Anne Borkowski, MD

Reproductive Endocrinologist
Infertility Specialist

4250 Dempster St.
Skokie, IL, 60076
847-763-8850

header
Welcome to the North Shore Fertility Web Site

FIND US ON
facebook

FOLLOW US ON
twitter

Fertility Tests- Hormone Evaluations

Hormone Evaluation

The reproductive processes in the male and female are under the complex control of numerous hormones. In the female, follicle stimulating hormone (FSH), luteinizing hormone (LH), progesterone, prolactin, estrogen, progesterone, bhCG, and others control the menstrual cycle and support the developing embryo. Several of these hormones are discussed here.

There are several infertility tests to document that ovulation will occur or that it has occurred. Ovulation must occur for the egg to be released and fertilized. Ovulation is the culmination of several hormonal events occurring during the menstrual cycle and must occur regularly for fertilization and pregnancy to occur.

Documenting Ovulation

Basal Body Temperature (BBT)

The BBT chart is used to document ovulation and to time intercourse. It is less accurate than some of the newer hormone monitoring kits but is still used by some physicians. In our practice, our infertility patients are advised to utilize the LH monitoring kits which are much more accurate and convenient.

Urinary LH Assay

The hormone evaluation/ test kits (Ovu Quick and others) predict ovulation by monitoring the surge in the level of luteinizing hormone (LH) that occurs approximately twenty-four hours before ovulation. The level is monitored by measuring the LH concentration in the urine via a simple home test. Intercourse or intrauterine insemination (IUI) can be timed to insure the best chance for pregnancy. This test does not rely on historical tracking data unlike the BBT chart and is a much better gauge of the most fertile times.

Ultrasound

A direct way to document ovulation is by ultrasound examination of the follicles before and after release of the egg. Ultrasounds are performed sequentially and the growth of the follicles is monitored. This process is most useful in predicting ovulation when the follicles are monitored to a particular size and an ovulation inducing medication (FSH) is given.

Progesterone Levels

An elevated progesterone level indicates that ovulation occurred. Progesterone supports the developing embryo and is produced by the corpus luteum, which is a structure on the ovary that develops from the remaining follicles after ovulation. Progesterone levels decline if fertilization does not occur.

Follicle Stimulation Hormone (FSH)

FSH is the hormone responsible for "recruiting" ovarian follicles and stimulating/supporting their growth. It is also the chemical component of the injectable medications used to stimulate the ovaries in in vitro fertilization cycles. Gonadotropin releasing hormone is released by a gland in the brain known as the hypothalamus, which stimulates the pituitary gland to produce FSH and luteinizing hormone (LH).

Levels of these hormones decrease as estrogen and inhibin increase during follicular development (feedback). In other words, as the follicles reach maturity less FSH is needed and the rise in estrogen signals the pituitary to reduce production. FSH is measured on day three of the cycle and a normal value is less than 10 IU/L. Levels over 12 are associated with lower pregnancy rates and usually indicate reduced ovarian reserve and impending menopause.

Luteinizing Hormone (LH)

The LH level is normally measured on day three of the menstrual cycle. LH levels rise abruptly immediately before ovulation and stimulate the release of the egg. LH is produced by the pituitary gland, which is controlled by the hypothalamus. Medications such as Ovidrel and Pregnyl (hCG) mimic the action of LH and are administered to stimulate ovulation.

Estrogen

Estrogen levels are measured using a blood test. As follicles develop, estrogen levels rise to stimulate the endometrium (lining of the uterus) to grow in preparation for the fertilized egg. Estrogen levels are used in conjunction with ultrasound measurements to insure that women receiving ovulation-inducing medications are responding properly.

Very high estrogen levels in a woman receiving fertility medications may indicate a potentially serious complication known as ovarian hyperstimulation syndrome. As follicles develop, they produce increasing amounts of estrogen roughly in proportion to the number of healthy follicles. Estrogen has numerous other effects on female metabolism including stimulation of endometrial development.

Human Chorionic Gonadotropin (bhCG)

b-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 can indicate pregnancy loss.

Progesterone Progesterone in Oil and/or Prometrium

Progesterone is a hormone produced by the ovaries during the menstrual cycle to help prepare the uterus to accept and support an embryo. The corpus luteum, a gland composed of tissue from the follicle after ovulation, synthesizes estrogen and begins to produce progesterone. Progesterone causes the lining of the endometrium to thicken and increases its blood supply. Progesterone is administered to women undergoing assisted reproductive procedures (IVF). After a pregnancy has been established, the placenta produces progesterone. Side effects of progesterone can include moodiness, and fluid retention, depression, irritability, and hypoglycemia.

Prolactin

Elevated levels of prolactin, in the absence of pregnancy, may indicate hypothyroidism or a tumor on the pituitary gland and cause irregular or absent ovulation. Prolactin is a hormone that stimulates milk production in the female and its level rises during pregnancy. The tumor is usually benign and can sometimes be removed via surgery or prolactin levels are lowered using medication (bromocriptine). Once the elevated levels are normalized, the chances of pregnancy are usually excellent.

Thyroid Hormone

Thyroid hormones are produced by the thyroid gland and levels are measured with blood tests. Hypothyroidism (low levels) can cause an increase in prolactin and negatively impact fertility. Hyperthyroidism can negatively affect the male's sperm.

Androgens

Women with polycystic ovarian syndrome (PCOS) typically have elevated androgen levels (testosterone, DHEAS sulfate, cortisol, 17-hydroxyprogesterone). Increased levels of these male hormones causes increased hair growth on the body and irregular or absent ovulation. Ovaries of PCOS patients have a "bumpy" or cystic appearance. PCOS can cause lack of ovulation.

One goal in the treatment of the PCOS patient is to lower androgen levels. The insulin sensitizing drug metformin has been successful in lowering insulin levels and normalizing androgen production by the ovaries.