What tests need to be done for endocrine induced infertility

Endocrinology is the excessive or insufficient secretion of hormones from the pituitary and ovarian gonadal axis in the female hypothalamus due to endocrine disorders. Endocrinology infertility has brought to female friends. It should be paid close attention to by everyone. Endocrinology does not

Pregnancy can cause ovulation disorders, amenorrhea and other phenomena. Active examination and treatment are the key. How much do you know about endocrine infertility examinations?

Symptoms of endocrine infertility

Skin deterioration: Dark yellow skin color is one of the more obvious symptoms of endocrine infertility.

Emotional changes: Many women will experience symptoms such as impatience and large emotional changes, and will have unstable tempers and other reasons, which are caused by the decline of women's endocrine function.

Easily obese: Failure to pay attention to diet, unbalanced diet nutrition, etc. will have an impact on endocrine.

Gynecologic diseases: Endocrine diseases are common. Endometriosis, irregular menstruation, dysmenorrhea and other phenomena are all related to endocrine disorders.

tEndocrine infertility test

1. Hormone determination

Radioimmunoassay (RIA) can be used to measure both steroid hormones and pituitary hormones. Immune reactions are highly specific and isotopes have high sensitivity and accuracy, making them widely used. The following hormones are often tested for infertile women.

1. Follicle-stimulating maturation hormone (FSH) is a glycoprotein hormone secreted by basophilic cells of the anterior pituitary lobe. Its main function is the development and maturation of ovarian follicles. The concentration of FSH is 1.5-10U/L during pre-ovulation and 8-20U/L during ovulation

Late ovulation 2-10U/L. Low FSH values are seen in estrogen, progesterone treatment, Sheehan's syndrome, etc. High FSH values are seen in premature ovarian failure, ovarian insensitivity syndrome, primary amenorrhea, etc.

2. Luteinizing hormone (LH) is also a glycogen protein hormone secreted by basophilic cells of the anterior pituitary lobe. The main function is to promote ovulation and form lutein-secreting hormone. LH concentration, 2-15U/L during pre-ovulation and 20-100U/

L, 4-10U/L in late ovulation. Below 5U/L indicates low gonadotropin function, which is seen in Sheehan's syndrome. If high FSH and high LH are added, ovarian failure is very certain. LH/FSH> =3, it is diagnosed as polycystic ovary syndrome

One of the reasons for

.

3. Prolactin (PR1) is secreted by lactating trophoblast cells, one of the eosinophilic cells of the anterior pituitary gland. It is a simple protein hormone whose main function is to promote the proliferation of milk in the mammary gland and milk production. When not breastfeeding, PR1 is normal

The value is 0.08-0.92nmol/L. Higher than 1.0 nmol/L means hypercholesterolemia.

4. Estradiol (E2) is secreted by the follicles of the ovaries. The main function is to cause the intrauterine glands to grow into a proliferative period and promote the development of female secondary sexual characteristics. The concentration of E2 is 48-52lpmol/L during ovulation, and 370-1835pmol/L during ovulation.

Later period 272-793pmol/L. Low values are seen in low ovarian function, premature ovarian failure, and Sheehan's syndrome.

5. Progesterone (P) is secreted by the corpus luteum of the ovaries. The main function is to promote the transition of the endometrium from the proliferative phase to the secretory phase. The progesterone concentration is 0- 4.8 mmol/L during pre-ovulation and 7.6- 97.6 nmol/L during post-ovulation. P value is low in late ovulation, seen in

Luteal insufficiency, ovulatory uterine dysfunctional bleeding.

6. Testosterone (T) In women, 50% of testosterone is converted from peripheral androstenedione, 25% is secreted by the adrenal cortex, and only one-quarter comes from the ovaries. The main function is to promote the development of the clitoris, labia and pubis, and it is antagonistic to androgens

'seffect has a certain impact on systemic metabolism. Women's plasma testosterone levels are between 0.7 and 2.1nmol/L, and the T value is high, which is called hypertestosteronemia, which can cause female infertility.

