Hormone testing or endocrine profile is generally performed during menstrual cycle day-3 to maximum day 7 through a blood test. Endocrine profile is a test for the hormones
Hormonal disturbances can occur in the brain, reproductive organs, thyroid and adrenal glands. But also other conditions like overweight or even underweight, chronic stress and extensive physical activity, lack of sun exposure to the skin could be causes for hormonal disturbances. This can lead to menstrual dysfunction affecting the egg maturation process and ovulation as well embryo implantation.
Follicle Stimulating Hormone (FSH): is produced by the pituitary gland and is the hormone which induces the follicular growth from small follicles to the mature ones.
Luteinizing Hormone (LH): similar to FSH, LH is also produced by the pituitary gland. The physiologic task of LH is to induce ovulation. Abnormally high levels on day 3 may indicate Polycystic Ovarian Syndrome (PCOS).
Estradiol (E2): is produced by the growing follicle, the bigger the follicle is, the higher the E2-level should be. In the beginning of the cycle low levels of E2 are expected, as there should not be a big follicle and levels on the lower end tend to be better for stimulating. Abnormally high levels on day 3 may indicate existence of a functional cyst.
Progesterone (P4): is the hormone which is produced by the luteal body or corpus luteum. The physiologic task of Progesterone is to create an environment, where the embryo will be able to implant.
Progesterone should be low in the first half (follicular phase) of the cycle and increase only in the second half (luteal phase) of the cycle. A premature increase of progesterone during the first half of the cycle will decrease the chance of implantation.
Prolactin: helps in milk production. Physiologically, its level is increased in women who are breastfeeding. An increased level due to other reasons like a Prolactinoma (a benign tumor which produces Prolactin), chronic stress or disturbances of the thyroid function can elevate the Prolactin level and therefore interfere with ovulation.
Moreover, very often, high levels of prolactin are diagnosed and treated unnecessarily, since many factors may interfere with the prolactin levels measured. Prolactin levels peak around 10 times per day in young adults with a marked day/night rhythm, highest during sleep and reaching a nadir during waking hours.
Time of measurement is thus important to standardise and is best undertaken in a fasting state in the morning. Measurement of levels during the day needs to be relatively precise as stress factors, exercise and eating can alter levels. In addition, there appears to be an annual variation with highest levels in March-May and lowest in September-November.
Thyroid Stimulating Hormone (TSH): is also produced in the pituitary gland. A high level of TSH combined with a low or normal T4 level generally indicates hypothyroidism, which can have a negative effect on fertility.
Free Thyroxine T4: this is the hormone produced by the thyroid gland. A low level may indicate a diseased function of the thyroid gland or may indicate a non-functioning pituitary gland which is not stimulating the thyroid to produce T4. If the T4 is low and the TSH is normal, that is more likely to indicate a pituitary problem.
Total Testosterone: even women have male hormones. Testosterone is secreted from the adrenal gland and the ovaries. High levels of Testosterone could lead to a male pattern of hair growth, especially on the upper lip and the chin, to hair-loss and development of acne. High levels will also interfere with the cycle regulation and the follicle growth.
In patients who are overweight or obese, there might be a link between the testosterone levels and the weight, so patients will benefit from weight loss. Some patients will even benefit from additional medication which is called Metformin (an Insulin sensitiser).
Dehydroepiandrosterone Sulfate (DHEA-S): this hormone is mainly produced by the adrenal gland. Elevated DHEAS-levels can also have a negative impact on the cycle regulation and can cause infertility. In patients with high DHEAS levels,tests have to be done to exclude genetic disease, which could affect a female baby already during pregnancy.
An elevated DHEAS level may improve through use of dexamethasone or prednisolone.
Anti-Müllerian hormone ( AMH ): is a protein, that has demonstrated to be useful in evaluating the ovarian reserve and predict the ovarian response. Higher AMH levels seem to be associated with greater chance of live birth after IVF, even after adjusting for age.
More information will be discussed in the outpatient clinic by our consultants. It is important to know, that an appropriate hormone test should be done between day 3 and day 7 of the cycle. So please book an appointment accordingly.
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