Female Hormone Testing

All female infertility patients will undergo a complete hormone evaluation. Many different hormones must interact precisely to cause proper ovulation, implantation of an early pregnancy, and the maintenance of an ongoing pregnancy.

The pituitary gland is under hormonal control of the hypothalamus, an endocrine organ located at the base of the brain. The pituitary is responsible for the production of FSH, LH, and other important hormones. FSH stimulates the recruitment and development of eggs within the follicles located in the ovaries.

The hormones discussed below are commonly evaluated. Because the menstrual cycle is a cascade of different hormonal events, these hormones are usually measured at a specific time during the ovulatory cycle.

Day 3 FSH, LH, and Estradiol 

FSH

The level of FSH is controlled by a complex interaction of several hormones. High levels of FSH on day 3 of the menstrual cycle may indicate the onset of menopause. The injectable FSH medications given to stimulate ovulation mimic the bodies natural FSH. Artificially raising FSH levels with medication (ovulation induction) during the first part of the ovulatory cycle causes the development of multiple eggs, which are needed for assisted reproductive procedures, such as IVF.

FSH should be measured in all women to exclude pre-menopause. Depending on the laboratory, an FSH level greater than 10 mIU/ml may be of concern. In certain patients, a Clomid challenge test may provide an indication of ovarian reserve. In the Clomid challenge test, Clomid is administered in a standardized dose of 100 mg between days five and nine. FSH and estradiol are measured again on day 10. This tests the ovaries response when stimulated.

Estrogen

As follicles develop, estrogen levels rise which helps to stimulate the endometrium (lining of the uterus) to grow in preparation for receipt of the fertilized egg. Androgen levels are elevated in conditions such as polycystic ovarian disease. LH is responsible for triggering the release of the egg from the follicle (inducing ovulation).

Thyroid

Thyroid testing is imperative in all women experiencing infertility as detection and correction of a thyroid problem is paramount to facilitating successful conception.

Prolactin

Prolactin is the “milk producing hormone” secreted by the pituitary gland. Elevated prolactin levels must be reduced for successful conception to occur. This condition, known as hyperprolactinemia, may be caused by hypothyroidism or a benign tumor in the brain and it responds well to medical or surgical treatment.

Progesterone

Progesterone, usually measured on day 21 of the cycle, is an accurate indicator of ovulation. A level above 15 ng/dl is desirable and levels can be compared for different ovulatory cycles. Progesterone is also necessary to support the developing fetus. Initially it is produced by the corpus luteum (the follicular structure remaining after ovulation) and later by the placenta.

Androgens

Male hormones such as DHEAS sulfate, testosterone, 17-hydroxyprogesterone, and cortisol may be measured in some patients. Elevated androgens may indicate the presence of PCOS.

B-hCG

B-hCG (the hormone of pregnancy) is measured to document pregnancy. The initial rise and precipitous fall of this hormone may indicate early pregnancy loss.

Inhibin

The premenopausal ovary looses its ability to secrete the hormone inhibin, which is part of the negative feedback loop. Assay of this hormone may be valuable in assessing ovarian function in older women. Anti Mullerian hormone is another marker of ovarian reserve.