Protocol Overview

Reproductive Health Protocol: Fertility Hormones, Ovarian Reserve & Male Factor

Reproductive health is governed by a tightly coordinated hormonal network spanning the hypothalamus, pituitary, and gonads. In women, Anti-Müllerian Hormone (AMH) reflects ovarian reserve, while cycle-timed FSH and estradiol reveal how the ovaries respond to stimulation. Mid-luteal progesterone confirms ovulation — the single event that fertility depends on. In men, spermatogenesis requires sustained FSH drive and adequate testosterone, and semen analysis remains the foundational diagnostic test. For both sexes, thyroid function, prolactin, and insulin sensitivity play supporting but clinically important roles. Understanding these markers — and critically, when in the menstrual cycle to test them — transforms fertility from guesswork into a measurable, optimisable process.

📅Last updated: May 31, 2026•📚Evidence-informed content•🔬Editorial policy

Key Biomarkers

The biomarkers that define this protocol

AMH

Ovarian reserve marker; cycle-independent and the most stable fertility predictor.

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FSH

Day 3 baseline reveals ovarian response; elevated values suggest diminished reserve.

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LH

Triggers ovulation; elevated LH:FSH ratio is a classic PCOS indicator.

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Progesterone

Mid-luteal level confirms ovulation occurred in that cycle.

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Total Testosterone

Primary androgen for male fertility; elevated in women suggests PCOS.

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Prolactin

Elevated prolactin suppresses GnRH pulsatility, disrupting ovulation and spermatogenesis.

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Common Patterns

Patterns we see across real lab reports

Elevated Day 3 FSH with low AMH indicates diminished ovarian reserve.
LH:FSH ratio >2:1 with elevated androgens and anovulation suggests PCOS.
Low testosterone with elevated FSH and LH points to primary hypogonadism in men.
Elevated prolactin with amenorrhoea warrants pituitary imaging.
TSH above 2.5 mIU/L in fertility contexts may impair implantation and embryo quality.
Low progesterone on Day 21 indicates anovulation regardless of regular cycle length.

90-Day Protocol

What a 90-day protocol includes

Cycle-timed hormone panel: Day 3 FSH/LH/E2, any-day AMH, Day 21 progesterone.
Male partner evaluation in parallel: semen analysis plus hormonal panel.
Thyroid and prolactin screening for both partners.
Metabolic assessment (fasting insulin, HOMA-IR) if PCOS is suspected.
Age-stratified evaluation timeline: 12 months under 35, 6 months at 35-39, immediate at 40+.
Retest semen analysis after 2-3 months; retest female hormones per cycle timing.

Example Priorities

A preview of how we prioritize action

AMH

Critical

Current0.4 ng/mL

Target1.5-4.0 ng/mL

Day 3 FSH

Suboptimal

Current11.2 mIU/mL

Target3-10 mIU/mL

Day 21 Progesterone

Critical

Current1.8 ng/mL

Target>10 ng/mL

Medical

Refer to reproductive endocrinologist if AMH <1.0 ng/mL or FSH >12 mIU/mL.
Screen for PCOS using Rotterdam criteria when LH:FSH ratio is elevated with irregular cycles.
Evaluate male partner with semen analysis and hormonal panel concurrently.

Diet

Mediterranean-style diet supports ovulatory function and sperm quality.
Adequate protein and healthy fats support sex hormone synthesis.
Folate-rich foods (or supplementation with methylfolate) before conception.

Lifestyle

Maintain healthy BMI — both underweight and obesity impair fertility.
Limit alcohol to fewer than 7 units per week for both partners.
Men: avoid scrotal heat exposure (hot tubs, laptops on lap, tight clothing).

This is an illustrative preview, not medical advice.

Next Step

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FAQ

Frequently asked questions

When should I get fertility bloodwork done?

If under 35 and trying for 12 months without success, or after 6 months if 35-39, or immediately if 40+. However, pre-conception bloodwork (AMH, thyroid, vitamin D) is valuable at any age before trying. Day 3 hormones must be drawn on cycle days 2-5; Day 21 progesterone at 7 days post-ovulation.

Can I have normal fertility with low AMH?

Yes. AMH measures egg quantity, not quality. Women with low AMH can and do conceive naturally. However, low AMH means less time to work with — the window may be narrower, so evaluation should not be delayed.

Should my male partner be tested at the same time?

Absolutely. Male factor accounts for approximately 50% of infertility. The ASRM recommends simultaneous evaluation of both partners rather than sequential testing, which only delays diagnosis.

Why does thyroid matter for fertility?

Even mild thyroid dysfunction (subclinical hypothyroidism) can impair ovulation, reduce implantation rates, and increase miscarriage risk. The fertility-specific TSH target is <2.5 mIU/L, tighter than the standard lab range of 0.4-4.0 mIU/L.

