Female Hormone Testing
There are many conditions, in both the female and male that can cause or contribute to infertility. These conditions are discussed in detail throughout our Web site. A thorough evaluation by an infertility specialist is essential to identifying all possible factors contributing to infertility, accurate diagnosis, and effective treatment.
The most important component of the male evaluation is the semen analysis. Tests used to diagnose male subfertility are discussed in detail in the “Male Infertility” section.
The female reproductive cycle, commonly referred to as the menstrual cycle, is controlled by a complex series of interactive hormonal events. These interactions occur between the endocrine glands such as the hypothalamus, pituitary and gonads by means of many chemical mediators and hormones like estrogens, follicle stimulation hormone, leutinizing hormone, progesterone and many others.
These hormones are critical to egg recruitment, follicle development, ovulation, embryo implantation, and maintaining a pregnancy. This process is discussed in detail on our “Ovulatory Dysfunction” page. All subfertile couples should undergo a thorough hormone evaluation conducted by a specialized endocrine laboratory.
Hormone levels vary dependent upon the stage of follicular recruitment and development. FSH levels are high during the follicular recruitment stage in order to stimulate egg development within the follicles. As the follicles mature, they produce estrogen and immediately prior to ovulation leutinizing hormone levels rise precipitously.
The first step in the female evaluation is a complete medical history. Previous conditions, such as pelvic inflammatory disease, can damage internal organs and contribute to infertility. It is important to be aware of any abdominal or reproductive surgeries as scar tissue, or adhesions, can form and interfere with reproductive processes.
Other factors that will be considered are menstrual history/regularity, previous pregnancies and/or terminations, birth control methods, and sexual developmental history. Lifestyle information such as drug abuse, exercise and dietary habits is also important.
Family medical history will be discussed to identify any increased risk for conditions such as endometriosis, genetic disorders, premature ovarian failure and infertility in general. Patients also undergo a thorough physical and gynecologic examination.
Follicle stimulating hormone (FSH), leutinizing hormone (LH), and estradiol levels are measured on cycle day three. If the FSH level is elevated (>10) it may be a sign of impending ovarian failure (perimenopause). FSH is secreted by the pituitary gland and stimulates the recruitment and development of eggs within the ovarian follicles.
Even if the day three FSH levels are normal, ovarian reserve may still be diminished. In infertility patients, this is sometimes further assessed using the clomiphene citrate challenge test (C3T), exogenous FSH ovarian reserve test (EFORT) or GnRH agonist test (GAST).
In the C3T, a day three FSH level is obtained and clomiphene (100 mg) is administered on cycle days five through nine. A second FSH measurement is taken on day ten and if it is elevated this is an indication of possible diminished ovarian reserve. Donor egg IVF is the only treatment option for women with documented ovarian failure.
Leutinizing Hormone (LH)
LH is measured on day three of the menstrual cycle. LH is produced by the pituitary gland after stimulation by gonadotropin releasing hormone ( GnRH) which is released by the hypothalamus. LH levels rise immediately before ovulation and stimulate egg release from the follicle. LH also plays a role in the hormonal feedback loop affecting estradiol levels. .Medications such as Ovidrel and Profasi (human chorionic gonadotropin) mimic the action of LH and are administered to trigger ovulation.
As follicles develop they produce estrogen roughly in proportion to their size and number. Estrogen stimulates the endometrium (lining of the uterus) to grow in preparation to accept the embryo.
Estrogen levels are used in conjunction with ultrasound measurements to insure that women receiving FSH are responding appropriately. Seriously elevated estrogen levels in a woman receiving exogenous FSH treatment may signal a potentially serious complication known as ovarian hyperstimulation syndrome (OHSS).
Women with polycystic ovarian syndrome (PCOS) usually have elevated androgen levels (testosterone, DHEAS sulfate, cortisol, and 17-hydroxyprogesterone). Increased levels of these male hormones cause increased body hair growth, irregular or absent ovulation, and a characteristic “pear shaped” body appearance. Ovaries of PCO patients have a “bumpy” appearance caused by the presence of small follicles that never reach full size and in the ultrasound screen they appear as a “string of pearls”.
Excessive exercise can also result in increased androgen levels and anovulation. Obesity is also correlated with increased androgen levels. Chronically elevated androgen levels can lead to long term negative health consequences.
Thyroid hormone levels are measured using a blood test. Hypothyroidism (low levels) can cause some other hormone imbalances leading to anovulation. Hyperthyroidism in the male can lower the sperm count.
Prolactin is the hormone responsible for stimulating breast milk production after birth. Hyperprolactenemia is a condition in which prolactin levels are elevated in the absence of pregnancy and can cause anovulation (lack of ovulation). It is sometimes accompanied by milk secretion from the breast. Hypothyroidism or small tumors of the pituitary gland can cause hyperprolactanemia.
Prolactin levels return to normal upon surgical removal of the tumor or medical treatment with bromocriptine. Surgical or medical treatment is selected based upon the size and location of the tumor. Success rates are high after correction of the prolactin imbalance in patients where it is the primary cause of their infertility.
Progesterone hormone measurements are useful in determining if ovulation has occurred. Progesterone stimulates the endometrial lining to grow, thicken and increase in vascularity in order to support the developing fetus. Progesterone is produced by the corpus luteum in the ovaries for two weeks after ovulation. In the lack of pregnancy, progesterone production decreases leading to the menstrual period. If pregnancy occurs progesterone production increases and remains high for at least the first trimester. Progesterone is usually administered in ART cycles in the form of injections, vaginal suppositories, or oral tablets to ensure that pregnancy is maintained.
Human Chorionic Gonadotropin (hCG)
In general hCG has functions similar to LH: it induces ovulation and supports corpus luteum function. hCG is a hormone produced by the placenta as the embryo develops. Elevated levels indicate the presence of an ongoing pregnancy. A precipitous rise or fall of this hormone’s level can indicate pregnancy loss. Also, this is the hormone that patients take prior to trans-vaginal aspiration to facilitate the release of the eggs from the follicles.