An important step before starting hormonal treatment aimed at restoring the correct hormonal balance in a woman’s body is to necessarily establish the cause of certain disorders and resolve the issue of identifying contraindications to this type of treatment. In our clinic, for the competent management of such patients, gynecologists-reproductologists and endocrinologists must collaborate to achieve the maximum effect from the therapy! With us you can quickly undergo an examination of any degree of complexity to diagnose endocrine (hormonal) infertility and get a consultation with a specialist doctor based on the results of the tests!
Hormonal methods of treating infertility are widely used to normalize the functioning of the endocrine (hormonal) system of a woman’s body and normalize reproductive function and include three main areas:
- Normalization of the functions of the endocrine system, restoring the functioning of the adrenal glands, thyroid gland and other organs responsible for the production of important hormones involved in the regulation of a woman’s menstrual cycle. Most often, when examining patients with infertility, a reproductive specialist has to deal with changes in the levels of substances that can affect the process of ovulation, and therefore the onset of pregnancy. These biologically active substances include prolactin, produced in the central nervous system by the cells of the anterior pituitary gland. An increase in prolactin can lead to anovulatory (lack of ovulation and release of the egg from the ovary) infertility or miscarriage. In this case, therapy with drugs such as bromocriptine, cabergoline, quinagolide and others may be prescribed. An important point in preparing for pregnancy is identifying an insufficient balance of thyroid hormones, and therefore hormonal preparations containing thyroid hormones (euthyrox, L-thyroxine) come to our aid. Regulation of the adrenal glands also requires, in some cases, the prescription of hormonal preparations in cases of increased levels of androgens (male hormones) in a woman’s blood, in diseases such as adrenal cortex dysfunction.
- Replacement of the hormonal function of the ovaries when their work is insufficient, and therefore a decrease in hormone production. Hormone replacement therapy is prescribed for conditions such as ovarian wasting syndrome, menstrual irregularities, accompanied by insufficient endometrial growth or insufficient production of the main female hormones progesterone and estrogens. The administration of drugs containing these active biological substances leads to the normalization of hormonal balance.
- Stimulant, aimed at stimulating ovarian function. The goal of such therapy is to restore the processes of follicle maturation and activate ovulation - the release of an egg from the ovary.
Indications for ovarian stimulation
- For infertility caused by lack of ovulation (impaired release of the egg from the ovary), which cannot be treated for more than 1 year before 30 years of age and more than 6-8 months after 30 years of age.
- In the absence of pregnancy after surgical treatment for 6 months (PCOS, external genital endometriosis).
Conditions for holding
- Assessment of the patency of the fallopian tubes using ECHO-GSS (hysterosalpingography), x-ray of the fallopian tubes (the conclusion confirming their patency is no more than 1 year old);
- Confirmation of the absence of a mature follicle (17 mm or more in diameter) on days 11-16 of the cycle or the absence of the corpus luteum on days 19-23 of the cycle.
- Determination of hormone levels on the 2-3rd day of the menstrual cycle (TSH - thyroid-stimulating hormone, FSH - follicle-stimulating hormone, LH - luteinizing hormone, testosterone, DHEA-S, 17-OP-hydroxyprogesterone, estradiol, prolactin), study of progesterone levels at 18-23 -th day of the cycle;
- Detection of the LH peak preceding ovulation using home urinary ovulation tests (Kliaplan test, EVITEST test, Frautest test, Clearblue test) on days 11-16 of the cycle.
- Absence of malignant neoplasms;
- Absence of acute inflammatory diseases of the pelvic organs and exacerbation of chronic forms at the start of stimulation;
- Absence of exacerbation of chronic diseases of other body systems at the time of stimulation of ovarian function;
- No problems with the patency of the fallopian tubes and the thickness of the mucous membrane of the uterine cavity.
Options for achieving pregnancy against the background of hormonal stimulation of ovarian function
- Ovulation induction (programmed conception). Prescribing drugs that stimulate follicle growth, administering drugs that induce ovulation, and determining the most favorable days for conception;
- Induction of ovulation in combination with artificial insemination with the sperm of the husband or donor. When combined with clomiphene citrate and urinary gonadotropins to stimulate the ovaries, the effectiveness of pregnancy increases from 4.3% to 18.8% compared to the natural cycle; according to foreign authors, up to 21.6%.
