Fertility -- Women

This marker sits in Sense -- signals being produced, detected and acted on.

A hormone secreted by small growing ovarian follicles, used as a proxy for how many eggs remain (ovarian reserve/quantity). It does **not** measure egg quality, and it is a poor predictor of natural per-cycle fertility in women without other risk factors -- its main clinical use is guiding IVF stimulation dosing.

Typical range: Highly age-dependent with no single universal "normal" number; rough lab bands (assay-dependent): >3.0 ng/mL runs high (sometimes PCOS-associated), 1.0-3.0 ng/mL "normal," 0.5-1.0 ng/mL "low-normal," <0.5 ng/mL "low." No legitimate functional-optimal target exists -- AMH is expected to decline with age, and that decline is normal, not a deficiency to correct.

Food first: Nothing reliably raises the number itself. General preconception nutrition -- vitamin D sufficiency, adequate antioxidant intake, healthy body weight, not smoking -- supports overall egg quality even though the AMH number won't change.

When to see someone: Be skeptical of any product marketed to "boost AMH" or "reverse ovarian aging" -- this is not supported by reproductive endocrinology evidence. DHEA is a real hormone with androgenic side effects (acne, hair growth/loss, mood changes, voice changes at high doses) and should only be used under a reproductive endocrinologist's supervision, especially given the large null trial above.

Pituitary gonadotropins -- FSH drives follicle development, LH triggers ovulation and supports corpus luteum function. Day 2-4 FSH was historically used as an ovarian-reserve screen; it has largely been superseded by AMH and antral follicle count because it's less sensitive and more cycle-variable.

Typical range: Conventional: day 2-4 FSH <10 mIU/mL is reassuring, >10-15 mIU/mL suggests diminished reserve (assay-dependent); LH runs similarly in the early follicular phase. An LH:FSH ratio >2-3:1 is sometimes invoked as PCOS-suggestive in older literature, but it is **not** part of the current Rotterdam diagnostic criteria for PCOS and shouldn't be over-weighted.

Food first: For anyone with signs of hypothalamic amenorrhea (low LH/FSH, absent or irregular periods, low body fat, high exercise volume), the fix is adequate total energy and carbohydrate intake -- not a supplement. There is no dietary way to lower a truly elevated FSH that reflects diminished ovarian reserve.

When to see someone: Don't chase an elevated FSH with supplements. A low LH/FSH picture with amenorrhea needs a full medical and nutritional workup -- it can reflect serious chronic under-fueling (relative energy deficiency in sport) that carries its own bone-health and cardiovascular risks beyond fertility.

The primary circulating estrogen, produced by the developing ovarian follicle; rises through the follicular phase, peaks just before ovulation, and supports endometrial lining development.

Typical range: Highly cycle-day dependent (approximate, assay-dependent): early follicular ~20-75 pg/mL, periovulatory peak ~150-750 pg/mL, luteal ~30-450 pg/mL; postmenopausal <20 pg/mL. No single "optimal" number applies outside a specific cycle-day context.

Food first: A Mediterranean-style dietary pattern, adequate healthy fat intake, and a healthy body-fat range support normal estradiol physiology better than any single nutrient.

When to see someone: A single estradiol value only means something in the context of the specific cycle day it was drawn -- don't over-interpret one number without that context.

Produced by the corpus luteum after ovulation; sustains the endometrial lining and early pregnancy. A mid-luteal draw is used mainly to confirm that ovulation occurred.

Typical range: Conventional: >3 ng/mL is generally used to confirm ovulation occurred; many clinicians prefer >10 ng/mL as more robust evidence of adequate luteal function. Functional-medicine opinion sometimes cites >15 ng/mL as an ideal target -- not an established consensus cutoff.

Food first: General reproductive health support -- healthy body weight, adequate energy intake -- rather than a specific "progesterone food." Vitex is popular but shouldn't be relied on as a proven progesterone booster.

When to see someone: Low luteal progesterone with recurrent pregnancy loss or confirmed luteal phase defect is a medical management question (progesterone supplementation is a real, evidence-based treatment in specific contexts) -- don't substitute herbs for that conversation with a reproductive endocrinologist.

A pituitary hormone whose primary role is lactation; mild elevation can suppress GnRH pulsatility and ovulation, while marked elevation suggests a prolactinoma or a medication side effect.

Typical range: Conventional: roughly 4-23 ng/mL in nonpregnant, non-lactating women (assay-dependent); mild, transient elevations are common with stress, recent breast stimulation/exam, or sleep.

