Wednesday, May 18, 2011

What Testing Can be Done for RPL? #2

Moving onto homronal imbalances, such as FSH, LH, Estradiol, Progesterone, TSH, T4, Prolactin, (Fasting) Glucose and Insulin and Inhibin B.

FSH stands for Follicle-Stimulating Hormone. FSH is secreted from the pituitary gland and is responsible for stimulating the production of eggs and producing a hormone called Estradiol (E2), better known as estrogen, during the pre-ovulatory phase of the menstrual cycle. FSH & E2 are tested on cycle day 3 because typically this is when FSH peaks. If the FSH is below 12 and E2 is below 35 a fertile cycle is likely to occur. However, if the levels of FSH are above 12 and E2 is above 35 an unsuccessful cycle most likely will occur. This can be a good indicator antibodies are at play too.

LH or lutenizing hormone is responsible for giving us positive OPK's. This is because E2 reaches its peak around the day of ovulation which sends a signal to the pituitary gland to secrete LH. LH is responsible for triggering the ovary to release an egg. Normal results vary between 6-30 U/L. Typically LH tests are performed when a woman is going through IVF to determine when ovulation would occur but this could also determine: anovulation, ovarian failure, PCOS (polycystic ovarian syndrome), pituitary disorders and chromosomal abnormalities.

Progesterone (P4) should be low during preovulatory phase and increase post-ovulation. The corpus luteum is responsible for the progesterone after ovulation. The production of progesterone helps in aiding a blastocyte to implant to the uterine wall. Normal P4 values at cycle day 3 should be < 1.5 ng/ml and at 7 dpo should be > then 10-15. Low progesterone may indicate a luteal phase defect, meaning there are too few days between ovulation and menstruation.

Prolactin as many of us know is the milk secreting hormone. Elevated levels when not breastfeeding may interfere with ovulation and conception. Hyperprolactinemia is commonly associated with PCOS. Normal levels at cycle day 3 are <24 ng/ml.

Another important hormone test is thyroid testing which includes TSH (thyroid stimulating hormone) and T4 (thyroxine). TSH & T4 will help determine if hypothyroid (lack TSH &/or T4) or hyperthyroid (produce too much TSH &/or T4) conditions are present. TSH is produced by the pituitary gland and signals the thyroid to make hormones.

Symptoms of Hypothyroidism:

- Fatigue
- Weakness
- Weight gain or increased difficulty losing weight
- Coarse, dry hair
- Dry, rough pale skin
- Hair loss
- Cold intolerance (you can't tolerate cold temperatures like those around you)
- Muscle cramps and frequent muscle aches
- Constipation
- Depression
- Irritability
- Memory loss
- Abnormal menstrual cycles
- Decreased libido

Symptoms of Hyperthyroidism:

- Palpitations
- Heat intolerance
- Nervousness
- Insomnia
- Breathlessness
- Increased bowel movements
- Light or absent menstrual periods
- Fatigue
- Fast heart rate
- Trembling hands
- Weight loss
- Muscle weakness
- Warm moist skin
- Hair loss
- Staring gaze


Signs and symptoms vary due to severity and are different for everyone.

- 10 million AMERICANS have hypothyroidism.

- Approximately 10% of women suffer from some type of thyroid hormone deficiency.


A great resource I found while researching thyroid conditions; www.endocrineweb.com.

The fasting insulin and glucose is a test for diabetes. There are 2 types; Type 1 & Type 2. Type 1 Diabetes typically comes on gradually but symptoms develop quickly. With Type 1 Diabetes your body loses its ability to produce insulin. This increases glucose levels.

Signs & Symptoms of Diabetes Type 1 include:

- Extreme weakness and/or tiredness
- Extreme thirst—dehydration
- Increased urination
- Abdominal pain
- Nausea and/or vomiting
- Blurry vision
- Wounds that don’t heal well
- Irritability or quick mood changes
- Changes to (or loss of) menstruation
- Weight loss—despite eating more
- Rapid heart rate
- Reduced blood pressure (falling below 90/60)
- Low body temperature (below 97ยบ F)

There are actually two types of Type 2 Diabetes; insulin resistant and not insulin resistant. Insulin resistant means your body does not use insulin properly. If you are not insulin resistant it means your body does not produce enough insulin to break down glucose.


Signs & Symptoms of Diabetes Type 2 include:

- Fatigue
- Extreme thirst
- Frequent urination
- Extreme hunger
- Weight loss
- Infections
- Slow wound healing
- Blurry vision

Inhibin B is a protein hormone that is secreted by your follicles once FSH has worked hard to develop those follicles. Inhibin B inhibits the pituitary from secreting FSH and will reach a peak in early-mid follicle phase and then a second peak at ovulation. The test is performed on cycle day 3 as well. This test is a newer test for predicting ovarian reserve or quantity and quality of eggs. This seems to be a more reliable for predicting ovarian reserve over FSH.

The mean value of Inhibin B for normal women on day 3 of the menstrual cycle is 40 pg/ml and the 95% confidence interval of the mean is 33 to 45 pg/ml. Women undergoing IVF with day 3 Inhibin B concentrations less than 45 pg/ml have a pregnancy rate 70% less than women with day 3 Inhibin B concentrations greater that 45 pg/ml.

- Millenova Lab

Stay tuned for more tests.

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