Groups of drugs used to stimulate ovarian function
- Antiestrogens (clomiphene citrate - Clomid, clostilbegit) 25 mg, 50 mg, 100 mg;
- Gonadotropins;
- Human menopausal gonadotropins (HMG) (contains FSH and LH), example Menopur, containing FSH 75 IU and LH 75 IU;
- Human chorionic gonadotropins (HCG) example, Horagon, Pregnyl (1500IU, 5000IU);
- Recombinant gonadotropins (higher degree of purification, no risk of infectious complications) rFSH preparations, example Gonal-F (75, 150 IU, etc.).
Indications for the use of clomiphene citrate
- Age up to 30 years
- Menstrual irregularities for no more than 5 years
- Duration of infertility no more than 2 years
- Menstrual irregularities
- No signs of ovulation based on pelvic ultrasound and urinary ovulation tests.
- Before starting to take the drug, it is recommended to study liver function, due to the fact that the metabolism of the drug is associated with the functioning of this organ.
- The drug should not be prescribed to women without prior hormonal examination, gynecological examination and exclusion of diseases of organs such as the thyroid gland, adrenal glands, pituitary gland (part of the brain).
- Before starting to use the drug, all other causes of infertility not related to ovulation disorders should be eliminated.
- If ovarian enlargement or cystic changes occur while taking the drug, treatment should be discontinued until the size of the ovaries returns to normal. In the future, you can resume taking it, but at the same time reduce the dose of the drug or the duration of treatment.
- When using clostilbegit, ultrasound monitoring or folliculometry is necessary to assess the size of the dominant follicle in the ovary and record the process of completed ovulation.
- Drug stimulation of ovulation increases the likelihood of developing multiple pregnancies.
- The drug should be prescribed with caution or replaced with other medications in women with galactose intolerance, lactase deficiency or glucose malabsorption, because Each tablet contains 100 mg of lactose.
- This medicine affects the ability to drive vehicles and operate machinery, due to the potential impact on the visual organs.
The problem of infertility is becoming especially relevant in the modern world. Many negative factors affect the human reproductive system. Even during intrauterine development, the fetal genitals are exposed to pathological influences through the mother’s blood (tobacco smoke, taking medications, unbalanced diet, infections). Further, the negative influence of the environment only intensifies. The number of so-called “infertile marriages” is growing all over the world. The World Health Organization calls this a marriage where a woman does not become pregnant after a year of regular sexual activity without contraception. One of the main ones is the hormonal factor. So in women, endocrine disorders are the cause of infertility in 35-40% of all cases, and in men - in 8-12%.
Hormonal infertility in women The basis of hormonal infertility in women is a violation of the ovulation process. Normally, in a non-pregnant woman of childbearing age, an egg matures monthly in the ovaries. Then fertilization and pregnancy may occur. Lack of ovulation (anovulation) occurs when the process of selection, growth and maturation of the dominant follicle in the ovaries is disrupted. The ovaries change their normal structure to polycystic (multifollicular). Such ovaries begin to produce excess amounts of androgens (male sex hormones), and the overall production of sex hormones decreases. Anovulation occurs in polycystic ovary syndrome, adrenogenital syndrome, hyperprolactinemia, hypothyroidism, hypogonadotropic hypogonadism, and insufficiency of hormonal function of the corpus luteum.
Diagnosis of hormonal infertility
Anovulation and, accordingly, infertility can occur with a regular menstrual cycle, but are more often observed in the form of a long absence of menstruation. Basal body temperature remains monotonically low throughout the month. During ultrasound examination, dominant follicles and the corpus luteum are not found. During a hormonal examination, a woman most often reveals normal levels of pituitary hormones: FSH (follicle-stimulating) and LH (luteinizing). There is no LH peak in the middle of the cycle. Depending on what disease led to the development of anovulation, disturbances in other hormones may be detected. In hypothyroidism, high levels of thyroid-stimulating hormone (TSH) and a decrease in thyroid hormones (T4 and T3) are found. With hyperprolactinemia, an increase in prolactin in the blood is detected. Hypogonadotropic hypogonadism is characterized by low levels of FSH, LH, and estradiol.
