[00:00:00] Testing, testing, one, two, three. Testing, testing, one, two, three. Oh, thought I was doing a mic test? No, no, no, no, no. Testing is the topic of today's installment of The Fertility Files. Thank you for returning for more of the files. When I first was drafting the outline for what I wanted to cover in The Fertility Files, I thought of testing in terms of getting blood tests done, getting health checks done, um, as part of your preconception care journey. Then when I went to record today, I was like, "Hang on. The thing that I really want to talk about, the thing that I keep seeing in fertility forums and trying to conceive forums, the thing that my friends keep asking me about is ovulation testing," and that's what I want to talk about first.

I will cover blood tests and stuff, but I want to talk about this first. So ovulation testing.

Something that comes up is, [00:01:00] "How do I know when I ovulate? My cycles are usually X amount, X days to X days long. Uh, my app tells me I ovulate on this day. When do you, when do you guys do your LH tests?" And I'm like, "Oh my God," that, ugh, ooh, ooh. Now, if you've listened to the cervical mucus episode, maybe you'll know some of my feelings about this already.

But LH tests, and if you don't know, these are also ovulation predictor kits that you can get from the chemist. These will be advertised and marketed as ovulation tests. Um, they're urine tests that measure a certain hormone in your body that you're outputting through your urine. And the problem, they can be quite tedious.

And in all the work I've done with women with getting them to start tracking their cycles, tracking their biomarkers, getting to understand their fertile window, and understanding their, their [00:02:00] bodies and their, their rhythm, the LH testing seems to be the layer that they are first to implement because they knew about it before working with me, because it's the thing that's kind of in the mainstream, and it's also the thing that leaves them most confused.

So my first beef is I have more beef, beef with the digital ones, but overall they can be confusing because essentially you can get a positive result, and if you read the instructions of a lot of these products, they'll say, "Yeah, when you get this positive result, that indicates that ovulation will happen, you know, within the next 12 to 24 hours."

The hormone that it's testing is called LH, luteinizing hormone, so we shorten it to LH. This hormone needs to be elevated above a certain point in order to trigger ovulation. But [00:03:00] that hormone can be raised beyond the threshold that these tests will pick up as a positive for other reasons.

The hormone can get high enough to trigger a positive test result without ovulation being guaranteed within 12 to 24 hours. Especially in the women I work with who have PCOS, PMOS, any degree of irregular cycles, LH can be more elevated as a general baseline. So generally, we'll see it on kind of like pulse on a daily basis, but then the closer you get to ovulation, it will have a really huge surge, and that's what these tests are designed to pick up on.

But they're not perfect, and your LH levels as a baseline may be high enough that you get all these positives, and you're like, "Okay, cool. I'm, I'm gonna ovulate. I'm gonna ovulate. I'm gonna ovulate." And then you're getting [00:04:00] all these positives at all different times in your cycle, and you're like, "Am I gonna ovulate?

Have I ovulated? What is going on?"

And there's specifically a handful of women that I'm working with at the moment who are tracking and charting their cycles, uh, because they are actively trying to conceive. They are ready to go. And there have been so many times where I've had to reassure them or s- kind of talk them down off a ledge in regards to their results that they're getting on these ovulation predictor kits, because it's driving them crazy, because they are not clear to interpret, um, especially with the history of irregular cycles, if you have that.

Um, but even, even on a great day, they can be really challenging to interpret. It is not clear when the best time to start testing is, so you can end up spending a lot of money ch- testing all cycle long. That is not the way to go about it.

You know how with pregnancy tests, [00:05:00] any line that you see next to the control line can indicate a positive result? With the, just the basic test strips for LH tests, it's kind of different in that you will always get a line appearing next to the control line, but what we're looking for is something that is specifically darker than the control line.

That indicates an LH surge that could predict ovulation, that could suggest that ovulation is impending, right? So that's already confusing, because, they are in the instructions, but it's not obvious to a lot of people who are using these tests. And so they're getting these kind of faint lines or lines that are similar to the control line or a bit lighter, and they're counting it as a positive.

