What is the optimal level for FSH for fertility? Day 3 fertility testing

Day 3 Fertility Testing FSH and Estradiol
Fertility Care: Day 3 Hormone Testing

In order to assess a woman’s reproductive health, I recommend laboratory tests be done on day 3 of the menstrual cycle. Day 3 testing will take a look at sex hormone levels that are necessary for women’s reproductive function.

What tests are included on day 3 testing?

Follicle-stimulating Hormone (FSH): FSH is a hormone produced by the pituitary gland. It communicates with the ovary to cause the growth of immature follicles in the ovary and stimulates the release of estrogen.

Estradiol (E2): this form of estrogen has a number of roles in female reproduction. Estradiol is produced mainly by the ovaries and stimulates follicle growth which can eventually lead to ovulation. Estradiol also helps prepare for implantation of the fertilized egg by thickening the uterine lining.

When is day 3 of my cycle?

Day 1 is considered the first day of menstruation. Day 3 is the third day after menstruation has started.

What are the optimal levels for estradiol and FSH?

Standard laboratory values reflect a range that considers anything too high or low in a disease state. While that can be helpful in conventional settings to rule out serious conditions, optimal ranges may be more beneficial for fertility. Optimal laboratory values reflect a range where optimal health and vitality occur. Listed below are the standard and optimal ranges for estradiol and FSH:


Standard Range(1,2) 15-75 pg/mL

Optimal Range(3) 10-50 pg/mL


Standard Range(1,2) 2.0-12.0 mIU/mL

Optimal Range(3) 2.0-9.0 mIU/mL

What does it mean if my estradiol level is low or high?


Diminished levels most commonly occur when a woman goes through menopause. Low levels of estradiol can impact bone health and increase fractures. Other symptoms include vaginal dryness and menstrual irregularities.


There are multiple causes for elevated estradiol including perimenopause, birth control, toxins, and diet. High levels of estrogen (estrogen dominance) can indicate a diminished ovarian reserve. Women with estrogen dominance can have irregular, shortened, and anovulatory cycles. There can also be increased difficulty in becoming  pregnant. Symptoms of estrogen dominance include PMS, weight gain, headaches, and trouble sleeping. If left untreated, chronically high estrogen can increase the risk of breast and uterine cancer.

How to naturally balance estradiol levels

One of the most effective treatments for high or low estrogen is to eat a healthy diet. This may include organic fruits and vegetables, lean proteins, and healthy fats with omega-3’s. For high levels of estrogen, reducing stress and consumption of processed foods can lower estrogen levels. Correcting vitamin deficiencies, including B6, and magnesium, can also lower levels. Nuts, seeds, fruits, vegetables are good sources of insoluble fiber which can bind to excess estrogen and excrete them.  For low levels of estrogen, pituitary dysfunction can lead to estrogen deficiency due to excessive exercising or an eating disorder. Supplementing the diet with Panax ginseng of 1,000mg twice daily can also help increase estrogen levels4.

What does it mean if my FSH levels are low or high?


Diminished FSH levels can indicate that a woman isn’t producing eggs. Low levels are seen with pituitary gland or hypothalamus dysfunction. Symptoms include fatigue, weight loss, and weakness. Other causes for low levels are reduced body weight, stress, or have high levels of estradiol (estradiol suppresses FSH levels).


One of the most common causes of high FSH for women of child-bearing age is PCOS. Symptoms include irregular periods, weight gain, acne, and thinning hair. Increased FSH can indicate a loss of ovarian function. FSH levels also increase as a woman enters perimenopause. Higher levels can be associated with increased difficulty in getting pregnant but it doesn’t mean you won’t be able to conceive.

How to naturally balance FSH levels

Maintain a healthy weight by a whole foods diet, exercising, and reducing stress. For diet, incorporate leafy greens such as kale, broccoli, spinach, and Brussels sprouts. Eating wild-caught salmon or anchovies twice a week can help boost omega-3’s and balance FSH. If vegetarian, incorporating walnuts and flax seeds can boost levels as well. Exercise helps maintain weight and reduces stress levels. Practicing yoga or getting 30 minutes of walking in each day can help relieve stress while naturally balancing FSH levels. Other ways to reduce stress can include meditating, journaling, listening to music, or talking to a friend. It’s important to get 7-8 hours of sleep every night in order for hormones to be properly balanced. Adding a Maca supplement of 2,000-3,000 mg per day can also help lower FSH levels5.


The reproductive system is complex and intricate. There are many causes of estradiol and FSH to be outside of the optimal lab range including PCOS, menopause, stress, excessive exercising, a poor-quality diet, environmental toxins, and more. The best way to balance estradiol and FSH levels is to get enough sleep each night, eat nutrient dense foods like nuts and leafy vegetables, increase consumption of omega-3’s, and reduce stress.


1.Endocrine Society (2015). Laboratory Reference Ranges. Retrieved from: https://education.endocrine.org/system/files/ESAP%202015%20Laboratory%20Reference%20Ranges.pdf

2. American Board of Internal Medicine (2020). ABIM Laboratory Test Reference Ranges- January 2020. Retrieved from: https://www.aacc.org/publications/cln/articles/2012/november/fertility-testing

3. Delaney, A., Jensen, J., & Morbeck, D. (2012). Fertility Testing How Laboratory Tests Contribute to Successful Infertility Treatments. Retrieved from: https://www.aacc.org/publications/cln/articles/2012/november/fertility-testing

4. Xu, Y., Ding, J., Ma, X. P., Ma, Y. H., Liu, Z. Q., & Lin, N. (2014). Treatment with Panax Ginseng antagonizes the estrogen decline in ovariectomized mice. International Journal of Molecular Sciences, 15(5), 7827–7840. https://doi.org/10.3390/ijms15057827

5. Meissner, H. O., Kapczynski, W., Mscisz, A., & Lutomski, J. (2005). Use of gelatinized maca (lepidium peruvianum) in early postmenopausal women. International Journal of Biomedical Science : IJBS, 1(1), 33–45. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23674952%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC3614576

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