2. Hormone function test

1. Progestogen test for progesterone or medroxyprogesterone. If there is uterine bleeding within 7 days after stopping the drug, the test is positive, indicating that there is enough estrogen in the body to allow the endometrium to grow into a proliferative phase, which belongs to degree I amenorrhea; if there is no uterine bleeding, it is a test

Negative indicates that the estrogen level in the body is very low, the endometrium cannot grow, or the endometrium is congenital lack such as naive uterus, or the endometrium is destroyed due to tuberculosis, intrauterine adhesions, etc.

2. If the estrogen test is negative, an estrogen test should be performed. After stopping the drug, uterine bleeding occurred, which belonged to second-degree amenorrhea, indicating hypothalamic-pituitary-ovarian axis dysfunction, resulting in low estrogen levels; if there is no uterine bleeding, then

Indication of uterine amenorrhea.

3. GnRH excitation test Dissolve 50ug of GnRH(10 peptide) in 50ml of physiological saline and inject it intravenously. Blood was taken before and 25, 45, 90, and 180 minutes after injection, and LH and FSH values were measured by radioimmunoassay.

Test results: ① In normal reactions, the LH value increased by 3 times higher than the base value, and the peak occurred 15-30 minutes after injection;② In active reactions, the LH value increased by more than 4 digits higher than the base value;③ Delayed reactions, the peak occurred 60-90 minutes after injection;④ None

Reaction or weak reaction, the LH value did not change after GnRH injection, or the LH value did not increase by twice the base value.

Clinical significance: ① Hypothalamic dysfunction, low FSH and LH base values, and normal response in GnRH excitation test;② pituitary dysfunction, low FSH and LH base values, and no response or weak response in GnRH excitation test, seen in surgery or radiation destruction

Pituitary tissue and Sheehan's syndrome;③ Ovarian dysfunction, high FSH and LH base values, and active response to GnRH excitation test;④ Polycystic ovary syndrome, normal or low FSH base value, high LH base value, and active GnRH excitation test

The response was abrupt, while FSH responded normally.

4. Clomiphene test Starting from the fifth day of the menstrual cycle, clomiphene 50-100mg/day for 5 consecutive days. Blood FSH and LH were measured 1, 3, and 5 days before taking the drug, and progesterone was measured on the 22nd day of the menstrual cycle.

After taking the drug for 3 days, the LH value increased by 85%, and FSH increased by about 50%. Both decreased after stopping the drug. If LH peaks occur again in the future, ovulation will eventually occur, which is an ovulation-type reaction. B-ultrasound monitoring and progesterone measurement in the luteal phase can be confirmed. If no peak LH occurs

Anovulation, that is, no response.

Responding to the GnRH stimulation test but not responding to the croffene test suggests that the lesion is in the hypothalamus.

5. TRH excitation test TRH 500ug was injected intravenously, and PR1 values were measured 30 minutes later. In normal conditions, both TSH and PR1 reached peak values. If the basic value of TSH is high, the response is increased, indicating hypothyroidism; if the basic value is low, the response is weak, the thyroid function

Advance. PR1 150ug/L indicates potential hyperprolactinemia. The PR1 value increased after the TRH test, but there was no response to chlorpromazine, indicating that the lesion was in the hypothalamus.

6. ACTH stimulation test ACTH20mg was injected intramuscularly 24 hours before and 24 hours after injection to measure the urinary 17-ketosteroid excretion. Polycystic ovary syndrome has normal responses, while adrenal cortex dysfunction has abnormal 17-ketosteroid and 1

7-hydroxysterol increased significantly.

7. Dexamethasone inhibition test Dexamethasone 0.5mg, once every 6 hours for 2 consecutive days. The decrease in urinary 17-ketosterol and 17-hydroxysterol values were measured before and after administration. When the pituitary or adrenal cortex secretions are hyperactive, as in Cushing syndrome

orpatients with adrenal cortical tumors did not decrease. This trial is suitable for patients with ovulation disorder and masculinity.