Leaves them more confused when they don't ovulate or their cycle keeps going and going, and they're like, "Oh, I thought I ovulated. What happened?" The digital ones I kind of interpret as worse because [00:06:00] you don't get to see a line. You don't get to judge a line for yourself, and you don't get to compare it to a control line.

You just get a little screen, and you will get, I think, a solid smiley face or a flashing smiley face. And I have heard, I, I've never used those ones myself. I have used the non-digital ones. I have heard differing things from different clients about the exact same tests. I've been told that the flashing smiley means peak or that the solid smiley means peak.

And so there's confusion even, uh, among the different clients using the same tests, there is confusion. And I find the smiley faces harder to interpret. And again, I'm currently working with people who will be testing at all different times in their cycle, and they will be getting positives and negatives everywhere, totally outside of their fertile window.

So if this is what you are using as your first line tool for understanding when you [00:07:00] ovulate, I feel you are gonna be left in more confusion than in clarity. And when you are trying to conceive, when pregnancy is your goal, that is the last thing that you want, more confusion, less clarity, not ideal. If you really wanna make the most out of these tests, if you are happy to keep using them, maybe you already have some, there is a way to use them that is more efficient.

Now, to understand that, I'm gonna invite you to listen to the cervical mucus episode again because your cervical mucus and how that changes throughout your cycle, and specifically how that changes before ovulation, is going to be the indicator for you when to start testing your LH levels, when to start using these ovulation tests, right?

When you notice a change to your cervical mucus from your basic infertile pattern, using some techie words here again, [00:08:00] listen to, go back and listen to the cervical mucus episode. I went a bit more deep into cervical mucus. Does that make sense? No, I went into more depth about cervical mucus, um, inside my Cycle Power Bundle.

It's $27 for a bunch of resources, but lots there on fertility and cervical mucus if you would like to learn more. But essentially, you get your period, and then you have what we call your basic infertile pattern of mucus, fluid, discharge. As soon as that changes, as soon as you get any more mucus or any kind of more fertile mucus from that basic infertile pattern, that is when I would recommend you start testing LH.

Generally not first thing in the morning, like, not with your first urine of the day. But, you know, late morning, afternoon, and then again at nighttime, um, just because of how, h- the, the frequency that this hormone pulses at from the brain. Um, it, it can be good to test twice a day, but not too [00:09:00] close together.

Yeah, eight to 12 hours apart. And your cervical mucus is gonna guide that. So you're not just gonna be taking random stabs in the dark throughout your cycle going, "Oh, should I start testing now? Yeah, it's day 10, maybe I'll start testing."

You know, if you have cycles that are 32 days or longer or irregular, day 10 might be way too early, and you end up going through way, way too many tests than you need to. Um, and then that cuts into your preconception budget, which I don't want you doing. So cervical mucus, let that be your guide for when to start testing.

When you notice more fluid, more discharge. Even if you don't know any of the parameters about cervical fluid tracking, if you haven't done any of my trainings, or if we don't work together, or if you're just like, "Cervical fluid, what are you talking about?" Start testing the LH when you notice more discharge in your underwear, more discharge when you wipe, um, with toilet paper after going to the toilet, or when you just feel more wet down there.

Yes, [00:10:00] that is enough of an indicator. So that's LH testing. If you really, really wanna do it, that's how I would go about it, and I wouldn't invest too much of your money, energy, emotionality into the results of these tests, okay? They are, they're a bit tricky to navigate. Even, you know, I've been charting my cycles for 13 years, and probably twice a year I like to buy a pack of LH tests just to correlate it with, with what else I'm tracking in my cycle, my basal body temperatures and my cervical fluid, just to see what I get, and it's, it's not always clear.

It's not always clear.

And then moving on to the blood test. And, you know, this is a really big area, so I really hope to give you a great lay of the land, but not anything that's gonna go, just fly over your head or, you know, go way beyond into, like, weird specifics that we don't need to go into. Blood testing and [00:11:00] health checks in general are always gonna be on a case-by-case basis.

