At present, there is no complete and unified value for the determination of endocrine sex hormones in obstetrics and gynecology in China, and due to the different sources of various reagents, methods of determination, data calculation and units used, even for the same hormone specimen, the results obtained by each laboratory are not exactly the same. The following reference values for sex hormone examination are gathered from various professional books and magazines at home and abroad, hoping to provide useful references for all colleagues.
I. General knowledge of sex hormone examination
You should not use sex hormone drugs (including progesterone and estrogen) at least one month before checking basic sex hormones, otherwise the results are unreliable (except for sex hormones that need to be rechecked after treatment).
Sex hormones can be checked at any time of menstruation, and the normal value varies for each period. However, the diagnosis and treatment of infertility must know the basal sex hormone level. First, we should choose the 2nd to 5th day of menstruation to check the level of sex hormones called basal sex hormone level, which is best measured on the 3rd day. To be sure that it is the 3rd day of menstruation, it is enough to check sex hormone 5, which can be done without checking progesterone, which should be checked during the luteal phase (21 days of menstruation or 7 days after ovulation); however, if you are not sure whether vaginal bleeding is menstrual or not, you should check 6 items to prevent misdiagnosis (according to P data, you can probably judge the period of menstrual cycle).
In cases of scanty menstruation and amenorrhea, a negative urine pregnancy test, absence of ≥10mm follicles in both ovaries on vaginal ultrasound, and EM thickness of 5mm can also be done as basal status.
The basic sex hormone laboratory test should be looked at in this way: the normal value of basic LH and FSH is 5~10IU/L, and the normal value of basic E2 is 25~50pg/ml (these 3 results should not be looked at the reference value on the laboratory test, but according to this standard); PRL and T can be compared with the reference value of the laboratory test in the hospital, and the normal value of P is shown after.
Second, the clinical significance of sex hormone examination
(A) FSH and LH: the basic value is 5-10IU/L
In normal menstrual cycle, early follicular period (2~3 days of menstruation) blood FSH and LH are maintained at low level, and rapidly increase before ovulation, LH is up to 3~8 times of the basal value, up to 160 IU/L or even higher, while FSH is only about 2 times of the basal value, rarely 30 IU/L, after ovulation FSH and LH rapidly return to the follicular phase level. FSH and LH levels in the early follicular phase can be monitored to determine the function of the gonadal axis, and FSH is more valuable than LH in determining ovarian potential.
1, Ovarian failure: Basal FSH 40IU/L, elevated LH or 40IU/L, as hypergonadotropic (Gn) amenorrhea, i.e. ovarian failure; if it occurs before the age of 40, it is called premature ovarian failure (POF).
2, Basal FSH and LH are 5IU/L for low Gn amenorrhea, suggesting hypothalamic or pituitary hypofunction, and the distinction between the two needs to be made with the help of gonadotropin-releasing hormone (GnRH) test.
3. Dysfunctional ovarian reserve (DOR): Basal FSH/LH2-3.6 indicates DOR (FSH can be in the normal range), which is an early manifestation of ovarian dysfunction and often suggests that the patient is not responding well to superovulation (COH), and the COH protocol and Gn dose should be adjusted in time to improve ovarian responsiveness and obtain the desired pregnancy rate. Because elevated FSH/LH only reflects DOR, not decreased ability to conceive, ideal pregnancy rates can still be obtained once ovulation period is obtained.
4. Basal FSH 12 IU/L, retested in the next cycle, 12 IU/L continuously indicates DOR.
5.Polycystic ovary syndrome (PCOS): basal LH/FSH2~3, can be used as the main indicator for the diagnosis of PCOS (basal LH level 10IU/L is considered elevated, or LH maintains normal level while basal FSH is relatively low level, it creates an elevated LH to FSH ratio).
6. Checking 2 times basal FSH>20IU/L can be considered as insidious stage of premature ovarian failure, suggesting possible amenorrhea after 1 year.
(II) P: Basal value is usually <1ng/ml
Under normal circumstances, blood P has been at a low level during follicular phase; when LH peak appears before ovulation, P secretion starts to increase, after ovulation, the ovarian corpus luteum produces a large amount of P, and blood P concentration rises rapidly; when the corpus luteum matures (6~8 days after LH peak), blood P concentration reaches a peak, up to 47.7~102.4nmol/L (15~32.2ng/ml) or higher, and then declines continuously, and menstruation The lowest level is reached during the premenstrual period. The P level in peripheral blood varies parabolically throughout the corpus luteum.
(C) E2:Basal value is 25~45pg/ml
1.Basal E2>165.2~293.6pmol/L (45~80pg/ml), regardless of age and FSH, suggests decreased fertility.
2. When basal E2≥367pmol/L(100pg/ml), ovarian response is even worse, even if FSH15IU/L, pregnancy is not possible.
3. Indicators for monitoring follicular maturation and ovarian hyperstimulation syndrome (OHSS).
(iv) PRL
PRL is synthesized and secreted by eosinophilic PRL cells in the pituitary gland, and its secretion is unstable.
Therefore, according to this rhythmical secretion characteristic, blood should be drawn on an empty stomach at 9~10 a.m. If PRL is significantly elevated, it can be determined in one test; if PRL is mildly elevated, a second test should be performed, and hyperprolactinemia (HPRL) should not be easily diagnosed and abused with bromocriptine treatment.