Fertility Investigation Panel

Are you planning pregnancy without success, or want to know how your hormones are working before starting investigations? From one blood collection, the Fertility Investigation Panel checks seven hormones important for ovulation and ovarian reserve: FSH, LH, estradiol, AMH, prolactin, testosterone and TSH. These results help a gynaecologist determine the next step more quickly.

Who is this panel for

• you have tried to conceive for 12 months without success, or 6 months if aged 35 or older;
• your periods are irregular, infrequent or absent;
• you are preparing for medically assisted reproduction (MPO);
• you have had ovarian surgery, endometriosis or chemotherapy and are interested in ovarian reserve;
• you have nipple discharge, excessive hair growth or other signs of a hormonal disorder;
• you are considering pregnancy later in life or egg freezing and want to assess ovarian reserve with a gynaecologist.

What the panel reveals

• FSH and LH: pituitary hormones stimulating egg maturation and ovulation. High FSH early in the cycle suggests reduced ovarian reserve.
• Estradiol: a hormone from the developing follicle, interpreted alongside FSH.
• AMH: helps assess ovarian reserve and expected stimulation response. It does not show the exact number or quality of remaining eggs (more about AMH).
• Prolactin: when high, it may inhibit ovulation.
• Testosterone: excess male hormones are common in polycystic ovary syndrome (PCOS), one of the most common causes of irregular ovulation.
• TSH: abnormal thyroid function may make conception difficult, so it is best corrected before pregnancy.

Fertility depends on both partners. For men, doctors usually request semen analysis and measure hormones according to findings (more in the article on causes of male infertility).

The test and preparation

A venous blood sample is taken, taking only a few minutes. If you menstruate, come between days 2 and 5 of your cycle, most often day 2 or 3 (the first day of menstruation is day 1), unless your doctor specifies otherwise. If periods are absent, you can attend any day.

Have blood taken in the morning, at least two hours after waking, and rest for around 30 minutes beforehand because prolactin depends on time of day and stress. Because the panel includes testosterone, come fasting after 8 to 12 hours without food (water is allowed). State whether you use hormonal contraception or recently stopped it, because it alters FSH, LH and AMH. If you take biotin (e.g. hair and nail supplements), mention this at blood collection.

What your results mean

• High FSH or low AMH: ovarian reserve is reduced. This does not mean pregnancy is impossible but may affect treatment planning and timing.
• High AMH with raised LH or testosterone: often accompanies PCOS, in which ovulation is irregular.
• Raised prolactin: may disrupt ovulation. A doctor often repeats sampling, sometimes as serial prolactin testing (blood is taken three times over two hours while you rest), and investigates a cause, such as medicines or a pituitary change.
• Abnormal TSH: thyroid function needs checking and treatment, preferably before pregnancy.
• Normal hormones: a good sign, but other causes such as blocked fallopian tubes, endometriosis or problems in the partner are not excluded.

Reference values depend on cycle day and age and are printed on the report. A gynaecologist interprets results alongside ultrasound, your age and your partner’s findings.

How to arrange testing

You can come for blood collection without an appointment or referral at one of our branches throughout Croatia (listed on the Contactpage). Prices for all tests and panels are listed in the price list. If irregular cycles are accompanied by acne or excessive hair growth, a doctor may suggest the PCOS Panel.

Frequently asked questions

On which cycle day should fertility hormones be tested?

With regular cycles, between days 2 and 5, most often day 2 or 3, or as instructed by your doctor, because FSH, LH and estradiol can then be compared with cut-offs. AMH can be sampled any day, but in this panel it is taken with the other hormones.

Can I conceive with low AMH?

Yes. Low AMH suggests lower ovarian reserve; it does not mean poorer-quality eggs or that natural pregnancy is impossible. Age matters more for the chances, which a gynaecologist assesses.

Does my partner also need investigations?

Yes. Conception difficulties may originate in the man, woman or both, so couples are investigated together. The first step for men is usually semen analysis.

Can hormones be tested while I take contraception?

The result does not then show the underlying state because contraception suppresses pituitary hormones and lowers AMH. Agree with your gynaecologist when blood should be taken after stopping.