Can anyone help me interpret thyroid/hormone, etc tests, symptoms and suggest next steps please?

[Becky348]

Hello, I’ve had some private Day 3, 21 and other basic fertility blood tests taken, and wondered if anyone could help me work out what to do next please?

I had a MMC and MVA in April last year after getting pregnant naturally on the third cycle of TTC - the embryo stopped developing at 8 weeks. Since then, we’ve been trying without any success. We’re both 39.

I had 2 normal periods post MMC, then in July last year, I started to get spotting up to a week before my period. Since then I’ve also had intermittent sharp pains and occasionally a soreness/bruised feeling in my pubic bone, usually post ovulation up to the start of my period. I've been wondering if gluten and too much sugar make the symptoms worse, but not entirely sure. The last 3 months, I’ve had less spotting and more actual bleeding at various points in my cycle and sometimes after DTD. But strangely no bleeding this month yet, currently CD22. I've taken B vitamins more regularly this month, not sure if this has helped.

I’ve had basic swabs taken by my GP and a Transvaginal Scan which came back normal. I was wondering if my symptoms suggest low progesterone and/or perimenopause, but I don’t think the test results indicate this, plus this wouldn’t address the pains I’ve been getting. I also wondered if it could be PID/endometritis (or endometriosis, though I’ve never had excessively heavy periods or pain pre pregnancy).

Here are my results of note. They’re all in range apart from the ones I’ve highlighted:

Day 3
Oestradiol - 259.0 pmol/l
FSH - 5.3 U/l (so maybe doesn’t indicate perimenopause?)
LH - 5 U/l
Progesterone - 0.64 nmol/l
Prolactin - 355 mIU/l
SHBG - 69.6 nmol/l
DHEAS - 2.9 μmol/l
Testosterone - 0.139 nmol/l (<0.29 Low)
Free Androgen Index - 0.2 % (<0.3% Low)

TSH - 1.84 mIU/l
FT4 - 12.6 pmol/l (Lowish?)
FT3 - 3.71 pmol/l
Anti-Thyroglobulin Antibody (Anti-Tg) - 40.4 IU/ml (≤115.0 optimal)
Anti-Thyroid Peroxidase Antibody (Anti-TPO) 13.6 kU/l (≤34.0 optimal)
(Are the presence of these antibodies suggestive of an auto immune condition?)

Vitamin D - 18 nmol/l (Deficient, started treatment dose)
AMH - 0.636 pmol/l (low, so I imagine this rules IVF or certain types out?)

Day 21 (Day 19 for me based on 7 days post ovulation)
Oestradiol - 245 pmol/l
FSH - 4.6 U/l
LH - 4.8 U/l
Progesterone - 30.50 nmol/l
Prolactin - 671 mIU/l (>496 High. Is this a problem? Or just high because I’d eaten before this test?)
Testosterone - 0.275 nmol/l (<0.29 Low)
SHBG - 61.40 nmol/l
Free Androgen Index - 0.45 % (Lowish but not as low as Day 3, Range: 0.3 -5.62 optimal)

Does anyone know if any of my out of range results can be easily fixed? Or if any of them indicate problems with fertility or hormones? I'm now waiting on a gynaecology appointment in July, but do I need an endocrinologist referral too? My GP won't refer to a fertility specialist until the gynaecology route has found anything. My husband is also having his sperm tested on the NHS but I imagine any problems currently are to do with the symptoms I'm experiencing.

I'm conscious of my age, and the referral wait times- does anyone have any suggests for what we should do next? Would a fertility clinic or private gynaecologist, or another route be a good idea? We don't have that much money to put towards this, and we're not sure if IVF is a route we'd go down yet, but would be really useful to know what others would suggest.

Thank you so much for reading, and for any advice, I greatly appreciate it!

@Becky348 Really sorry to hear about your loss.

Not a doctor, but two of the results I can shed some light as they came up on our TTC journey.

Prolactin is pretty much the lactating hormone, but this can rise when your body is under stress whether it's mental or physical, and can be a factor in infertility. I had similar levels to yours when I started getting blood checks 18 months ago. My NHS doctor didn't offer me any medication to treat it and told me to rest more and try not to stress as much - not helpful. I ended up leaving that job, and my prolactin levels halved, so that was definitely my trigger. If you can find out what is yours it could be helpful in reducing your prolactin levels.

