really understand why you're reaching out to get extra support, what's going on, why you can't just be going to your regular old doctor and getting this kind of support or why you need to be spending a little extra finances and time on these things. So showing them results. is super helpful to be like, okay, look, look at these hormone levels. They're not doing what they're supposed to be doing. Look at these deficiencies I've got with vitamin D and iron, then this needs to be optimized to help fertility. So that can be an excellent benefit to getting labs done with PCOS.

[00:02:46] But the other important aspect of lab tests with fertility is interpreting the results from an optimal fertility standpoint, which not all the fertility doctors are doing.[00:03:00]

[00:03:00] So it's one thing to look at the standard reference range when a lab comes back. That's what. you know, will tell you, oh, whatever you're testing for is high or low because they're, they're doing that against the standard reference range. They're saying, okay, are you in this standard reference range?

[00:03:17] That's one thing, but then there's also an optimal range for fertility. This is really important for thyroid levels. Okay, for iron levels for vitamin D. So you need to be interpreting the labs or have a doctor who can interpret the labs from an optimal fertility point of view.

[00:03:39] Now, you might be wondering, well, why am I just spending a whole episode talking about labs? Because aren't doctors running labs for fertility? Yes, they are. But there's a big shortfall. The labs that are getting run for fertility are typically not comprehensive enough, and particularly for PCOS. [00:04:00] So you want a specific set of labs that really dives into what's going on in your unique picture, because you know that I am a huge proponent of individualized care with PCOS.

[00:04:16] I mean, that is when fertility opens up, when you can get that individualized care. And having these labs creates that. That groundwork to understand what specific things are going on in your body that need to be addressed and if you're not getting the right labs run or enough labs run, then you're just getting little bits and pieces of this framework. Right? So you might be just getting the concrete. But you need the structural supports as well. So you're just getting little pieces of the bigger picture, and what you need is [00:05:00] the entire foundation. Because with PCOS, you really need to know what's going on inside the body that is contributing to your fertility struggles.

[00:05:11] So that's why this episode is super important for you to listen to. You can read the transcript and see what labs you have and then what labs are missing that you need to go out and ask for.

[00:05:25] Before we get into it, I just want to say. Thank you so much for being here. Honestly, it is such a joy to have you here in this community and to be able to just talk with you on this platform. So thank you. And if you are enjoying this podcast, please leave a positive review over on Apple podcasts. That would mean so much to me because reviews right now are what fuels this podcast, what keeps it going. And it also helps other people who need this information to be able to find it and get access to it. [00:06:00] So thank you.

[00:06:02] All right. When we are talking about PCOS fertility labs, I want you to know that there's actually a variety of ways to get labs done. And what I mean by that is it's not just blood tests. Okay. Which might surprise you there. You can get blood tests. You can also run labs through saliva and through urine.

[00:06:26] Some tests are actually better to look through urine and Saliva. Some you can only look at urine tests to see particular hormones. I'm going to talk about that at the end, but understanding how to get tested for certain hormones is really important.

[00:06:51] Another benefit of doing something more than just a blood test, specifically doing the either saliva or urine tests, is that [00:07:00] those are typically done at home. So your doctor can order you a kit that's straight, that's sent straight to your house. And then you complete the sample at home. And then you mail it into the lab, the lab. Evaluates your sample gets your report together and sends it back to your doctor to talk through. Okay. But just that doing it at home piece is super simple.

[00:07:24] And then also, if you're afraid of needles, it's a great way to get some lab work done because if that fear of needles is keeping you from getting this type of information, please know that there are options.

[00:07:39] Alright, so let's dive into the top seven labs not to miss with PCOS fertility. So the first one is progesterone and progesterone is really important because it's pretty much what keeps the pregnancy going once [00:08:00] you've made a baby and if you're not getting enough progesterone, then you're not actually going to be able to keep that pregnancy going. So that's why it's really important to know your progesterone levels when you're trying to get pregnant. And then if you got pregnant to get tested them as well, because Your body's own progesterone production is what keeps the pregnancy going in the first trimester in the second trimester that switches so the placenta takes over the progesterone production for the rest of the pregnancy and your body's Production of progesterone can doesn't have that job anymore.