Food first: Stress management and adequate sleep are reasonable general support; food does not reliably move a truly elevated prolactin level.

When to see someone: A significantly elevated prolactin needs medical workup (including pituitary imaging if very high) -- don't rely on herbal approaches to manage what could be a prolactinoma or medication effect.

This marker sits in Sense -- signals being produced, detected and acted on.

Testosterone is physiologically important in women too, at much lower levels than in men; elevated levels (often with low SHBG) are a hallmark of PCOS-related hyperandrogenism.

Typical range: Conventional: total testosterone roughly 15-70 ng/dL, free testosterone roughly 0.1-6.4 pg/mL (both highly assay-dependent -- standard immunoassays are notoriously imprecise at the low female range; mass spectrometry-based assays are more reliable).

Food first: For PCOS-driven elevation, weight management and a lower-glycemic-load dietary pattern (improving insulin sensitivity, since insulin resistance drives ovarian androgen production) are the most evidence-backed levers -- see the Fasting Insulin/HOMA-IR section below.

When to see someone: Elevated testosterone accompanied by rapidly progressive virilizing signs (fast hair growth, voice deepening, clitoromegaly) needs prompt medical evaluation to rule out an androgen-secreting tumor -- don't assume "it's just PCOS" without that workup.

An adrenal androgen precursor hormone that declines steadily with age; also frequently elevated as part of the PCOS hyperandrogenic picture.

Typical range: Highly age-dependent, roughly 35-430 mcg/dL in adult women, declining through the 30s-60s; no consensus "optimal" replacement target outside diagnosed adrenal insufficiency.

Food first: General metabolic health (healthy weight, exercise, stress management, sleep) is reasonable, but nothing reliably restores a lower DHEA-S to a younger baseline.

When to see someone: DHEA is sold over-the-counter in the US and has real androgenic effects. Given the null 821-woman RCT above, and the fact that many women being told to take it for fertility already have some degree of PCOS-related androgen excess, it should only be used under reproductive-endocrinology guidance, not self-prescribed.

This marker sits in Sense -- signals being produced, detected and acted on.

A liver-made protein that binds testosterone and estradiol, controlling how much circulates "free" and biologically active; low SHBG is common in PCOS and insulin resistance and raises free androgen exposure.

Typical range: Conventional: roughly 20-130 nmol/L in women, highly lab- and assay-dependent.

Food first: Weight management and a lower-glycemic dietary pattern for insulin-resistant women; treat boron/DIM supplement marketing claims skeptically.

When to see someone: Same caution as above -- don't rely on boron or DIM supplements to meaningfully change SHBG or symptoms.

This marker sits in Sense -- signals being produced, detected and acted on.

Pituitary signal to the thyroid; central to preconception and pregnancy screening because maternal thyroid hormone drives early fetal brain development before the fetal thyroid becomes functional (~week 12).

Typical range: Conventional nonpregnant upper limit is roughly 4.0-4.5 mIU/L (or 4.12 mIU/L using the reference population in the 2024 ASRM guideline). Older functional-medicine guidance and the 2011 ATA pregnancy guideline popularized a stricter <2.5 mIU/L preconception target. **Important honest update:** ASRM's 2024 practice guideline (Fertil Steril 2024;121:765-82), after a fresh systematic review that explicitly screened out lower-quality and data-integrity-flagged studies, concluded there is moderate evidence that **TSH levels between 2.5 and 4.0 mIU/L are NOT associated with increased miscarriage risk**, and found only weak evidence that subclinical hypothyroidism is associated with infertility at all. Universal preconception TSH screening is not recommended; the guideline reserves screening for higher-risk patients (autoimmune disease, thyroid symptoms, personal/family thyroid history, prior thyroid surgery/radiation). This directly contradicts the popular "get your TSH under 2.5 before trying to conceive" advice still common in functional-medicine circles. (cite: ASRM Practice Committee, Fertility and Sterility, 2024, subclinical hypothyroidism in the infertile female population guideline)

Food first: Adequate iodine without megadosing; selenium sufficiency, particularly if autoimmune thyroiditis (elevated TPO/Tg antibodies) is present.

When to see someone: The "under 2.5" TSH target came from older guidance and is not an agreed treatment threshold -- chasing it with high-dose iodine can worsen autoimmune thyroid disease specifically. The band is the target, not the floor.