As for AMH, it's the hormone given off by your developing follicles in order to grow the egg inside which you need to release in order for chance to get pregnant. So low AMH is an indication of low ovarian reserve. You only need one good egg released for you to get pregnant and fact you were able to get pregnant naturally despite some of your markers being out of range can be taken as a good thing. Everyone says its a luck thing with conceiving, your husband could have super sperm which improves your chances just that more than the average person, and there will always be case studies of couples with near impossible results than can conceive naturally then cases where a couple have great stats, but have unexplained infertility.

I'm pretty much in range with all the markers, 33 with not a single pregnancy TTC 2 years - just completed one cycle of ICSI.

Some clinics will take on patients with AMH less than 1, but the annoying thing is if you go private you have to pay for an appointment to be told they won't take you on. We had this experience with one London clinic (my AMH was 3.9) and they basically messed us around and said they couldn't help us. Luckily we found another clinic that has been fantastic. There's a youtuber I came across during my IVF research called Hellynn (although she did her cycle abroad) but mentioning in case you want someone watch and get an insight what its like to do IVF with low AMH, I think she's 40 and her AMH was even lower than yours and she had to go through multiple cycles of IVF to get eggs.

In terms of improving your markers, both my husband and I did the following and saw big improvements (mainly his side). Cut out all caffeine and alcohol (this was our choice, guidelines say both are ok in moderation, but we were ok to make the cuts in order to maximises our chances), reduce sugar and processed food in take (not sure how much this contributed, but we both lost weight without dieting strictly which was a plus, eat as clean and single source ingredient cooking weekdays and maybe a couple of treats on the weekend). Our IVF doctor recommended Mediterranean diet with lots of protein. Lastly vitamins, folic acid is the most important one and only one I was on first year TTC, but later changed to a multivitamin with COQ10 and omega 3. During my stims cycle for IVF my doctor also prescribed melatonin and spermadine - check with your doctor first, but this was to help me relax, sleep better and improve egg quality before collection. Stopped Melatonin and Spermadine now.

I hope you get your NHS appointments soon! I've heard its a postcode lottery with how quickly you get seen. IVF is a really mentally and physically draining process, so its a discussion you and your husband need to have to see if its something you want to consider. Doing IVF privately is expensive and one of the first things the doctor will tell you is that it's a process, the average is 3 cycles to get a successful pregnancy. Prices will vary where you are in the UK but to give you an idea (£3.5k average starting just for the IVF cycle easily can go into £10k range for some clinics and thats not even top end, most expensive one I saw was £17k! Medicine cost is dependent what protocol your doctor puts you on and situation, I've seen most clinics advertise medicine costs £1-2k, and we were quite shocked mine have come to almost £3.5k, then costs for blood tests and check up's will set you back £1-3k depending how much additional testing you need for you and your husband). Im sure there are good clinics out there that will cost less, just sharing what I've come across based in London.

Wishing you the best of luck on your journey x

I would suggest you book to see a fertility consultant if you want to expedite things, but be mindful they may well request repeat bloods etc anyway as there will have been a time lapse. Its not a good idea to get people to interpret tests online for you as blood work is just one part of a fertility assessment alongside physical examination etc.

Unfortunately if you haven't got much money to throw at this and are not sure if you would go down the route of private IVF, it's worth considering what the point of seeking a private opinion is. With your history they are likely to recommend further test/investigations and depending on those IVF may well be the suggestion. But if you are then going to go back into the NHS, they are unlikely to take the private clinics findings and recommendations and may repeat the tests/investigations anyway. All fertility doctors work in slightly different ways and have their own process/method. Just worth considering where you are wanting this to go. The essential fertility guide is an excellent book by Robert Winston if you are wanting pragmatic, evidence based advice.

@Lavendermarshmallows Thank you so much for the really comprehensive reply, that's a lot of really useful info. Thanks for sharing your experience and I'm sorry that it's been a tough journey for you so far.

That's great to hear that your prolactin came down after removing stress. I'm not currently too stressed but I am overworked, which I'm sure is roughly the same end result! Thanks for the vitamin suggestions, I'm taking most of those already and will definitely look into the melatonin. We generally eat fairly healthily but I need to cut down on sugar, I have too much of a sweet tooth.

