4 Key Blood Biomarkers Associated with Female Fertility

By Diana Licalzi, MS, RD, CDCES, April 23, 2021

female fertility markers


Female infertility can be confusing, discouraging, and all-around difficult to talk about. But if you're experiencing it, know that you're not alone. The truth is, female infertility is a common problem in the United States – roughly 10% of all women aged 15-44 experience difficulty getting pregnant or staying pregnant.1 Some contributing factors, like age and conditions affecting the female reproductive system, are out of anyone's control. But there are steps you can take to improve your fertility status, as certain lifestyle changes can improve critical blood biomarkers.2

Want to learn more about how hormone health? Get to know your biomarkers and the foods and nutrients that support women's health by downloading this guide. 

InsideTracker blood tests assess a handful of hormones linked to reproductive health. In this article, we'll explain how these biomarkers impact female fertility and point out possible causes of abnormal levels. Please note that these biomarkers do not give a comprehensive picture of fertility, and there are numerous other markers associated with fertility that InsideTracker does not test. Consult your physician for a better understanding of your reproductive health.


1. Dehydroepiandrosterone (DHEAS)

DHEAS, a sex hormone, acts as a precursor for both estrogen and testosterone. Estrogen plays a vital role in reproduction as it is needed for ovulation – the release of an egg from a woman’s ovaries.3 And because DHEAS gets converted to estrogen, lower DHEAS can result in lower estrogen and difficulty getting pregnant.3,4

Increased stress levels, over-exercise, and insufficient calories (especially fats) can all potentially lead to below-normal levels of DHEAS. DHEA supplements are readily available in the United States but InsideTracker does not recommend them due to their unreliable quality and unknown health risks. Stress-reducing techniques, adequate nutrition, and regular exercise of moderate intensity can all help increase DHEAS levels. It is important to note that DHEAS in women naturally peaks in the mid-20s before slowly declining with age.

female fertility markers

On the contrary, overactive adrenal glands, polycystic ovary syndrome (PCOS), and early puberty can lead to high DHEAS levels. These conditions can result in difficulty controlling weight, menstrual irregularity, and infertility.5


2. Testosterone

Testosterone plays an important role in reproductive health. Women need only small quantities of testosterone – too much or too little can interfere with fertility.6 A recent study indicated that testosterone helps to promote the development of follicles - structures that hold and release eggs during ovulation.7 Testosterone is also closely linked to normal libido and sex drive, indirectly affecting fertility.

As women age and enter menopause, their testosterone levels naturally decrease by as much as 15%.8 Similarly, birth control changes normal hormone balances in women; it can decrease testosterone by up to 50% and cause it to remain relatively low, even after birth control has stopped.9,10

Biomarkers 101 - Testosterone Copy (1)On the other hand, lifestyle factors including elevations in blood pressure, LDL cholesterol, and total cholesterol can all lead to increased testosterone levels.11 Underlying medical issues like polycystic ovarian syndrome (PCOS) can also cause women to consistently produce too much testosterone in their ovaries.

If you have tested with InsideTracker and noticed elevated testosterone, it could also be due to your menstrual cycle. Testosterone levels spike around day 14 of normal menstrual cycles in premenopausal females.12 Use an app like Period Tracker to track your cycle, and test during a more optimal time. As with all other markers, speak to your doctor about high levels of testosterone.


3. Sex Hormone Binding Globulin (SHBG)

SHBG is responsible for safely transporting sex hormones, mainly testosterone, throughout the bloodstream and regulating testosterone levels within the body. Since SHBG plays a big role in maintaining proper hormone function, it is extremely important that our bodies have healthy levels of SHBG.

Multiple factors increase SHBG in the blood and, thereby, decrease free testosterone. The aging process (particularly seen in postmenopausal women), pregnancy, and undernourishment all contribute to above-normal levels.13 And as before, hormonal contraceptives can significantly influence levels of this biomarker – up to a 400% increase.9,14 Even after ceasing birth control, women may still have increased levels of SHBG in their bloodstream.10 Proper nourishment and switching to non-hormonal contraceptives can help achieve normal SHBG levels.

Birth control's impact on markers of fertility

Similar to DHEAS, certain conditions like PCOS, Cushing's syndrome, and steroid use can result in low SHBG, and as a result, also contribute to elevated free testosterone.6


4. Cortisol

Cortisol, a steroid hormone produced by the adrenal glands, performs many vital functions in the body, including the regulation of energy, metabolism, and immunity. The body also releases cortisol to activate our "flight-or-fight" responses to counteract acutely stressful situations. If cortisol levels stay elevated for extended periods, however, they can lead to chronic stress. This long-term activation of the stress-response system can interfere with the normal functioning of other body systems, including reproductive health. Several studies demonstrate a relationship between stress, cortisol and infertility – higher levels of stress and cortisol result in a decreased fertility rate.15

Cortisol levels and fertility

Inadequate calorie intake and strenuous physical activity can also contribute to elevated cortisol levels.6 Women with elevated cortisol levels should consider lifestyle changes such as increasing sleep, engaging in stress-reduction techniques like meditation, and ensuring adequate calorie intake.


How to measure these markers and address any concerns

An InsideTracker blood test can help you better understand the levels of these biomarkers which are optimal for you and your body. These biomarkers do provide a glimpse into reproductive health, but are in no way comprehensive measures. If you are concerned by abnormalities in your blood levels of any of these biomarkers, we recommend you speak to a doctor, particularly an endocrinologist.



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[1] https://www.womenshealth.gov/a-z-topics/infertility

[2] https://www.hormone.org/~/media/Hormone/Files/Questions%20and%20Answers/Women/FS_MWH_Infertility_Women_EN%20612.pdf

[3] https://www.medicalnewstoday.com/articles/321064.php

[4] https://www.zrtlab.com/blog/archive/struggling-with-infertility-part-2-hormones-tested-in-the-zrt-fertility-profile

[5] https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/113595

[6] https://labtestsonline.org/tests/sex-hormone-binding-globulin-shbg

[7] https://www.urmc.rochester.edu/news/story/4022/female-fertility-whats-testosterone-got-to-do-with-it.aspx

[8] Rannevik, G., et al. "A longitudinal study of the perimenopausal transition: altered profiles of steroid and pituitary hormones, SHBG and bone mineral density." Maturitas 21.2 (1995): 103-113.

[9] Zimmerman, Y., et al. "The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis." Human reproduction update20.1 (2014): 76-105.

[10] https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1743-6109.2005.00198.x

[11] Kische, Hanna, et al. "Clinical correlates of sex hormones in women: The study of health in Pomerania." Metabolism 65.9 (2016): 1286-1296.National Academies Press.

[12] Murphy, Ana Alvarez, et al. "Effect of low-dose oral contraceptive on gonadotropins, androgens, and sex hormone binding globulin in nonhirsute women." Fertility and sterility 53.1 (1990): 35-39.

[13] https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/9285

[14] Raps, M., et al. "Sex hormone‐binding globulin as a marker for the thrombotic risk of hormonal contraceptives." Journal of Thrombosis and Haemostasis10.6 (2012): 992-997.

[15] Vitale, Salvatore Giovanni, et al. "The Impact of Lifestyle, Diet, and Psychological Stress on Female Fertility." Oman medical journal 32.5 (2017): 443.

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