They should always be tailored to you, unique to your circumstances. We should be looking at specific tests based on any symptoms or specific history that you have. But if I'm being general, LH is one of the tests that you're gonna wanna test, so we are gonna want a basic hormone panel. LH, FSH. These are the hormones that come from your brain that, uh, have a huge influence on your ovaries and your menstrual cycle and the rest of your hormones, right?

There's a lot of different factors, but they give your ovaries one input of information that kind of dictates what your ovaries are gonna do. Um, These are best tested through the blood, and they are best tested on day two and three of your cycle, and again, uh, seven days after ovulation on the same cycle.

That's the most... This, I'm giving you the gold standard. I'm not tailoring this to you. This is just, if we're [00:12:00] being the most ideal, this is what we'll do. As for the rest of the hormones, your doctor, if you're getting a basic hormone panel, your doctor will probably put, um, estradiol, progesterone, um, maybe free testosterone as well, um, maybe DHEA.

Just some other, um, sex hormones and related hormones that can paint, uh, a bigger picture. Sometimes blood testing is not the best method of looking at these hormones. This is why my gold standard, my personal gold standard, is dried urine testing. Specifically in Australia, I use a test called the Endomap, um, endo being short for endocrine, so, like, your hormonal system in your body.

This Endomap is done over four urine samples taken across a day. You dry those samples. You send them back. You get a [00:13:00] really comprehensive panel of not just, like, your hormone lev- levels, not just, like, what your estrogen's doing, but all the metabolites of estrogen because that what, that's what goes out through your kidneys and in your urine, right?

So there is a lot we can test through urine, and it is very reliable and valid as far as your hormones go, and they can give a lot more information than just getting a blood test done So you get a blood test, and a blood test is very static. A blood test is very specific of, like, what were you doing on that exact day, at that exact time that the blood was taken?

Also, how was the blood taken? Was there any trauma to the surrounding tissue? Um, were you fasted? How fasted were you? Were you beyond 12 hours fasted? Um, did you exercise that day? Did you have sex that day? There are a l- so many [00:14:00] variables, um, that aren't always accounted for by the doctors or by the, um, pathologists, by the pathology lab, um, that can sort of, again, one, like, kind of like the LH testing, leave you in the dark as to what your results are actually saying.

So you just get these single nu- numbers that are snapshots in time, whereas with the Endomap, with the dried urine testing, you get your hormone results all throughout a day, and you get the metabolites of your hormones. So you can see how one hormone is being metabolized, and we know what pathway is used in the body for that metabolism to take place.

We know what organ that happens in. We know what tissues that happens in. It gives us so inf- so much information when we can see how a hormone, like your estrogen, is being metabolized down several pathways. There's, like, three major kinds of estrogen, and then they have all sorts of ... They have all these metabolites, right?

And each of those metabolites can give us [00:15:00] very specific insight into what's happening in your body. Same thing with progesterone. Progesterone is the hormone we want to be looking out for specifically after you ovulate, but we now know that you need sufficient, progesterone. You need, like, a little surge, um, before ovulation.

This is quite new information. We used to say that you only produce progesterone after ovulation, but there is a little peak before ovulation, and then you get the most progesterone after ovulation, right? Doing blood tests, you just get progesterone and a number, and they say, "Take it on day 21."

Because they're aiming for seven days after ovulation when progesterone should be at its peak, because that's what we want to see. Well, if you don't have a regular 28-day cycle, and even if you do, you might not be ovulating on day 14. That means seven days after ovulation would be day 21, which is when they're recommending you to get your blood tests.

So this is why body literacy, tracking your [00:16:00] own cycle is so important. Even if you are gonna go down the mainstream route of just getting your normal blood tests done, you want to know exactly what cycle day you were on and exactly where you were in relation to ovulation when you get those results.

Because you could get a hormone panel on any day of your cycle. If you don't know when you ovulated that cycle, there's not a lot that we can clearly interpret from any of those results, which is really, really unfortunate. Because for each phase of the cycle, each time in your cycle, before ovulation, after ovulation, there's different reference ranges for those hormones, right?

