The Blood Tests Every Woman with PCOS Needs Before Trying to Conceive
Most women with PCOS aren’t getting the right tests before trying to conceive.
They’re told their blood work is “fine” — but no one checks the markers that actually explain why cycles are irregular or ovulation is missing.
That’s why so many women start fertility treatments without a clear understanding of what’s going on inside their bodies.
In this blog, we’ll go through the essential PCOS fertility blood tests I recommend before TTC, why they matter, and how results guide the personalised nutrition and lifestyle changes I use inside the PCOS to Pregnant Protocol.
Why Blood Tests Matter for PCOS and Fertility
PCOS is complex. It’s not just about ovaries — it’s about hormones, metabolism, and how your body responds to food, stress, and your environment.
Blood tests give us the full picture. They help pinpoint what’s driving your symptoms, why ovulation isn’t happening regularly, and what needs to shift for conception to become possible.
PCOS Fertility Blood Tests I Recommend
1. Fasting Insulin & Glucose
Why: Insulin resistance is common in PCOS and can inhibit ovulation.
What we look for: Even “normal” glucose can hide high insulin levels. We want insulin under 10 mU/L, ideally closer to 5.
Next step if high: Adjust carb quality and timing, increase protein, and add movement that supports insulin sensitivity.
Mini-story:
When my client K started the Protocol, her blood sugar was “normal” — but her insulin came back at 53 mU/L. No wonder she wasn’t ovulating. Three months of tailored nutrition and movement later, her insulin had halved.
2. SHBG (Sex Hormone Binding Globulin)
Why: Low SHBG often points to high insulin or high androgens — both linked to irregular cycles.
What we look for: Levels in the healthy mid-to-upper range.
Next step if low: Work on lowering insulin, supporting liver health, and balancing hormones through diet.
Mini-story:
E’s SHBG was so low it barely registered. Within eight weeks of adding more protein, switching to low-GI carbs, and boosting her liver-support foods, her SHBG rose into the healthy range — and she noticed her skin clearing and cycle length shortening.
3. Androgens (Testosterone, DHEA-S)
Why: Elevated androgens can stop follicles from maturing, which means no ovulation.
Next step if high: Reduce inflammation, improve insulin sensitivity, and adjust nutrition to lower androgen production naturally.
Mini-story:
S had been told her “male hormones” were high, but no one explained what that meant. We made small swaps — like switching intense HIIT workouts for walking and resistance training — and within three months her testosterone dropped enough to restart ovulation.
4. Liver Enzymes (ALT, AST, GGT)
Why: Elevated liver enzymes often go hand-in-hand with insulin resistance and can signal fatty liver — both more common in women with PCOS. Liver health plays a big role in hormone metabolism, including oestrogen balance and SHBG levels.
What we look for: ALT and AST ideally in the low-to-mid range; GGT under 20.
Next step if high: Increase fibre-rich veggies, add healthy fats, reduce processed carbs, and include liver-supportive foods like beetroot, leafy greens, and citrus.
Mini-story:
L’s liver enzymes were slightly above range — and her fasting insulin was high too. Her GP told her it “wasn’t a big deal,” but we knew the two were connected. Once we addressed both — adding more leafy greens, swapping soft drinks for water, and supporting her gut health — her enzymes returned to optimal, her insulin dropped, her skin improved, her cycles shortened, and her SHBG increased without medication.
5. Vitamin D
Why: Low vitamin D can affect ovulation, egg quality, and implantation.
What we look for: Levels between 100–150 nmol/L for optimal fertility.
Next step if low: Safe supplementation and dietary sources.
Mini-story:
M lived in a sunny climate but worked long hours indoors. Her vitamin D came back at 38 nmol/L. A few weeks of supplementation and some safe sun exposure brought her levels into the optimal range — and her energy and mood noticeably lifted.
6. Thyroid Panel (TSH, Free T4, Free T3, Thyroid Antibodies)
Why: Thyroid issues can mimic PCOS symptoms and impact fertility.
Next step if off: Address nutrient deficiencies, stress, and underlying autoimmune activity.
Mini-story:
J’s cycles were long, her hair was thinning, and she felt constantly tired. Her GP said her TSH was “normal” — but when we ran a full thyroid panel, her antibodies were sky-high. Supporting her thyroid helped her cycles shorten and her energy return.
7. Full Iron Studies
Why: Low iron affects ovulation and egg quality; too much can cause oxidative stress.
Next step if low/high: Tailor supplementation or dietary changes.
Mini-story:
Tara was supplementing with iron “just in case” — but her ferritin was actually double the ideal range. Cutting back on unnecessary supplements and adjusting her diet brought her levels back down, improving digestion and reducing inflammation markers.
How These Results Guide My Protocol
Inside the PCOS to Pregnant Protocol, we use these results to build a plan that:
Restores ovulation naturally.
Regulates cycles without medication.
Improves egg quality for a healthy pregnancy.
Quick Win for You Today
If you have PCOS and want to conceive, request these tests before making any big decisions. And don’t settle for “everything looks fine” — request a copy of your results and learn the optimal ranges, not just the “normal” ones.
If you want your bloods ordered and reviewed by someone who knows exactly what to look for, the PCOS to Pregnant Protocol is open. Together, we’ll get the right tests done, interpret them properly, and create a plan that works with your body — so you can move from guessing to conceiving.