Hormone Evaluation

Women are born with all the eggs in their ovaries that they will need for a reproductive lifetime. Each month, as part of the menstrual cycle, follicles develop on the ovaries. Each follicle contains one egg and its development is stimulated and supported by FSH, which is released by the pituitary gland under the influence of the hypothalamus.

The female reproductive processes involve complex interactions between several hormones ultimately leading to follicle recruitment, egg development, ovulation, and implantation. The hypothalamus can be thought of as the "reproductive hormone control center" functioning like a thermostat as it adjusts various hormone levels. During the first few days of the ovulatory cycle, the hypothalamus produces gonadotropin releasing hormone (GnRH), which stimulates the pituitary to produce follicle stimulating hormone (FSH). FSH causes follicular recruitment (each follicle contains one egg) and supports the follicles as they mature.

As healthy follicles mature they produce estrogen, which stimulates the development of the endometrium (lining of the uterus). The hypothalamus monitors these levels and, as they increase, reduces the production of GnRH thus lowering FSH production. Once the follicles mature, the hypothalamus signals the pituitary to release a surge of luteinizing hormone (LH) that triggers ovulation 36 hours later.

After ovulation, the remaining follicular structure forms the corpus luteum, which begins production of progesterone. Once the placenta develops, it also begins to produce progesterone to support the developing fetus.

Ovulation- There are several ways to document and predict ovulation including basal body temperature charts, urinary test kits, ultrasound measurements, and assessment of progesterone hormone levels.

Hormone Evaluation, Egg Quality- Day 3 Values

Egg Quality- A blood sample is taken on day three and levels of FSH and estrogen are measured. An elevated FSH level (>12 mcg/ml) indicates reduced "ovarian reserve" and is associated with a reduced change of achieving pregnancy. Ovarian reserve can be thought of as the "quality" of the eggs remaining in the ovaries. When the FSH level is abnormally elevated it usually indicates reduced ovarian reserve, or the likelihood that the eggs will not fertilize and develop properly. The best course of treatment to produce a child related to the husband is usually donor egg IVF. We have an active donor egg program in Baton Rouge, Louisiana that serves New Orleans and the surrounding region.

Basal Body Temperature - BBT Charting

Before the advent of urinary LH test kits, BBT charting was the best means to predict ovulation. Some physicians still recommend BBT measurements because it is less expensive. The BBT is the temperature taken upon waking in the morning, prior to getting out of bed. There is a slight rise in body temperature (of 0.4 to 1.0 degrees) Fahrenheit) after ovulation due to progesterone production by the corpus luteum. BBT charting allows the patient to predict the cycle day of the temperature increase and begin regular intercourse approximately 2-3 days prior to ovulation. BBT charting is much less accurate then the urinary test kits as body temperatures can be affected by numerous factors unrelated to ovulation.

LH Urinary Test Kits

Once the eggs mature, the hypothalamus signals the pituitary gland to release a surge of luteinizing hormone (LH). This surge causes ovulation 36 hours later. The increase in LH is detectable in the urine using urinary test kits. LH detectable in the urine means LH has been in the blood supply for several hours. If one tests negative one day and positive the next day, we can assume the surge began within the last 24 hour period. If we arbitrarily divide that 24 hours by 2 to say the surge began 12 hours earlier, we can subtract 12 hours from 36 hours and conclude that ovulation will occur about 24 hours after the detectable urinary LH surge.

Prolactin

Prolactin is known as the "breast milk hormone" because elevated levels stimulate breast milk production in pregnant women. Elevated prolactin levels (hyperprolactinemia) in the absence of pregnancy also cause breast mild production and anovulation. Hyperprolactinemia is often caused by a small nonmalignant tumor located on the pituitary. Surgical treatment to remove the tumor is usually effective in lowering prolactin levels. Parlodel (bromocriptine) is a medication that also reduces prolactin levels.

Progesterone

After ovulation, the "leftover" follicle forms a structure known as the corpus luteum. The corpus luteum produces progesterone to help the implanting embryo and functions until the placenta begins to produce progesterone. Progesterone levels are one indication that "quality" ovulation occurred. Additional progesterone is administered in IVF cycles because the ovulation induction drugs interfere with its natural production.

Endometrial Biopsy

The endometrial biopsy is performed near the end of the menstrual cycle and examines the thickness and vascularity of the endometrium (uterine lining). The endometrium must develop properly to support embryonic and fetal development.
A small sample of the endometrium is obtained by biopsy in our office. If the cellular development correlates with the cycle day, the biopsy is "in phase". If it does not correlate, a luteal phase defect may be present. A luteal phase defect can often be treated effectively with progesterone supplementation.

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