A cornerstone of the female infertility evaluation is cycle day 3 testing of ovarian hormones including Follicle stimulating Hormone (FSH), Lutenizing Hormone (LH) and Estradiol (E2). Because this hormone evaluation provides crucial information about ovarian reserve – the number and quality of eggs remaining in the ovaries, we typically order this test as part of the initial workup for all female patients. Understanding a patients ovarian reserve allows us to anticipate a patient’s response to medications and select a treatment regimen and medication doses that will be most likely to produce a good response and eventual pregnancy. Normal Estradiol levels accompanied by an elevated FSH are an indicator of diminished ovarian reserve which predicts decreased chances for conception. Women with elevated FSH levels may be candidates for our donor egg program. Women with unexplained infertility, recurrent miscarriages or over the age of 34 may benefit from a more sensitive evaluation of ovarian hormones called a Clomid Challenge Test(CCCT). In the CCCT, an FSH and E2 are drawn on cycle day 3, the woman then takes 100 mg Clomid on cycle days 5-9, an FSH level is then tested again on day 10. Clomid Challenge Testing provides an additional level of sensitivity when evaluating ovarian reserve.
Anti-Mullerian Hormone (AMH)
Recently another test has been shown to be useful for evaluating ovarian reserve. Anti-mullerian hormone (AMH) is a blood test that can be obtained at any time during the menstrual cycle. It can also be tested while a woman is taking oral contraceptives. As ovarian reserve decreases ,so does the AMH while FSH usually rises. It is a useful additional test when FSH results are confusing or inconsistent. Normal AMH levels indicate adequate egg supply. Lower AMH levels suggest decreasing ovarian reserve or egg supply. High AMH levels may be indicative of polycystic ovarian syndrome.
Elevated androgens (male hormones) can lead to irregular or no ovulation. Polycystic ovarian syndrome (PCOS) is a common cause of female infertility marked by irregular cycles, androgen excess, and an increased number of antral follicles (small cysts on the ovary). A severe excess of androgens leads to the expression of male characteristics such as increased body hair, male pattern baldness, lowering of the voice, and acne. In many PCOS patients, excess androgens are a result of chronically elevated insulin levels, a condition known as hyperinsulinemia or insulin resistance.
Androgens are male hormones that are normally found in both men and women. If a female patient has elevated androgens, it cause ovualtion to become irregular or stop altogether (anovulation). Elevated androgens are often seen in patients with Polycystic Ovarian Syndrome (PCOS). PCOS is a common cause of female infertility marked by irregular menstrual cycles, androgen excess, and an increased number of antral follicles. Severely increased androgen levels in female patients can lead to the expression of male characteristics like increased body hair, male pattern baldnessm acne and lowering of the voice. In many PCOS patients, elevated androgen levels are caused by chronically elevated insulin levels caused by insulin resistance.
Thyroid hormones are produced by the thyroid gland and levels are measured with blood tests such as Thyroid Stimulating Hormone [TSH]) and/or free T4. Hypothyroidism (low levels of thyroid hormone (T4) but usually high levels of TSH) can cause anovulation and early pregnancy loss. Hyperthyroidism (high levels of thyroid hormone (T4) but usually low levels of TSH) is associated with many abnormal conditions including irregular ovulation, fetal abnormalities, and premature labor.
The thyroid gland produces hormones that are essential to normal metabolism, hormone production and fertility. Thyroid function is measured by blood tests for Thyroid Stimulating Hormone and T3 and T4. An assessment of thyroid function is typically part of the initial workup for female patients. Hypothyroidism, or decreased thyroid function, can lead to ovulatory dysfunction and early pregnancy loss. Hyperthyroidism, or abnormally elevated thyroid function, can lead to ovulatory dysfunction, fetal abnormalities and premature labor. Treatment with medication to optimize thyroid function is one of the initial treatments many of our patients require.