[00:08:44] So again, if you don't have enough progesterone early on, when you're trying to get pregnant, then there's pretty low chances that it's going to be a successful pregnancy and low progesterone is really common. And that can [00:09:00] extend the period to be longer. And it also is a sign that you're not ovulating if you have low progesterone. So progesterone is super important to get dialed in.

[00:09:13] But when looking at direct levels of progesterone, either through saliva or blood, you'll want to get those run on day 1920 or 21 of your cycle. or seven days post ovulation. Okay, so we say day 19, 20, 21 for people who are ovulating on day 14, but if you're not ovulating until day 20, like you get a positive ovulation test, then you're going to be testing progesterone on day 27.

[00:09:47] And so understanding what your progesterone level is, because I've never ever seen it too high. I usually see it too low. And, and sometimes I'll see it [00:10:00] right where it's supposed to be. Okay. But usually the issue with progesterone is that it's too low and particularly with PCOS. If you're somebody who has irregular cycles and really long cycles or cycles that, you know, you only get one cycle a year, like a really long cycle, that progesterone, is going to be important.

[00:10:24] Okay, so progesterone is what keeps the pregnancy going. You need it for ovulation and to help the uterus prepare for pregnancy and you want to get it tested seven days after ovulation.

[00:10:39] Here's something interesting. I have named this podcast title, the seven most important labs, but there's more than seven that I'm going to list here.

[00:10:49] So the second one is estrogen, LH and FSH. Three hormones that I'm going to lump together because [00:11:00] they're tested on the same day, which is day three of the cycle. And again, day one is the first day of bleeding.

[00:11:07] So estrogen is the sister hormone to progesterone. Estrogen is dominant in the first half of the cycle at ovulation that switches estrogen drops and progesterone rises.

[00:11:21] Progesterone is dominant in the second half of the cycle. And so estrogen being that. dominant hormone in the first half of the cycle, that follicular phase, we test it in that first phase and at day three. LH and FSH are tested on day three as well. And those are two hormones that are coming from your brain that help to support ovulation.

[00:11:47] They're typically not where they're supposed to be with PCOS. I'll say that, but those three hormones again are day three hormones, and they're really important to understand [00:12:00] is, well, are they in where they're supposed to be where they can be doing their jobs to help with fertility as they're supposed to be estrogen.

[00:12:10] Often I see it really elevated. or really low. You want estrogen to be in that optimal place for fertility. It's not one of those hormones that you want to just keep driving down lower and lower.

[00:12:25] Lab test number three, testosterone. Testosterone is one of those labs that you really want to dive down pretty low, or one of those hormones that you want to dive down pretty low for people who have female hormones.

[00:12:40] Testosterone is a male dominant hormone. For people with male organs, testosterone is their dominant hormone. For women and people with female organs. Testosterone is still an important hormone in the body. It helps with muscle building and [00:13:00] libido and a variety of other things, but it really needs to stay in its optimal range, and testosterone is one of the parts of PCOS diagnosis.

[00:13:12] Okay, having too much testosterone and some doctors will just go off your symptoms to say, Oh, you know, okay, you've got this much extra hair growth, like on your chin and your back and you have, acne, lots of acne. Those are the two classic signs of excess testosterone. And so then they would say, okay, this, you know, fits you into that PCOS diagnosis. But you do want to get testosterone tested because you want to see, again, you want to have that concrete number in front of you to understand, okay, where are my levels at?

[00:13:52] And to get a comprehensive look at testosterone, you want free and total testosterone [00:14:00] levels run to understand what's going on. So free testosterone is the active testosterone running around in the body. Total testosterone tests both that free testosterone and then the bound testosterone. So that's helpful to see how much testosterone is free versus bound up and not being used.

