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

Ovulatory disorders, amenorrhea and other phenomena can occur in infertile infertility. 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 female endocrine function.

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

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

tEndocrine infertility check

1. Hormone determination

Radioimmunoassay (RIA) can be used to measure both steroid hormones and pituitary hormones. This immune response is highly specific and has high sensitivity and accuracy of isotopes, so it is widely used. For infertile women

Female, the following hormones are often tested.

Follicle-stimulating maturation hormone (FSH): A glycoprotein hormone secreted by basophilic cells in the anterior pituitary lobe. Its main role is to promote the development and maturation of ovarian follicles. The concentration of FSH during pre-ovulation is 1.5 - 10U/L

8 - 20U/L during ovulation and 2 - 10U/L in late ovulation. Low FSH values are common in estrogen, progesterone treatment, Sheehan's syndrome, etc. High FSH values are seen in premature ovarian failure, ovarian insensitivity syndrome, and primary ovarian failure

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Luteinizing hormone (LH): Also secreted by basophilic cells in the anterior pituitary lobe, it is a glycogen protein hormone. The main function is to promote ovulation, form corpus luteum and secrete hormones. LH concentration during pre-ovulation is 2 - 15U

/L, 20 - 100U/L during ovulation and 4 - 10U/L in late ovulation. Below 5U/L indicates low gonadotropin function and is common in Sheehan's syndrome. High FSH combined with high LH can determine ovarian failure.

LH/FSH≥3 is one of the basis for the diagnosis of polycystic ovary syndrome.

Prolactin (PR1): It is a simple protein hormone secreted by lactating trophoblast cells, one of the eosinophilic cells of the anterior pituitary lobe. The main function is to promote the proliferation of the breast, milk production and milk drainage. In non-nursing

During the

period, the normal value of PR1 is 0.08 - 0.92nmol/L. Higher than 1.0 nmol/L is hyperprolactinemia.

Estradiol (E2): secreted by the follicles of the ovary. The main function is to cause the growth of intrauterine glands to enter a proliferative period and promote the development of female secondary sexual characteristics. The concentration of E2 is 48 - 52lpmol/L during the ovulation period, and 37

0 - 1835pmol/L, and 272 - 793pmol/L in late ovulation. Low values are seen in low ovarian function, premature ovarian failure, and Sheehan's syndrome.

Progesterone (P): 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. platoon

The P value in the postoegg stage is low, which is seen in luteal dysfunction and ovulatory uterine dysfunctional bleeding.

Testosterone (T): 50% of the testosterone in women's body is converted from peripheral androstenedione, 25% is secreted by the adrenal cortex, and only a quarter comes from the ovaries. The main function is to promote the development of the clitoris, labia and pubis

It has an antagonistic effect on androgens and also has a certain impact on systemic metabolism. Women's plasma testosterone levels range from 0.7 to 2.1nmol/L, and high T values are called hypertestosteronemia, which can lead to female infertility.

2. Hormone function test

Progestogen test: Use 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; for example,

No uterine bleeding is a negative test, indicating that the estrogen level in the body is extremely low, the endometrium cannot grow, or there is a congenital lack of endometrium such as naive uterus, or the uterus due to tuberculosis, intrauterine adhesions, etc.

The inner membrane is destroyed.

Estrogen test: If the progesterone test is negative, an estrogen test should be performed. After stopping the drug, there was uterine bleeding, which belonged to second-degree amenorrhea, indicating dysfunction of the hypothalamic-pituitary-ovarian axis, resulting in low estrogen levels

If there is no uterine bleeding, uterine amenorrhea is indicated.

GnRH excitation test: Dissolve 50ug of GnRH (10 peptide) in 50ml of physiological saline and inject it intravenously. Blood was taken for 2ml 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 times higher than the base value;③ Delayed reactions, the peak occurred at 60 -

90 minutes;④ No response or weak response, no change in LH value 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, no response or low weak response in GnRH excitation test, which is common in the hand

Surgery or radiation to destroy pituitary tissue and Sheehan's syndrome;③ Ovarian dysfunction, high basic FSH and LH values, and active response to GnRH excitation test;④ Polycystic ovary syndrome, FSH baseline values are normal or low, and LH baseline values are lower than

High, LH responded actively in the GnRH excitation test, while FSH responded normally.

Clomiphene test: Starting from the fifth day of the menstrual cycle, take 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 the peak of LH occurs later, it will eventually lead to ovulation, which is an ovulation-type reaction. It can be confirmed by B-ultrasound monitoring and progesterone measurement in the luteal phase. Such as

There is no peak LH, no ovulation, that is, no response.

Response to the GnRH excitation test but no response to the clomiphene test suggests that the lesion is in the hypothalamus.

TRH

stimulation test: TRH 500ug intravenous injection, 30 minutes after the determination of PR1 value, normal TSH, PR1 peak. If the TSH base value is high, the response is enhanced, indicating hypothyroidism; the base value is low, and the response is weak

Hyperthyroidism. 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.

ACTH stimulation test: ACTH20mg was injected intramuscularly, and the urinary 17 -ketosteroid excretion was measured 24 hours before and 24 hours after injection. Polycystic ovary syndrome responds normally, but adrenal cortex functions differently

Both 17 -ketosterol and 17 -hydroxysterol were significantly increased in patients with chronic symptoms.

Dexamethasone inhibition test: Dexamethasone 0.5mg, once every 6 hours, for 2 consecutive days. The urinary 17 -ketosterol and 17 -hydroxysterol values were measured before and after administration. When the pituitary or adrenal cortex secretes hyperactivity, such as Cu

Patients with shing syndrome or adrenal cortical tumors will not decrease. This trial is suitable for patients with ovulation disorder and masculinity.