Fertility Testing: More than Just Ovulation Tests

Written by: Dr. Amy Beckley, PhD, Founder and Inventor of the Proov test the first and only FDA-cleared test to confirm ovulation quality at home.

Written on: 2/7/22

Studies show that 85% of couples will conceive in 1 year if they have frequent intercourse. But some couples will need a little extra help when it comes to getting pregnant, and others are just excited to do all they can to speed the process along.

Luckily, the world of fertility testing offers plenty of tools to help you reach your goals faster. Regardless of how long you’ve been trying, there’s probably something interesting and useful you can learn through fertility testing.

It used to be that most fertility testing happened in a doctor’s office. While your doctor is a great resource, today it’s easy to get tons of valuable information independently by testing at home. At-home fertility testing options are convenient and non-invasive, and often cost less than the price of a doctor’s visit.

Plus, testing at home provides you with useful data you can share with your doctor down the road, if you determine that an office visit is needed.

Let’s get started!

fertility testing: more than just ovulation tests

Fertility testing at home provides you with useful data you can share with your doctor down the road.

SO WHAT IS FERTILITY TESTING?

If you’re researching this topic, you probably already noticed that the language out there can be pretty confusing. It’s common for different doctors and companies to have their own definitions of the term “fertility test,” and to use that term interchangeably with lots of other names that refer to specific fertility hormones or biological processes (“ovulation test,” we’re looking at you). That’s why diving just a bit deeper with your understanding of cycle hormones and their role in fertility can be so helpful. 

At Proov, we offer a comprehensive range of fertility and ovulation testing products that allow you to understand your hormones with inexpensive, non-invasive tests. All you need is your urine sample (and his sperm, if your partner is male). We know the body is complex, but understanding it doesn’t have to be! And we’re here to help.

Below, we’ve identified 4 key cycle hormones that influence fertility, what each can tell you, and how to test them easily at home.

LH TESTING TO PREDICT OVULATION

LH tests, which measure luteinizing hormone, are the most common at-home fertility hormone test available. They’ve been around for a long time, and — confusingly! — go by many different names. You might see them referred to as “Ovulation Tests,” “Ovulation Predictor Kits (OPKs),” or even just “Fertility Tests.”

These tests are super helpful on any trying to conceive (TTC) journey, but it’s also important to know that they only provide one small piece of the fertility puzzle. Specifically, LH tests reveal the timing for when ovulation is likely to occur (your 2 most fertile days or “peak fertility”).

Here’s how it works: LH tests track hormone levels to detect your body’s LH surge each cycle. According to studies, this hormonal surge typically precedes ovulation by 12-36 hours. So if you know your LH is surging, you know ovulation can’t be far away. And this is critical for accurately timing intercourse for your best chance at getting pregnant.

LH tests, like 99% accurate Proov Predict, can help you identify your 2 most fertile days each cycle with an easy pee test you do in the comfort of your own bathroom.

When thinking about your fertility testing approach, it’s important to keep in mind that LH tests only predict the timing for expected ovulation — they don’t confirm that ovulation actually occurred. This fact is widely misunderstood, thanks to all the confusing names out there, but it can make a big difference on your TTC journey.

PROGESTERONE & PDG TESTING TO CONFIRM OVULATION AND OVULATION QUALITY

Measuring progesterone in the second half of your cycle is the key to confirming that ovulation actually occurred, and understanding the quality of that ovulation. (High-quality ovulation means a higher chance of successful conception and pregnancy!)

Progesterone’s job is to prepare the uterus for pregnancy by making the uterine lining “sticky” enough so a fertilized egg can comfortably implant. In a healthy cycle, progesterone rises during the second half of the cycle to set this process in motion, and remains elevated for several days to support implantation. Specifically, progesterone levels need to remain elevated for the entire implantation window, which occurs on days 7-10 past peak fertility. We call this hormone pattern a signal of “high-quality ovulation.”