So actually, no matter which way you're going to go about it, because even with the dried urine Endomap testing, we do want to time that seven days after ovulation. But I got to say, even on their instructions, they're like, "If you're got irregular cycles, count your last cycle length and then count back this many days, and then do the test on that day."

And [00:17:00] even that, I don't recommend. Th- the, the body literacy, the tracking your own body really has to come first. And even with clients who haven't been super deep into the cycle tracking, I've just educated them a little bit about cervical mucus. Um, maybe they're keen to do the temperature charting as well, and we can see, yep, you probably ovulated around here.

Do the test seven days after that. And we get the clearest results, and then their period comes another week after they've done the test. And I'm like, "Yep, you ovulated two weeks ago. We got that timing perfect." And it's really satisfying. Anyway, that's a rambly rabbit hole that maybe you don't need to know about, and I said I wasn't going to go over your head, and here I am going over your head with stuff.

So I just want you to know that to not place heaps and heaps and heaps of weight on your hormone results if it's just a blood draw taken at one time in your cycle, especially if you don't know when you ovulated that cycle. If you'd like to learn more about Endomap testing that I'm talking about, this [00:18:00]really rich, comprehensive picture we get of all your hormones, your cortisol pattern throughout the day, your melatonin pattern throughout the day, all your sex hormones, all your testosterones and androgens, um, and some, e- even some extra markers that sort of paint a richer picture about, um, how your hormones are working in your body, how inflammation is working in your body, uh, let me know.

Just send me an email, send me a message on Instagram saying, "Hey, what was that hormone testing you were talking about?" I will tell you all about it. So that's hormones aside. And then we want to make sure that you're getting a really rich annual blood check. But like with everything, right?

We want the full blood exam looking at your red blood cells, your white blood cells. So they're your immune cells. We wanna see liver function tests. We wanna see a full cholesterol panel. We want to see urea and electrolytes, so what's moving through your kidneys. We want to see, thyroid function.

Ideally not just TSH. Ideally, we want to see what T3 is doing, T4 is doing, your [00:19:00] actual thyroid hormones. We want to see nutritional panels are really, really important. Full iron studies, B12, active B12, folate.

Vitamin D. Vitamin D is a big one. Um, I'm gonna be more interested in your sun exposure than I am gonna be interested in your vitamin D result. As in, I'm not just gonna prescribe vitamin D if your vitamin D is low. Uh, sunlight plays such an important role in so many processes, and is really the best, the best way that we get our vitamin D up.

And then of course, and again, if you're going through the mainstream route, they're gonna do generally an STI check. They're gonna look for the hepatitises. They might do your blood type to see if you've got, um, positive or negative, uh, Rhesus factor. Rhesus factor?

The thing that kind of determines if your blood type is like a positive or a negative. And if your partner has a different blood type, and then your baby could have a blood [00:20:00] type that you don't have, and then they just need to be aware of that.

And sometimes they check viral, uh, presence of viruses as well, just to sort of see if you have been immunized in the past, like how that's sitting now, but also just to see if you have had viruses in the past because some, some viruses can have an impact on your fertility and reproductive system, and could play a role in your conception journey

Beyond this, so that's kind of like the mainstream. If I'm taking it a step further, now they could also- you could also get your AMH tested. This is anti-Müllerian hormone, and this is generally, what they call, like, your egg reserve.

I'm also gonna encourage you to really not place too much weight on this, because there is so much nuance with AMH. AMH is highly variable. You can get very different results in a very short period of time. We absolutely can [00:21:00] get some information from it, but it is not the be all and end all if it's low or if it's too high.

It's, it's another layer of information, but I feel like more weight gets placed on this than I think should be placed on. And then going beyond that, and now especially if you do have a history of recurrent miscarriage or early miscarriage, some genetic testing can be really important to get done.

There's a few different ones we can look at. The one I'm gonna bring to your attention is, uh, called, it's long acronym, MTHFR.

Some of the population, in fact, a large amount of the population does have a, mutation of this gene. Essentially, this gene impacts how your DNA is taken care of, and looked after, and protected in your body.