Sources

References & Further Reading

Primary citations supporting Reproductive Health:

Our content is informed by peer-reviewed research, clinical guidelines, and authoritative health sources. Additional references include:

PubMed / MEDLINE — Peer-reviewed biomedical literature
UpToDate — Evidence-based clinical decision support
StatPearls / NCBI Bookshelf — Clinical reference summaries
Lab Tests Online (AACC) — Patient-focused lab test information

For specific citations or questions about our content, please contact us or review our editorial policy.

Reproductive Health Protocol: Fertility Hormones, Ovarian Reserve & Male Factor

📅Last updated: May 31, 2026•📚Evidence-informed content•🔬Editorial policy

Patterns we see across real lab reports

Elevated Day 3 FSH with low AMH indicates diminished ovarian reserve.

LH:FSH ratio >2:1 with elevated androgens and anovulation suggests PCOS.

Low testosterone with elevated FSH and LH points to primary hypogonadism in men.

Elevated prolactin with amenorrhoea warrants pituitary imaging.

TSH above 2.5 mIU/L in fertility contexts may impair implantation and embryo quality.

Low progesterone on Day 21 indicates anovulation regardless of regular cycle length.

What a 90-day protocol includes

Cycle-timed hormone panel: Day 3 FSH/LH/E2, any-day AMH, Day 21 progesterone.

Male partner evaluation in parallel: semen analysis plus hormonal panel.

Thyroid and prolactin screening for both partners.

Metabolic assessment (fasting insulin, HOMA-IR) if PCOS is suspected.

Age-stratified evaluation timeline: 12 months under 35, 6 months at 35-39, immediate at 40+.

Retest semen analysis after 2-3 months; retest female hormones per cycle timing.

A preview of how we prioritize action

AMH

Critical

Current0.4 ng/mL

Target1.5-4.0 ng/mL

Day 3 FSH

Suboptimal

Current11.2 mIU/mL

Target3-10 mIU/mL

Day 21 Progesterone

Critical

Current1.8 ng/mL

Target>10 ng/mL

Medical

Refer to reproductive endocrinologist if AMH <1.0 ng/mL or FSH >12 mIU/mL.
Screen for PCOS using Rotterdam criteria when LH:FSH ratio is elevated with irregular cycles.
Evaluate male partner with semen analysis and hormonal panel concurrently.

Diet

Mediterranean-style diet supports ovulatory function and sperm quality.
Adequate protein and healthy fats support sex hormone synthesis.
Folate-rich foods (or supplementation with methylfolate) before conception.

Lifestyle

Maintain healthy BMI — both underweight and obesity impair fertility.
Limit alcohol to fewer than 7 units per week for both partners.
Men: avoid scrotal heat exposure (hot tubs, laptops on lap, tight clothing).

This is an illustrative preview, not medical advice.

Frequently asked questions

When should I get fertility bloodwork done?

Can I have normal fertility with low AMH?

Should my male partner be tested at the same time?

Absolutely. Male factor accounts for approximately 50% of infertility. The ASRM recommends simultaneous evaluation of both partners rather than sequential testing, which only delays diagnosis.

Why does thyroid matter for fertility?

References & Further Reading

Primary citations supporting Reproductive Health:

Our content is informed by peer-reviewed research, clinical guidelines, and authoritative health sources. Additional references include:

PubMed / MEDLINE — Peer-reviewed biomedical literature

UpToDate — Evidence-based clinical decision support

StatPearls / NCBI Bookshelf — Clinical reference summaries

Lab Tests Online (AACC) — Patient-focused lab test information

For specific citations or questions about our content, please contact us or review our editorial policy.

Reproductive Health Protocol: Fertility Hormones, Ovarian Reserve & Male Factor

The biomarkers that define this protocol

AMH

FSH

LH

Progesterone

Total Testosterone

Prolactin

Patterns we see across real lab reports

What a 90-day protocol includes

A preview of how we prioritize action

AMH

Day 3 FSH

Day 21 Progesterone

Medical

Diet

Lifestyle

See your protocol in action

Explore related protocols

Hormones

Metabolic Health

Thyroid

Frequently asked questions

References & Further Reading

Reproductive Health Protocol: Fertility Hormones, Ovarian Reserve & Male Factor

The biomarkers that define this protocol

AMH

FSH

LH

Progesterone

Total Testosterone

Prolactin

Patterns we see across real lab reports

What a 90-day protocol includes

A preview of how we prioritize action

AMH

Day 3 FSH

Day 21 Progesterone

Medical

Diet

Lifestyle

See your protocol in action

Explore related protocols

Hormones

Metabolic Health

Thyroid

Frequently asked questions

References & Further Reading