Getting insight into the second half of your cycle used to require a progesterone blood test at the doctor’s office. Now, with FDA cleared Proov Confirm PdG tests, you can understand your levels easily at home and gain even more insight into ovulation quality.

Here’s the difference: a lab blood draw measures progesterone directly in the blood, but it only captures one moment in time. Since studies show it’s normal for progesterone levels to vary pretty widely through the day, and from one day to the next, the information you can get from a single blood draw is limited.

In contrast, the Proov at-home pee test protocol measures PdG, a marker of progesterone that shows up in urine, over a 4-day window. Your PdG test result reflects an “average” of progesterone blood levels from the prior day, and by looking at multiple days throughout the implantation window, it reveals the pattern of elevated levels that is all-important to confirm ovulation and ovulation quality.

Proov Confirm is the first and only FDA cleared PdG test to confirm high quality ovulation at home. When used with LH tests to predict ovulation, PdG tests give you a much more complete picture of exactly what’s going on with your ovulation each cycle. Our Predict & Confirm kit is a convenient and economical way to pick up both tests at once!



Proov Confirm is the first and only FDA cleared PdG test to confirm high quality ovulation at home.

FSH TESTING TO UNDERSTAND OVARIAN RESERVE

FSH tests measure follicle stimulating hormone, and they’re all about understanding how many eggs you have on hand (known as “ovarian reserve”). You’re born with all the eggs you’ll ever have and, as you ovulate throughout your life, your ovarian reserve slowly decreases over time.

FSH’s job is to stimulate the ovaries to prep eggs for ovulation. The hormone rises at the beginning of every cycle to set this process in motion. When you have many eggs left, only a small amount of FSH is needed to stimulate the ovaries.

As your ovarian reserve decreases, the ovaries have a harder time recruiting an egg for ovulation each cycle. This challenge signals the brain to send more FSH to the ovary to give it some extra help. That’s why when it comes to FSH testing, higher hormone levels equate to lower ovarian reserve. (It’s a little confusing, but stick with us!) Elevated FSH levels at the beginning of the cycle indicate your ovaries are working overtime to prepare an egg, so you may have a lower ovarian reserve.

You can test FSH levels with at-home, urine-based hormone tests like Proov Reserve. While studies show that elevated FSH levels do not directly impact the ability to conceive naturally, they can impact your chances if you’re pursuing assisted reproductive technology. Additionally, less eggs left may indicate less time to get pregnant. Understanding ovarian reserve is just one more helpful piece of the fertility puzzle.

ESTROGEN TESTING FOR THE LONGEST FERTILE WINDOW

Understanding estrogen levels can provide all kinds of useful information when you’re trying to conceive. First and foremost, testing estrogen can reveal the earliest possible opening of your fertile window, giving you even more insight about the best time to “try.”

Estrogen rises early in the cycle to help thicken the uterine lining. This rise happens even earlier than the LH surge measured by standard ovulation predictor kits. A rise in estrogen is your body’s very first signal that it might be time to get busy!

Estrogen can’t be measured directly in urine, but pee tests can accurately measure E1G, a marker of estrogen that correlates to blood levels. Our Proov Complete testing system measures both E1G to identify up to 6 fertile days, and LH to identify your 2 most fertile days.

Estrogen levels are also helpful in detecting possible hormone imbalances, such as estrogen dominance, a condition that may impact chances at conception. Estrogen dominance occurs when estrogen levels during the first half of the cycle are elevated in comparison to progesterone levels during the second half of the cycle.

Especially in those with polycystic ovarian syndrome (PCOS), estrogen dominance can be a sign or cause of anovulatory cycles, i.e. a cycle in which ovulation does not occur. Without an egg, pregnancy just isn’t possible.

Lastly, studies show that elevated levels of estrogen may falsely suppress FSH levels. This could hide the signs of diminished ovarian reserve, further complicating the fertility picture.

WHAT SHOULD I DO WITH MY FERTILITY TESTING INFORMATION?

The more information you have about your fertility hormones, the more empowered you can be to get pregnant faster.