If you don't mind, would you be willing to share which 2 London clinics you mentioned (the one you'd recommend and the one you'd avoid!) please? I'm in South London so am just starting to look into recommendations if we did decide to go down an investigation, if not IVF route. Thanks also for the breakdown of costs, particularly the hidden ones.

Thanks again and I hope everything goes well for you x

@SErunner I so appreciate the helpful reply, thank you. I totally understand it's not the best idea to ask online for test interpretations, but just thought it might help me to work out what to do and who to turn to next.

That's really useful to hear your thoughts on the pitfalls of going back and forth between private and NHS. Thanks for the book recommendation too, I've read the sample that's available online and will be looking into purchasing it.

Wishing you all the best x

No problem. The one we had a negative experience with was London Women's clinic, London bridge branch and the clinic we had a positive experience with and ended up having treatment with was Lister Fertility Clinic, Great Portland Street Hospital.

This was just our personal experience and maybe we just got really unlucky, I've seen many positive reviews for LWC which is why we went there in the first place. Our reasons for the negative feedback on them aren't just being told we can't do IVF or ICSI with them but also:

1. The admin response was terrible - we were chased to send medical information 3 times despite having it sent over in the first email request. Then when we got to the doctors appointment for initial discussion we were told they had received none of our medical reports. Luckily I had paper copies on me that day and I showed the doctor we had sent them across 10 days prior to our appointment.
2. They wanted us to re-do all our testing with them which was an additional cost. We had our appointment in December and all our most recent test results were within 3 month.
3. The follow up call with the doctor is phone appointment only, no video call and no in person appointment which was difficult for us because they put us on speakerphone and it was a strain to hear what was being said as call quality was poor. We were told multiple times on the call we should consider using donor sperm which you can imagine made my husband feel awful especially as telephone manner was poor.
4. After being told we were not suitable for treatment with them they told us we should see a urologist and would email us with some urologist recommendations. We received an email 3 days later saying an appointment had been made with one of their other doctors at the clinic, rather than urologist recommendations. After a quick google of the name, it was just another fertility doctor at the clinic and not a urologist specialist. Decided to check the details of the doctor who called us to give us our results, and she's not even a fertility doctor, just licensed GP! Medical professional or not it didn't give much confidence.
5. Then lastly of course it their right to deny us treatment, but they told us our situation wasn't suitable for treatment at all, we were devastated especially as they kept saying we should consider donor sperm if we want children. I should mention other than 0% morphology, my husbands markers are all well within range, and just my AMH is low for my age. We were never given a proper reason why couldn't do ICSI with them other than sperm quality too poor and should make more appointments with doctors at their clinic, so personally it just felt like they were trying to make more money out of us by having extra testing and seeing more doctors and concern accepting us as patients was going to affect their success rates as they claim to have very high success rates.

Our experience with Lister Fertility Clinic was very good. I saw Dr. Farahani, lovely, personable doctor, who was equally surprised we were denied ICSI after looking at our test results. We did not need to pay for any additional testing and they were happy to use all our most up to date test results as they were within 3 months. Never had issues with the admin or nursing team and most importantly after being told by LWC we can't do ICSI and would need donor sperm, we ended up getting 3 excellent embryos with Lister!

South London costing might be more favourable, central London definitely seems to have a premium. All the best on your journey too and I hope you are able to have a conversation with your doctor or better yet good baby news soon x

Thanks @Becky348. Just spotted you're in south london. We've had all our treatment with kings fertility and would highly recommend them. Good luck to you too x

Thank you again @Lavendermarshmallows for kindly sharing your thoughts on both clinics, I really appreciate it. I'm sorry that the Women's clinic experience was such a disappointing and frustrating one, but that's great that Lister has been so much better! I've seen a few other posters mention them so too I'll look into them.

Thanks for your kind words too, fingers crossed for the outcome you're hoping for x

Thank you @SErunner, I was wondering if the 'SE' stood for this area! I'll definitely look into Kings - I didn't realise they had a private fertility clinic, but I had my miscarriage care at their EPU, and I know their research centre is supposed to be highly thought of. Lots of luck to you x