Diagnosis of hormonal causes of infertility is carried out jointly by a gynecologist and an endocrinologist. Particular attention is paid to the most common pathologies - polycystic ovary syndrome, hypothyroidism, hyperprolactinemia. Hormonal testing is prescribed several times during the menstrual cycle. Ultrasound diagnostics is also recommended at least twice. An ultrasound of the thyroid gland, adrenal glands, computed tomography or magnetic resonance imaging of the pituitary gland may be needed.
Treatment of hormonal infertility
Hypothyroidism is treated with thyroid hormones (usually L-thyroxine). If the cause of infertility is prolactinoma, conservative therapy (currently most often cabergoline) or surgical treatment is selected. In the event that hormonal infertility is a consequence of adrenogenital syndrome, it is prescribed. Insufficiency of the corpus luteum is corrected by prescribing progesterone drugs. Treatment of polycystic ovary syndrome begins with lifestyle changes, diet therapy, and normalization of body weight. Metformin is often prescribed to overcome insulin resistance.
In general, treatment of endocrine forms of infertility is based on restoring ovulation. Ovulation is stimulated using hormonal drugs (after tubal patency is established). Stimulation of ovulation can be direct or indirect.
Indirect stimulation of ovulation is possible in two ways. Firstly, combined oral contraceptives are prescribed for 3-4 cycles in a row, followed by their discontinuation. After stopping the drug, the level of your own gonadotropic hormones (FSH and LH) increases, as the so-called “rebound effect” develops. Against this background, the likelihood of ovulation and pregnancy increases. Secondly, it is possible to use clomiphene. This drug blocks estrogen receptors, which causes an increase in FSH and LH levels. Lack of sensitivity to the drug is an indication for direct stimulation of ovulation.
To directly stimulate ovulation, preparations of gonadotropic hormones are used. These include drugs from the urine of menopausal women (menotropins), from the urine of pregnant women, and genetically engineered gonadotropins.
In the event that treatment with these methods of hormonal infertility turns out to be ineffective, the question of.
Hormonal infertility is the inability to conceive a child due to improper production of hormones responsible for reproductive function. In women, this condition is associated with anovulation; in men, it often goes along with erectile dysfunction..
A combined form of infertility cannot be ruled out, when disorders are detected in both partners. Timely detection and correction of hormonal abnormalities significantly increases the chances of conceiving a child in such a couple.
| Hormone | Effect on the reproductive system |
|---|---|
| Follicle stimulating hormone (FSH) | In women: stimulates the development of follicles, affects the synthesis of estradiol and testosterone. In men: enhances testosterone production, affects sperm maturation and potency |
| Luteinizing hormone (LH) | In women: triggers ovulation, initiates the formation of the corpus luteum and the production of progesterone, promotes the production of estradiol and androgens. In men: affects testosterone synthesis and spermatogenesis |
| Prolactin | In women: reduces estrogen levels, prevents ovulation, ensures milk production in the mammary glands. In men: reduces testosterone synthesis |
| Estradiol | In women: regulates the menstrual cycle and the onset of ovulation, has a feminizing effect on the body. In men: affects metabolism |
| Progesterone | In women: prepares the uterus for implantation, affects the start of menstruation. During pregnancy, it ensures gestation of the fetus: it reduces the tone of the uterus and inhibits the immune response. In men: affects metabolism |
Testosterone | In women: affects the synthesis of estrogen. In men: regulates spermatogenesis and influences sexual behavior |
| DHEAS | Affects the production of estrogens and androgens |
| Anti-Mullerian hormone (AMH) | Marker of ovarian reserve in women and sperm quality in men |
| Thyroid hormones (TSH, T4, T3) | Affect the functioning of the gonads and the production of hormones |
Causes of hormonal infertility
Hormonal infertility is associated with insufficient or excessive production of certain hormones that affect the functioning of the gonads.
Causes of female infertility
Insufficiency of the hypothalamic-pituitary system:
- damage to the pituitary gland or hypothalamus;
- hyperprolactinemia;
- luteal phase deficiency.