This gene can play a huge role in really important detoxification processes in your body that [00:22:00] require a lot of nutrients, that ends up impacting, like, every system of your body. I do find that a lot of early or recurrent miscarriages can have an association with this gene mutation. And having this gene mutation kind of changes your need for specific nutrients generally.

And there are some really clear prescriptions based on your symptoms, based on your gene test results, and based on blood test results. We can have some really clear indications of you need this nutrient in this amount, in this specific form. And we've got some really great, um, nutritional tools that we can use that can really support your body.

I know that's a bit, like, heavy or confusing, but I just want you to know that that exists. And I want you to know that that has a huge role, that MTHFR enzyme plays a huge role in how your body metabolizes [00:23:00] folate or folic acid. Folic acid is a s- synthetic form. Our body can have a lot of issues processing the synthetic form.

But it's also the form that is in most prenatals that you get off the shelf. Things can get complicated. I don't want you to be fearful about anything. But I just want you to know that there's some layers there. This trying to conceive shit is not as simple as anyone made it out to be when we were teenagers, hey?

Anyway, I will talk about prenatal supplements in a different episode. The other thing I want you to be aware of, so you've got your, your urine testing for hormones. You've got your blood testing for nutrients and hormones and all the markers in your body, looking at your blood cells and all that. And then you've got ge- genetic testing, which is usually, can be a blood test, can be a saliva test.

Then we've also got other factors that are really important to test when it comes to preconception, again, especially if you [00:24:00] have a complex history or if you have any history of chemical pregnancy, recurrent miscarriage, early miscarriage. Your vaginal microbiome. Let's, and let's pause there. Your vaginal microbiome.

There is a whole ecosystem on your vulva, in your vagina, in your cervix, in your uterus that creates the immune system of that part of your body. And your immune system in your uterus, in your vagina, is really pivotal to how sperm will be received, how they'll be accepted if they happen to find themselves in your reproductive tract, but also how a fertilized egg will be received by your body.

If you have any kind of vulvovaginal symptom, history of recurring thrush, [00:25:00] bacterial vaginosis, vaginitis, any STIs that have affected the tissues of your vulva, vagina, really, really, really important to be aware of because that can play a role in not getting pregnant as quickly as you'd like.

Um, again, early pregnancy loss. And it's not usually, it's not the first place that any doctor or fertility specialist that I've worked with will look. But it can be really, really useful to look there, and there is some very specialized comprehensive testing that we can get done, uh, that will assess our vaginal microbiome.

That tells us a lot about the ecosystem, if anything is lacking, if anything is in excess, and it can sp- it, it can explain a lot in terms of our conception journey if we've been having some troubles. Similarly, much more complexly, but similarly, [00:26:00] semen has its own microbiome. This is a very new area, and I'm not gonna go further than that.

I just want you to know that there is a whole ecosystem of bacteria and all sorts of tiny microscopic guys that can make or break the quality of semen. The testing is in its very, very early days. But something that does exist is semen testing. So I've spoken all about you and, like, what you can get checked in your female body, but what can your male partner get checked?

Well, they can have all the same hormones checked. They can have all the same blood tests that I described checked because that's gonna be influencing their sperm production and their hormonal health as well, and their overall health. And if you've listened to the first episode, you'll know how I see fertility as health.

So semen, semen analysis. And my God, there's, there's caveats here. There's caveats here because if the [00:27:00] semen is analyzed too long after ejaculation occurred, the reference ranges are gonna be totally off. The interpretation is gonna be totally skewed. It also depends on the pathology lab that is interpreting, that is analyzing the, uh, ejaculate sample.

There's good and there's bad. And you won't just want to go to any clinic to get this done. You'll want to go to a specialized andrology clinic to do the best quality interpretation of semen. You can get two really different samples in a short period of time, uh, of semen. There is so much... There's, there's so much nuance.

And so it's not just like looking at the semen is good enough. Oh yeah, he's got enough there. No, no, no, no, no, no, no. The number doesn't tell us about the quality of the DNA in that semen. Which, so I should be saying sperm cell. It's not determining the quality of DNA in those sperm [00:28:00] cells, right? And the DNA in the sperm cell is what is going to ter- determine the quality of your pregnancy, your maternal health throughout the pregnancy, as well as half the DNA of the baby, right?