HOMA-IR = (fasting glucose mg/dL x fasting insulin uIU/mL) / 405, a calculated estimate of insulin resistance. Insulin resistance and compensatory hyperinsulinemia drive ovarian androgen production in a large subset (not all) of PCOS patients.

Typical range: No single universal HOMA-IR cutoff exists -- research studies commonly use thresholds ranging from 1.67 to 2.5+ depending on the population studied. Fasting insulin: <10 uIU/mL is often called "normal" on a standard lab report; functional-medicine opinion favors <5-7 uIU/mL, which is not a consensus clinical cutoff.

Food first: A lower-glycemic-load eating pattern, adequate fiber and protein, regular physical activity (resistance training especially improves insulin sensitivity), and weight management if BMI is elevated remain more consistently evidence-backed than any single supplement -- metformin is the best-studied pharmaceutical comparator in this space.

When to see someone: Inositol is generally well tolerated, but anyone combining it with metformin or other glucose-lowering medication should loop in their clinician. NAC can cause GI upset at higher doses. None of these supplements substitute for an actual PCOS diagnostic workup (androgen levels, pelvic ultrasound, glucose tolerance testing) or ruling out other causes of anovulation.

This marker sits in Exchange -- moving iron across boundaries and handing it between carriers.

Reflects iron stores (though it also rises with inflammation, so it isn't iron-specific in isolation); relevant to fertility both through anemia's effect on energy/ovulation and through iron's cofactor role in cellular metabolism.

Typical range: Conventional: roughly 15-150 ng/mL in women (lab-dependent). Functional-medicine opinion often cites 50-100 ng/mL as a better fatigue/functional target than the low end of "normal" -- not an official diagnostic threshold.

Food first: Heme iron sources (red meat, poultry, fish) are more bioavailable than plant iron; pair plant iron with vitamin C-rich foods; avoid pairing iron-rich meals with coffee, tea, or calcium supplements, which block absorption.

When to see someone: Confirm it before correcting it. Iron overload causes real organ damage, and ferritin doubles as an inflammatory marker, so a "normal" number can hide a deficiency -- interpret it with iron saturation and CRP rather than in isolation.

This marker sits in Build -- the raw material for making and renewing structure.

Homocysteine is an amino acid byproduct that rises when B-vitamin-dependent "remethylation" back to methionine is inadequate; elevated homocysteine is associated with cardiovascular risk and, observationally, with recurrent pregnancy loss.

Typical range: Conventional: roughly 4-15 micromol/L (lab-dependent); functional-medicine opinion favors <7-8 micromol/L, tighter than the standard upper limit.

Food first: Leafy greens and legumes (folate), animal products/fortified foods (B12), poultry/fish/potatoes/bananas (B6); a standard prenatal vitamin covers this for most B-vitamin-replete women. Supplementing the *specific* deficient B-vitamin lowers homocysteine reliably; extra B-vitamins in an already-replete woman do not further lower homocysteine.

When to see someone: Very high-dose B6 (>100 mg/day long-term) can cause peripheral neuropathy. High-dose folic acid (as in the emerging miscarriage-prevention data above) can mask an underlying B12 deficiency by normalizing red-cell size while the neurological effects of B12 deficiency continue unchecked -- always check B12 alongside folate, especially in vegans/vegetarians or after bariatric surgery. Kidney disease independently raises homocysteine regardless of B-vitamin status.

This marker sits in Build -- the raw material for making and renewing structure.

The standard clinical measure of vitamin D status; functions more like a hormone than a classic vitamin, with roles in calcium regulation, immune function, and (per emerging fertility data below) reproductive outcomes.

Typical range: Conventional (Endocrine Society): deficient <20 ng/mL, insufficient 20-29 ng/mL, sufficient >=30 ng/mL. Functional-medicine opinion often cites 40-60 ng/mL, but the Endocrine Society's own 2024 guideline update declined to set an optimal target for healthy adults, noting outcome-specific benefit levels haven't been established in trials.

Food first: Fatty fish, egg yolks, fortified foods, sensible sun exposure; supplementation (typically 1000-4000 IU/day) is often needed to reach sufficiency, and correcting a true deficiency preconception is low-risk and low-cost even given the modest outcome data above.

When to see someone: Toxicity is rare but real above ~10,000 IU/day sustained without monitoring (causes hypercalcemia). People with granulomatous disease or hyperparathyroidism need medical supervision before supplementing.