I. General knowledge of sex hormone examination
You should not use sex hormone drugs (including progesterone and estrogen) for at least one month and preferably three months before checking basic sex hormones, otherwise the results will not be reliable (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, and the first choice is to check the 2nd to 5th day of menstruation, called basal sex hormone level, which is best measured on the 3rd day. In cases of scanty menstruation and amenorrhea, if the urine pregnancy test is negative and there are no ≥10mm follicles in both ovaries with EM thickness of 5mm on vaginal ultrasound examination, it can also be done as the basal status.
II. Clinical significance of sex hormone examination
(A) FSH and LH: Basal value of 5-10 IU/L
1, ovarian failure: basal FSH 40IU/L, LH elevated or 40IU/L, for 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: suggest hypothalamic or pituitary hypofunction, and the distinction between the two needs to be made with the help of gonadotropin-releasing hormone (GnRH) test.
3, poor ovarian reserve (DOR): basal FSH/LH 2 to 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: The next cycle will be retested and 12 IU/L continuously indicates DOR.
5.Polycystic ovary syndrome (PCOS): Basal LH/FSH 2 to 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, check 2 times basal FSH > 20IU/L: can be considered as premature ovarian failure insidious stage, suggesting possible amenorrhea after 1 year.
(B) P: Basal value is usually <1ng/ml
1.Determination of ovulation: mid-luteal phase (21st day of menstruation for women with 28 days of menstrual cycle) P＞16nmol/L (5ng/ml) suggests ovulation, 16nmol/L (5ng/ml) suggests anovulation.
2.Diagnosis of luteal insufficiency (LPD): P32nmol/L (10ng/ml) at mid-luteal phase, or P measured 3 times on the 5th, 7th and 9th day after ovulation, and the total sum of 95.4nmol/L (30ng/ml) is LPD; or P47.7nmol/L (15ng/ml) before 10th week of pregnancy is the criterion for the diagnosis of LPD.
3. To determine the prognosis of in vitro fertilization-embryo transfer (IVF-ET): Pre-ovulatory P level can estimate the prognosis of IVF-ET. P ≥ 3.18 nmol/L (1.0 ng/ml) on the day of myeloablative HCG should be considered elevated, with decreased implantation rate and clinical pregnancy rate, and P 4.77 nmol/L (1.5 ng/ml) suggesting premature luteinization.
In IVF-ET long protocol ovulation promotion, even if there is no elevation of LH concentration on the day of intramuscular HCG injection, if P(ng/ml)×1000/E2(pg/ml) >1, it indicates premature follicular luteinization and the clinical pregnancy rate is significantly lower in this group of patients. Premature luteinization is also a manifestation of DOR.
4. Identification of ectopic pregnancy: blood P levels in ectopic pregnancy are low, with most patients having a blood P of 47.7 nmol/L (15ng/ml). Only 1.5% of patients have ≥79.5 nmol/L (25ng/ml). In normal intrauterine pregnancies P is 79.5 nmol/L in 90% and 47.6 nmol/L in 10%. blood P levels can be used as a reference in the differential diagnosis of intrauterine versus ectopic pregnancy.
(iii) E2: basal value of 25-45pg/ml
1.Basal E2＞165.2~293.6pmol/L (45~80pg/ml), regardless of age and FSH, indicates 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)
①To promote follicle expulsion, when follicle ≥18mm and blood E2 reaches 1100pmol/L (300pg/ml) during ovulation promotion treatment, stop HMG and inject HCG 10000IU on the same day or 24~36 hours after the last HMG injection.
②E23670pmol/L (1000pg/ml), OHSS usually does not occur.
③E29175pmol/L (2500pg/ml), a high risk factor for OHSS, timely discontinuation or reduction of HMG dosage and disabling HCG to support luteal function can avoid or reduce the occurrence of OHSS.
When E214800pmol/L (4000pg/ml), OHSS occurs in nearly 100% and can develop rapidly into severe OHSS.
(iv) PRL
PRL secretion is unstable, and its secretion status can be affected by emotion, exercise, sexual intercourse, hunger and eating, and there are small fluctuations with the menstrual cycle, with a rhythm related to sleep; PRL secretion increases in the short term after sleep, and rises in the afternoon compared to the morning. 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.
PRL ≥ 25ng/ml or higher than the normal value of this unit test is HPRL.
PRL 50ng/ml, about 20% have prolactinoma.
PRL100ng/ml, about 50% have a prolactinoma and may be selectively treated with pituitary CT or MRI.
PRL200ng/ml, often with microadenoma, must be done with pituitary CT or MRI.
Reduced PRL: Silhan syndrome, use of anti-PRL drugs such as bromocriptine, levodopa, VitB6, etc.
(v) Testosterone (T)
T is mildly to moderately elevated in patients with polycystic ovary syndrome (PCOS); ovarian or adrenal gland with androgen-secreting
T is elevated in patients with tumors, adrenal cortical hyperplasia and hirsutism.