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 check can not be used at least one month before the basic sex hormone check (including progesterone and estrogen), otherwise the results are not reliable (except for the sex hormone check 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. Progesterone can be checked without 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, you should check 6 items to prevent misdiagnosis (according to P data you can roughly determine the period of menstrual cycle).
In cases of scanty menstruation and amenorrhea, a negative urine pregnancy test, absence of ≥10 mm follicles in both ovaries on vaginal ultrasound, and EM thickness of 5 mm can also be done as basal status.
The basal sex hormone laboratory test should be looked at in this way: the normal values of basal LH and FSH are 5-10 IU/L, and the normal value of basal E2 is 25-50 pg/ml (these 3 results should not look at the reference values on the laboratory test, but according to this standard); PRL and T can be compared with the reference values on the laboratory test of the hospital, and the normal value of P is shown later.
B. Clinical significance of sex hormone examination (a) FSH and LH: the basic value is 5-10 IU/L normal menstrual cycle, early follicular (2-3 days of menstruation) blood FSH, LH are maintained at low levels, rapidly rising before ovulation, LH up to 3-8 times the basic value, up to 160 IU/L or even higher, while FSH is only about 2 times the basic value, rarely 30 IU/L, after ovulation 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 and elevated LH or 40IU/L are considered as hypergonadotropic (Gn) amenorrhea, i.e. ovarian failure; if it occurs before the age of 40, it is called premature ovarian failure (POF).
2, Both basal FSH and LH 5IU/L are 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/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, retested in the next cycle, 12 IU/L continuously indicates DOR.
5.Polycystic ovary syndrome (PCOS): basal LH/FSH 2 to 3, which can be used as the main indicator for the diagnosis of PCOS (basal LH level of 10 IU/L is considered elevated, or LH maintains normal level while basal FSH is relatively low level, which 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 generally <1ng/ml Normally, blood P during follicular phase has been at a low level, average 0.6~1.9nmol/L, generally <10nmol/L (3.15ng/ml); when LH peak appears before ovulation, P secretion starts to increase, after ovulation ovarian corpus luteum produces a large amount of P, blood P concentration rises rapidly; when corpus luteum matures (6~8 days after LH peak At the time of luteal maturation (6~8 days after LH peak), blood P concentration reaches a peak of 47.7~102.4 nmol/L (15~32.2 ng/ml) or higher, and then declines continuously, reaching the lowest level in the premenstrual period. The P content of peripheral blood in the whole corpus luteum changes parabolicly.
1.Determination of ovulation: P > 16nmol/L (5ng/ml) in the mid-luteal phase (21st day of menstruation for women with a 28-day menstrual cycle) 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: the basal value is 25-45pg/ml in normal menstrual cycle, the E2 is about 183.5pmol/L (50pg/ml) in early follicular phase, reaches the first peak before ovulation, up to 917.5-1835pmol/L (250-500pg), decreases rapidly after ovulation, and forms the second peak in luteal phase, about 458.8pmol/L ( After a period of maintenance, the luteal phase drops to the early follicular phase level, which should be 91.75~183.5pmol/ml (25~50pg/ml) on the 3rd day of menstruation.)
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) ①Promoting follicular discharge: when follicles ≥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.
④E214800pmol/L(4000pg/ml), nearly 100% of the occurrence of OHSS, and can quickly develop into severe OHSS.
(iv) PRLPRL is synthesized and secreted by the eosinophilic PRL cells of the pituitary gland. PRL secretion is unstable, and its secretion status can be affected by emotion, exercise, sexual intercourse, hunger and food. 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) T is mildly to moderately elevated in patients with testosterone COS; T is elevated in ovarian or adrenal glands with androgen-secreting tumors and hirsutism.