[00:14:24] All right, so an important PCOS fertility lab number four is thyroid, and this again is a panel, so it's more than one test, and the most important thing with PCOS fertility is to get a comprehensive diagnosis. Thyroid panel, because it's pretty well known in the medical community. It's very well known that thyroid issues impact fertility and testing for thyroid is done very frequently at fertility clinics.

[00:14:57] I'm guessing you've had some thyroid testing done. [00:15:00] If you have gone to see a doctor and talked about your fertility, the shortfall is that Not enough of the thyroid labs are getting tested as in you're not getting a comprehensive look at Thyroid, I will say nine times out of ten when I'm talking to somebody they haven't gotten a comprehensive thyroid panel run and when it comes to PCOS People with PCOS have a three to four times greater chance of having thyroid issues than somebody without PCOS.

[00:15:34] And thyroid, it interacts directly with the ovaries. And you know, you don't just need a comprehensive thyroid panel. You also need somebody to help you to read your results from a optimal fertility standpoint.

[00:15:51] Let's dive into this a little bit more, but we've been going like about a halfway through. So I want to bring a joke in because this type of information is a [00:16:00] little, like can be a little dry. So I want to bring some humor in here. Okay what did the snail say when it sat on the turtles back? Whee. I think that's hysterical.

[00:16:16] So we are talking about the thyroid and how important it is to get a comprehensive thyroid panel run with fertility and then to also get it interpreted from an optimal fertility standpoint. So that comprehensive thyroid panel looks at TSH. which is your main thyroid hormone, that's your brain talking to your thyroid, and then looking at free T4 and free T3, which are the hormones going from your thyroid to the rest of the body, including your ovaries.

[00:16:51] So you want to see what they are doing. You also want to get thyroid antibodies run. Thyroid antibodies look to see if you [00:17:00] have an autoimmune condition of the thyroid, which is Hashimoto's thyroiditis. I see this very commonly along with PCOS. And the issue is, is that Most doctors aren't running thyroid antibodies, but it's very well known that Hashimoto's impacts fertility because of the inflammation going on in the body with those antibodies running around. That impacts fertility.

[00:17:29] Also, Hashimoto's, like kind of the classic sign of Hashimoto's is a TSH level, that main thyroid hormone from the brain to the thyroid, going up and down. So if you have a TSH level, if that's all your doctor is ordering and they say, Ooh, look, that's a nice, healthy level. It's in our standard reference range. You're all good to go with that. Yet they aren't interpreting that from a fertility standpoint. [00:18:00] So maybe your TSH is at like a four or five, which is in the standard reference range, but way too elevated for fertility. And then they haven't ordered your thyroid antibodies and your antibodies are like 600 or above, which is Out of the roof. And I've seen before commonly, then you are missing out on this important piece of your fertility puzzle. And you can go and try and use as many fertility medications as you want. But if that thyroid picture is not getting fixed, then you're missing out and you're keeping your chances of getting pregnant pretty low.

[00:18:36] Do you see how this works? All right, so important lab test number five is sex hormone binding globulin. It's also known as just SHBG, easier to say it that way. And this binds to testosterone to make that testosterone unavailable to use. So if you have [00:19:00] too little of this SHBG running around the body, then that means testosterone, the testosterone that's in your body, can be more active.

[00:19:09] And when there's too much testosterone, that shuts down ovulation. So this is a part of the testosterone picture that's really important to see, okay, what's going on here.

[00:19:23] Lab test number six that's super important for PCOS fertility is vitamin D. Vitamin D is very closely intertwined with pregnancy. One research study found that women with vitamin D levels of 30 or more had higher levels of live birth rates.

[00:19:43] And women with PCOS have a greater chance of having a vitamin D deficiency. So this is a super... low level, easy thing to get tested for, to understand where your [00:20:00] current level is and how, like, to then figure out how much you need to take in order to bring your levels up to optimal fertility. And with vitamin D, it's a hormone.

[00:20:12] So And there are risks of taking too much of vitamin D. So you have to know how to, how much to give the body to help you get the right levels to support fertility.

[00:20:25] And PCOS important lab number seven is ferritin. Ferritin is a storage form of iron. Iron, the importance of iron is to support your blood and it supports fertility.

