|
|
Abnormalities of ovulation may appear in several ways. Menstrual cycles shorter than 21 days or longer than 35 days are often associated with anovulation. In addition, patients may skip menstrual periods for time intervals of three months or more and this is called oligomenorrhea (infrequent periods). If the periods stop entirely, this is called amenorrhea.
Many hormonal systems work together to produce regular menstrual periods, and the blood levels of the hormones that make up these systems need to be tested in order to determine the reason for the ovulatory disorders.
The hormone blood tests, which are usually done on the third day of your cycle, include:
The FSH level gives a good idea of the ovarian reserve a index of the number of eggs remaining in the ovaries. A high FSH level suggests that the ovary has either failed or has started to fail. If the FSH level is very high (in the menopausal range) then the diagnosis is ovarian failure. If the level is elevated then some doctors will do a clomiphene stimulated FSH level which allows for an earlier diagnosis of failing ovaries. On the other hand, a low FSH level suggests hypogonadotropic hypogonadism. This seemingly verbose term simply means that the ovary in these patients is not working properly because of inadequate production of FSH by the pituitary gland. However, in most anovulatory patients, the FSH level will be in the normal range, and this can be reassuring.
This is the other gonadotropin hormone produced by the pituitary; and provides much the same information the FSH level does. Another useful test is the LH:FSH ratio, which is normally 1:1.
If, however, the LH level is much higher than the FSH level, this suggests a diagnosis of polycystic ovarian disease.
These tests for thyroid function. The thyroxine level is high in patients with overactive thyroid glands (hyperthyroidism). In patients with decreased thyroid function (hypothyroidism), the TSH level is increased.
Prolactin is a hormone produced by the pituitary gland that induces lactation or milk formation. High prolactin levels (hyperprolactinemia) can interfere with ovulation. A milky discharge from the breast nipple, not related to pregnancy or nursing, is called galactorrhea, and this is a telltale symptom of high prolactin levels and needs to be investigated. If the prolactin level is elevated, the doctor will need to recheck it to confirm it is persistently high. There are many reasons for an elevated prolactin level, including certain drugs as well as stress.
In some women, the reason for a high prolactin level can be a small tumor in the pituitary gland. This is called a prolactinoma or microadenoma, and the doctor may advise you to have an X-ray of the skull (or even a CT scan or MRI scan) to rule out this possibility. However, most infertile women with hyperprolactinemia can be easily treated with a medicine called bromocryptine, which is a dopamine agonist medication. Another medication which can be used to treat hyperprolactinemia is oral cabergoline, which is usually taken twice a week. Only if the pituitary tumor is very large (macroadenoma) is surgical removal needed, and this is very uncommon.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