And it's gonna determine your placenta, because it's the DNA instructions in the sperm cell that produce the placenta. This is really new up-and-coming information. It's really exciting. It's also really broad, and so there's lots to cover. So do consider semen testing, but just know that there's nuance, and really, really consider going to a fertility, holistic health specialist, going to a fertility-focused naturopath or Chinese medicine practitioner or nutritionist.

Just someone who has experience looking at these semen results through a nuanced holistic health lens. No diagnosis should be made from [00:29:00] one set of blood test results, one set of hormone results, one set of semen results. There always has to be a second assessment done on a second set of results, okay? So no diagnostics from one test.

I want you to keep that in mind if any doctor is trying to tell you something is this way because of one single test result, unless it's a genetic test, right? Or unless it's, like, a very, a clear positive or negative result, like, you know, if they're doing the Hep B check or doing the viral checks.

So remember, it does take two to tango. If you're getting preconception testing done, your partner should be getting preconception testing one, it done as well. It really does take two to tango. Semen analysis and microbiome assessments are things to consider, especially if you've been trying for maybe th- three to six months and there hasn't been success, or there's been early pregnancy loss, or one or both of you has a complicated health history where there might be some factors that could be acting [00:30:00] as obstacles that might need a little bit more support to get cleared to make it easier for you to conceive successfully.

Remember that there's blood, but blood does not tell the whole picture. Remember that there are dried hormone testing for your hormones that can tell us a lot more about what your whole endocrine system is doing, which can be so clarifying, especially if you've been trying for six months or longer, and maybe you've had cycle issues in the past.

Maybe you've been on the pill for a long time before trying. Maybe you've got PMOS or PCOS. Maybe you've got endometriosis. It will be so clarifying, and sort of going through the blood test route and being like, "Oh, yeah, your bloods look normal enough," or maybe this thing is out. It can take longer than needs to.

It can be more confusing than needs to. It's a really high-quality investment. Feel free to ask me if you have more questions about that. And genetic testing, remember that there's a layer of genetic testing, and again, some practitioners [00:31:00] might recommend this straight off the bat. Again, I would want to look at your unique health history before I'm saying, "Yes, please invest in this genetic testing," or try, let's give ourselves a timeline of three months, and if there's no luck, maybe we do the genetic testing then.

And even then, that timeline, that is just a broad, generalized timeline. It will be so specific to your situation, your goals, your personal timeline, and also your personal health history. So have I made things more confusing? Testing can be great, but just remember it's not the be-all and end-all, and remember that there will always be nuance.

I think the thing I want you to take home from this the most is to not place too much weight on any single test, and especially, especially those very well-marketed mainstream ovulation predictor kits or LH tests. Don't place too much weight on them. I would much rather you [00:32:00] invest time in learning about your body, in taking your basal body temperatures every day, in tracking your cervical fluid, rather than investing too much money in these tests that can be more confusing than not.

So get that baseline of reading your body first before adding in these more complex and more nuanced layers of test results. That can take a whole other set of skills to interpret with confidence. If you have any questions about anything I have brought up in this episode, you can email me any questions that you have.

And if you are trying to conceive or you are thinking about trying to conceive, and you would rather have more information sooner rather than later, if you would rather understand what's happening in your body, what your hormones are doing sooner rather than later, book in for a free fertility clarity call, okay?

We'll go through your history. We'll go through what your body's saying to us, what [00:33:00] issues, what obstacles that may be on the road in your fertility journey, and ways that we can support your body to get through those obstacles. Things that your body might be asking for that would obliterate those obstacles.

And just, just to get started on understanding your body sooner, right? That, that can be the thing that makes the biggest difference in your conception journey.

So to learn more, please book in for your free fertility clarity call. I would love to meet you, and I can't wait to help you make babies. Until the next installment of The Fertility Files, take care, and I'll catch you next time.