We believe the more information you have about your fertility hormones, the more empowered you can be to get pregnant faster. Our tests work with the Proov Insight app, which helps you understand your results and provides action steps to reach your goals — it’s like a fertility coach in your pocket!

If your testing results indicate hormone levels that are out of the expected range, there’s no need to panic. The fact is every body is different and there can be a lot of variation in what “normal” looks like. It’s common for it to take some time to get pregnant, and we recommend testing for multiple cycles to gather the information you need to be set up for success.

And if there is an issue, often the fix is simple. Basics like healthy lifestyle choices and natural supplements can be a good place to start!

Additionally, we always recommend bringing your at-home testing data to your doctor. Together, you can develop the best plan for you based on your unique results, situation, and medical history. A doctor can also run additional tests and prescribe medications if needed.

WHAT ARE SOME OTHER FERTILITY TESTING OPTIONS?

At Proov, we’re focused on the 4 key cycle hormones — but there’s more to the world of fertility testing. Here are a few more testing options you can consider:

Sperm testing: It takes two to tango! Get his swimmers checked so you know that they have the best possible chance at fertilizing the egg. 

Anti-mullerian hormone (AMH) test:AMH is another marker of ovarian reserve. Your doctor can perform this test. 

Thyroid-stimulating hormone (TSH): TSH stimulates the thyroid gland to make reproductive hormones. Imbalances in TSH can cause imbalances in reproductive hormones.

Testosterone: While women should only have low levels of testosterone, some experience elevated levels (such as those with PCOS), which can interfere with fertility.

Dehydroepiandrosterone (DHEA): DHEA is a hormone that helps produce other hormones. Elevated DHEA can be a sign of PCOS or cause increased levels of testosterone.

Prolactin: Prolactin increases during breastfeeding. Elevated prolactin can inhibit ovulation. 

Vitamin D: Studiesshow that high levels of vitamin D are associated with higher pregnancy rates.

Comprehensive fertility testing can set you up for success on your trying to conceive journey!

FAQ

Is fertility testing the same as ovulation testing?

Not quite — “fertility testing” can refer to a whole range of tests that provide helpful insight when you’re trying to conceive. “Ovulation testing” usually refers only to LH tests. Accurate ovulation (LH) tests help you time intercourse by indicating when ovulation is likely to take place. While LH tests are extremely useful, they only reveal one piece of the fertility puzzle.

When is the right time to begin fertility testing?

Taking advantage of convenient at-home fertility hormone tests is very common, even for couples who’ve only just started trying. But only you can know if and when fertility testing should be part of your personal TTC journey. At Proov, we believe it’s never too early to begin testing your main cycle hormones to get more in tune with your hormone patterns. Having a clear picture of what’s going on with your cycle can help with timing intercourse, understanding ovulation quality, understanding how many eggs you have on hand, and more.

What hormones are part of fertility testing?

The 4 key hormones we recommend testing are follicle stimulating hormone (FSH), estrogen (or its urine marker, E1G), luteinizing hormone (LH), and progesterone (or its urine marker, PdG).

How do ovulation tests work?

Ovulation test strips measure luteinizing hormone (LH) levels in urine to identify your 2 most fertile days each cycle, so you know exactly when to “try.” Accurate ovulation tests are the most common fertility hormone test on the market.

Do ovulation tests confirm ovulation?

No, ovulation tests do not confirm ovulation. If you’d like to confirm ovulation, you’ll need a PdG test instead.

What are other fertility tests I can consider?

If you’re looking for more information or have done the main fertility tests and still aren’t conceiving after 12 months, you may want to consider additional testing. Here are some options to discuss with your doctor:

Sperm testing

Anti-mullerian hormone (AMH) test

Thyroid-stimulating hormone (TSH)

TestosteroneDehydroepiandrosterone (DHEA)

Prolactin 

Vitamin D

If you’re looking for more information or have done the main fertility tests and still aren’t conceiving after 12 months, you may want to consider additional testing.