Understanding your fertility results: AMH test, FSH and LH test, estradiol

By Constance McGraw, MPH

Testing blood hormone levels is crucial when exploring fertility concerns or contemplating treatment cycles like IVF or egg retrieval. Several of these key tests, including Anti-Müllerian Hormone, follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2), offer insights into ovarian reserve, indicating egg quantity and quality. These are often called 'Day 3' tests because they are conducted on the third day of your menstrual cycle to precisely measure these hormone levels, guiding adjustments in treatment plans during fertility treatments.

AMH test results

AMH (Anti-Mullerian Hormone) is a popular hormone blood test that is typically used to examine ovarian reserve and response to fertility treatments. AMH tests can also assist with understanding how close women are to menopause. Key points about results of AMH tests include:

• AMH levels typically stay stable throughout the menstrual cycle, allowing testing at any time.
• High AMH: ≥5.0 ng/mL (can indicate PCOS ~2-5 x higher than normal range for age
• Average AMH: 1.0 ng/mL-3.0 ng/mL (depends on age, testing method, manufacturer)
• Low/severely low AMH: 0.4-1.0 ng/mL (low or diminished ovarian reserve)
• Age significantly impacts AMH levels, with a natural decline post-35 impacting fertility potential.

Below are some common AMH lab values used by LabCorp to determine appropriate ranges of AMH based on a woman’s age. Please consult with a medical provider before making your own interpretations.

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FSH and LH blood test results

Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) test results play important roles in follicle development and ovulation. In women, both FSH and LH rise during the early part of the menstrual cycle (the follicular phase). Ovulation occurs just after they peak. The levels of both hormones remain low during the luteal phase of the cycle (until the next menstrual period). Because of this, FSH testing needs to be performed on a specific day of the menstrual cycle (day 2 or 3), and all reference values reflect FSH at this time. 

 Interpretations include:

• A low FSH level (<10 IU/mL) is generally associated with better ovarian function. 
• A high FSH level (>10 IU/mL) is generally associated with diminished ovarian reserve. 
• Low LH levels may indicate that the pituitary gland is not making enough to spur changes in sexual development or reproduction.
• Elevated/High LH levels may signal issues with reproductive processes or hormonal imbalances.

Below are the LabCorp ranges for common FSH and LH test results based on an adult woman’s menstrual cycle stage. Please consult with a medical provider before making your own interpretations.

Estradiol test results

Estradiol tests, also called E2 tests, diagnose low estrogen production or menstrual irregularities. They compare estradiol levels against a standard range, which fluctuates during the menstrual cycle, lowest in the follicular phase and highest before ovulation. Often done on day 3 and aligned with FSH and LH tests, discussing abnormal levels with a healthcare provider is pertinent due to potential underlying health concerns. Estradiol ranges are categorized as:

• Low estradiol with specific hormone levels could indicate pituitary or hypothalamus-related conditions 
• High estradiol levels with irregular periods could indicate PCOS or hormone-producing tumors. 

Below is one standard used by LabCorp to determine common ranges of estradiol lab results based on where women are in their cycles. Please consult with a medical provider before making your own interpretations.

Key takeaways about AMH tests, FSH and LH tests, & estradiol tests:

These hormonal blood tests don’t definitively predict your fertility or ability to conceive naturally. Considering all test results together helps assess reproductive health. Your healthcare provider utilizes these results for tailored treatment steps. Discuss standard ranges with your provider for accurate interpretations. Interpreting results requires considering menstrual cycle phases, health factors, age, and lab variations. Seek professional guidance instead of self-diagnosis based only on test results.

References:

1. The American Society for Reproductive Medicine (ASRM) (2014). Ovarian Reserve (Prediciting Fertility Potential in Women). Retrieved January 2024 from: https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/ovarian-reserve-predicting-fertility-potential-in-women/
2. Cleveland Clinic (2023). Ovarian Reserve Testing. Retrieved January 2024 from: https://my.clevelandclinic.org/health/diagnostics/25142-ovarian-reserve-testing
3. Cleveland Clinic (2023). Follicle Stimulating Hormone (FSH). Retrieved January 2024 from: https://my.clevelandclinic.org/health/articles/24638-follicle-stimulating-hormone-fsh
4. LabCorp (2023). Follicle Stimulating Hormone (FSH). Retrieved January 2024 from: https://www.labcorp.com/tests/004309/follicle-stimulating-hormone-fsh
5. Cleveland Clinic (2022). Luteinizing Hormone. Retrieved January 2024 from: https://my.clevelandclinic.org/health/body/22255-luteinizing-hormone
6. LabCorp 2023. Luteinizing Hormone (LH). Retrieved January 2024 from: https://www.labcorp.com/tests/004283/luteinizing-hormone-lh
7. LabCorp 2023. Estradiol. Retrieved January 2024 from https://www.labcorp.com/tests/004515/estradiol
8. Cleveland Clinic (2022). Anti-Mullerian Hormone Test. Retrieved January 2024 from: https://my.clevelandclinic.org/health/diagnostics/22681-anti-mullerian-hormone-test
9. ACOG Committee Opinion No. 773 Summary: The Use of Antimüllerian Hormone in Women Not Seeking Fertility Care. Obstet Gynecol. 2019 Apr;133(4):840-841. doi: 10.1097/AOG.0000000000003163. PMID: 30913192.
10. Li HWR, Robertson DM, Burns C, Ledger WL. Challenges in Measuring AMH in the Clinical Setting. Front Endocrinol (Lausanne). 2021 May 24;12:691432. doi: 10.3389/fendo.2021.691432. PMID: 34108942; PMCID: PMC8183164.
11. Harris BS, Jukic AM, Truong T, Nagle CT, Erkanli A, Steiner AZ. Markers of ovarian reserve as predictors of future fertility. Fertil Steril. 2023;119(1):99-106. doi:10.1016/j.fertnstert.2022.10.014
12. LabCorp 2023. Anti-Müllerian Hormone (AMH) (Endocrine Sciences). Retrieved January 2024 from: https://www.labcorp.com/tests/500183/anti-m-llerian-hormone-amh-endocrine-sciences