[00:20:45] Lots of doctors will just look at your CBC, will look, which your CBC is your red blood cells and white blood cells and what they're doing, which does show you anemia. And so they'll just look at that basic test to see, okay, is there [00:21:00] anemia going on? Do we need to replace iron? But. Ferritin is the next level.

[00:21:08] Again, it's a super easy test to get run and it gives you a lot of information because you can have a regular red blood cell that doesn't show any signs of anemia and yet if you have low iron you're still keeping your chances of getting pregnant low. Again, ferritin is that storage form of iron and it Needs to be at a, at a pretty high level to be supportive for fertility

[00:21:41] the standard reference range for iron or for ferritin specifically, that range is typically around 10 to 100. That is a humongous range. And if your doctor is interpreting your test and [00:22:00] you have a ferritin of 15, and they're telling you, okay, great, you know, your ferritin is in standard reference, you know, it's within range, looks good, let's, you know, get you on some letrozole or clomid. You have got to put the brakes on because the ferritin level has to be up at a much higher level to help increase your chances of getting pregnant.

[00:22:25] We've talked about these seven important PCOS lab tests, which, yes, there are more than seven, I know. I did, I did warn you to have you grab a piece of paper and a pen so you could write down notes. And it's old school to say, Hey, grab a piece of paper and a pen to make some notes. I don't know. Maybe everyone's making their notes on the computer, but anyway.

[00:22:52] So we've gone through seven important fertility lab tests. And I do want to talk to you about how [00:23:00] getting the just. I would say the straightforward values of these labs are really important for some of them. It's going to be important for you to take it to the next step. So, in the beginning of this episode, I mentioned that there's salivary, there's urine and blood tests.

[00:23:21] Most of these tests that we've, all of these tests that we've talked about so far are super easy to be run through a blood test, like simple blood draw, get it done. But if you're getting that type of lab test and things look kind of normal, and yet your periods are still super irregular, or they give you a little bit of information and you get a plan based off that, and then a few months later, just things aren't working. That's when you want to take it to the next step, and there are some extra tests that you can get run to look even deeper into this [00:24:00] picture.

[00:24:01] One of those is a, a test that is a urine test that looks at your hormone metabolites. So it's one thing to just see what your progesterone or estrogen or testosterone are doing on that specific day, but looking at hormone metabolites helps you understand a bigger picture of what the hormones are doing in the body.

[00:24:25] Because with estrogen. Right. There's actually three different types of estrogen and you want to see which pathway the body is pushing. Same with testosterone is maybe you have a regular level of testosterone, like in the standard reference range. And yet you're pushing the, the, the worst. I'm doing air quotes here for those of you who are watching the video, the worst form of testosterone.

[00:24:54] And so. Even though you have a normal value on your blood tests, [00:25:00] you're still getting extra hair growth. You're still getting tons of acne. And so you need to see, okay, oh, am I having, am I pushing this different metabolite pathway?

[00:25:10] The other, the other lab tests that I want to mention that can be super helpful if you need that kind of next level of of care and understanding of what's going on in your body is something called a menstrual cycle mapping test. And this again is a urine test. It's pretty cool. You do a sample almost every day of your cycle, even if your cycles are 45 days or 60 days. And then you send your samples back into the lab. And what you get is a, A chart that shows you on every day of your cycle, what your estrogen, progesterone, and LH levels are doing.

[00:25:51] So that's really helpful to see, are you ovulating when you think you're ovulating? Is your estrogen doing what it's supposed to be doing? [00:26:00] all throughout the first half of the cycle. Is progesterone doing what it's supposed to be doing all throughout the second half of the cycle? So I also want you to know that there's more options, like there's more investigating that can be done to understand what's going on in your body, to help get things smoothed out, to help you increase your chances of getting pregnant with PCOS.

[00:26:25] Okay, great. So we talked about these seven lab tests. Thank you so much for being here. If nobody has told you today, you are amazing and you are doing exactly what you need to be doing to just continue getting more information and figure out answers for your body and your fertility.