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FSH-LH- Measurements of (FSH) follicular
stimulating hormone, luteinizing hormone (LH)
and others are conducted on day two or three of
the menstrual cycle. FSH is responsible for stimulating
the recruitment and development of eggs within
the ovarian follicles. FSH levels above 10 usually
indicate low ovarian reserve and if the FSH is
very high (greater than 25) it could be consistent
with approaching menopause. Usually, a level of
less than nine indicates adequate ovarian reserve.
The ratio of LH to FSH is also analyzed.
Progesterone-
Progesterone is measured to document that "quality"
ovulation has occurred. This hormone is produced
by the corpus luteum which is formed from the
"shell" of the ovarian follicle after
ovulation. After implantation, the placenta begins
to produce progesterone (between 7 and 9 weeks
of pregnancy). Progesterone is routinely prescribed
during assisted reproductive technology cycles
(since there is no ovulation and thus no "shell"
left).
Prolactin
Levels- Prolactin is the hormone that stimulates
breast milk production after pregnancy has occurred.
Elevated prolactin levels can cause irregular
or no ovulation (anovulation). Abnormally elevated
prolactin levels in the absence of pregnancy are
often caused by a small benign tumor on the pituitary
gland. Prolactin may also be elevated in hypothyroidism
(low functioning thyroid gland). Hyperprolactinemia
(elevated prolactin) is a condition treated with
the medication; bromocriptine (Parlodel) or through
surgery to remove the tumor.
b-HCG- b-HCG is also known as the "pregnancy
hormone" and is produced by the placenta.
Rising levels of b-HCG indicates that pregnancy
has occurred. It usually doubles (or at least
increases by 67%) every 48 hours.
Ultrasound-
Ultrasound is used to measure the size and number
of follicles and the width of the endometrium
(lining of the uterus). The endometrium increases
in thickness and vascularity under the influence
of estrogen and progesterone. This development
is necessary for the embryo to implant and be
adequately nourished during development. Ultrasound
is also used to follow fetal development and it
often times identifies masses such as fibroids,
polyps, or endometriosis.
Hysterosalpingogram
(HSG) - A hysterosalpingogram involves injecting
die into the uterus and following its flow through
the fallopian tubes into the uterus. This procedure
is conducted in the office or at the hospital
as an outpatient. The physician can see abnormalities
in the uterine cavity such as fibroids and polyps.
Obstructions in the tubes can also be visualized.
Hysteroscopy-
The hysteroscope is used to visualize the uterine
cavity. CO2 gas or water is introduced into the
uterine cavity causing it to expand. The doctor
then inserts a small "telescope device"
and directly examines the inside of the uterus.
Conditions such as fibroids, polyps, or congenital
malformation are readily apparent.
Hydrosonogram
or Sonohysterogram- In the hydrosonogram,
saline is injected into the uterine cavity causing
it to expand and vaginal probe ultrasound is used
to examine the uterus. This test helps to visualize
the relationship between the wall of the uterus
and the cavity of the uterus.
Post
coital test- A post coital test may be ordered
to learn how the sperm interacts with the cervical
mucus. The couple has intercourse at home and
the female comes to the office within twelve to
twenty four hours.
Once sperm are ejaculated, they swim through the
cervical mucus, past the cervix and into the uterine
cavity. The mucus must be of the right consistency
and contain enough nutrients. Sometimes the female
produces antibodies to the sperm. When this happens,
her body mistakes the sperm for invading pathogens
(virus or bacteria) and seeks to destroy it. A
man may also make antibodies against his own sperm.
If numerous dead or damaged sperm are seen in
the cervical mucus it is indicative of incompatibility.
Intrauterine insemination (IUI) is often a first
choice treatment for this condition.
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Estradiol- Estradiol (estrogen) levels
rise as healthy follicles develop and low levels
indicate poor development. If the ovaries produce
adequate amounts of estrogen, the pituitary gland
will produce its normal amounts of FSH. However,
if ovarian function is compromised, the pituitary
gland will send out more and more FSH in attempt
to stimulate the ovaries to produce more estrogen.
Thus an elevated FSH level is indicative of low
ovarian function. Levels of male hormones, known
as androgens, are also measured. Elevated androgen
levels may indicate the presence of polycystic
ovarian disease.
Clomiphene Citrate Challenge Test-(CCCT)
- The CCCT may be ordered to further assess ovarian
reserve. This test is performed by measuring the
day 2 or 3 FSH and estradiol levels. The patient
takes 100 mg of Clomid on cycle days 5 through
9, and her FSH is measured again on day 10. The
test is abnormal if either the day 3 or day 10
FSH values are elevated or if the day 3 estradiol
is greater than 80 pg/ml. A poor clomiphene citrate
challenge test is indicative of poor ovarian reserve,
and may mean that a stimulated cycle will most
likely not be successful.
BBT
and Urinary Test Kits- Basal body temperature
(BBT) measurements can be used to predict or note
ovulation. These measurements were used extensively
prior to the availability of urinary test kits
which are more accurate and convenient.
A woman's body temperature varies predictably
during her ovulatory cycle and it increases at
ovulation. A basal body thermometer is used daily
to take the temperature immediately upon arising
before leaving bed. These temperatures are charted
on a basal body temperature graph. A pattern of
temperature increases is established after several
months of charting. Intercourse is timed according
to the most fertile times when the temperature
begins to rise preceding ovulation.
There are several disadvantages to using the BBT
method. First, it is inconvenient to take daily
measurements, especially for busy career women.
Second, it takes several ovulatory cycles to adequately
establish an ovulatory pattern. Third, daily measurements
are a constant reminder of sub fertility.
Urinary test kits are very accurate and measure
the surge in LH that occurs immediately prior
to ovulation. LH appears in the urine and this
is what is measured by the kits. Urine samples
are tested around the time of predicted ovulation
and intercourse is timed accordingly.
Laparoscopy-
The laparoscopy allows the physician to directly
view the reproductive organs and determine if
conditions such as endometriosis are present.
This is an outpatient procedure usually performed
in an ambulatory center (at your doctor's office
or at the hospital). The physician makes two small
holes, one in or near the belly button and the
other just above the pubic hair line. The abdomen
is filled with gas causing it to expand making
the internal organs visible. A device similar
to a telescope is inserted through one opening
and the surgical instruments are inserted through
the other. Many times the specialist will treat
conditions, such as endometriosis, during the
laparoscopy.
Endometrial
Biopsy- A small sample of the endometrium
is taken using a small catheter. This procedure
can be accompanied by mild discomfort and cramping
after the procedure. The endometrium must develop
properly (be in phase) by thickening and becoming
more vascular to accept the developing embryo.
Microscopic examination of the tissue determines
if it is "out of phase" or "a luteal
phase defect" is present. This condition
is often treated with progesterone.
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