Ovarian insufficiency:
- gonadal dysgenesis;
- polycystic ovary syndrome;
- resistant ovarian syndrome;
- ovarian wasting syndrome;
- hyperandrogenism of ovarian origin;
- iatrogenic damage to the gonads.
Damage to other organs:
- congenital insufficiency of the adrenal cortex;
- thyroid diseases.
Causes of male infertility
Key factors:
- Damage to the hypothalamic-pituitary system.
- Testicular damage.
- Disruption of the thyroid gland and adrenal glands.
Common reasons
The direct damaging factor in men and women may be one of the following conditions:
- genetic abnormalities;
- injuries to the bones of the skull and genitals;
- tumors;
- infectious lesion;
- metabolic disorders;
- severe somatic diseases;
- radiation exposure;
- taking medications.
Analyzes, diagnostics
The leading sign of hormonal infertility in women is anovulation. The follicles do not mature in the ovaries, ovulation does not occur, and conceiving a child becomes impossible. With chronic anovulation, infertility is often mixed and is associated not only with hormonal disorders, but also with other factors.
An imbalance of hormones leads to pathology of the tone of the fallopian tubes, affects the condition of the endometrium and cervical mucus and creates additional obstacles to conceiving a child.
Hormonal infertility in men is often combined with changes in sexual behavior, decreased libido and erectile dysfunction. Combination with other forms of infertility is possible.
Both men and women may have an asymptomatic course of the pathology. The only complaint in this case is the inability to conceive a child after a year or more of regular sexual activity without the use of contraception.
Many forms of hormonal infertility are combined with impaired development of the genital organs and secondary sexual characteristics. A general examination, a special examination by a gynecologist/andrologist and an ultrasound can help clarify the diagnosis.
To identify the cause of the pathology, the hormonal profile is determined:
- FSH and LH;
- prolactin;
- testosterone;
- DHEAS;
- anti-Mullerian hormone;
- thyroid hormones: TSH, T3, T4.
Women are additionally prescribed:
- estradiol;
- progesterone.
Rules for donating hormones to women:
- With a regular menstrual cycle, progesterone is released on the 21-23rd day of the cycle, the remaining hormones - on the 2-3rd day of the cycle.
- In case of an irregular cycle, the day for donating progesterone is calculated individually.
- If you have amenorrhea, tests can be taken on any day of the cycle.
Men take tests on any convenient day.
Diagnosis of hormonal infertility is carried out simultaneously with the search for other causes of this condition.. Combined forms of infertility are often detected in both men and women.
Treatment
Therapy includes several stages:
- Elimination of the cause of hormonal imbalance: selection of medications, surgical treatment.
- Correction of concomitant endocrine disorders (including normalization of body weight).
- Creating optimal conditions for conceiving a child.
In women, the main goal of therapy is to restore the menstrual cycle and ovulation. Hormonal drugs based on estrogens and gestagens are prescribed for a course of several months. Next, follicle maturation is monitored.
If there is no effect, drug stimulation of ovulation is indicated. If it is not possible to conceive a child within a year, a diagnostic laparoscopy is performed. Infertility is often caused by a combination of endocrine and tubo-peritoneal factors. IVF is possible.
In men, the main goal of therapy is to restore normal spermatogenesis. Hormonal medications are prescribed taking into account the identified cause of infertility and the level of one’s own hormones. Surgical correction is performed according to indications. If infertility cannot be treated, IVF + ICSI or IVF with donor sperm is indicated.
Infertility is a scary diagnosis for many. But not everyone knows that it can be relative. The causes of infertility are different: chronic inflammatory diseases of the reproductive organs, congenital or acquired pathologies. Hormonal imbalance can lead to infertility, and not only in women. This form of pathology is the most common. If there is a deficiency or excess of hormones in case of infertility in women, the disease can be cured. The main thing is not to do this yourself, so as not to further aggravate the situation.
In order for a doctor to make a correct diagnosis, he is required to take a hormone test for infertility. Here you need to take into account the patient’s age, time of year, time of day, as well as the day of the menstrual cycle, what food was consumed the day before, and what the woman’s emotional state was.
The process of regulating reproductive function in girls is not easy. It is provided by three organs: the hypothalamus, pituitary gland and ovaries, and they must interact smoothly with each other. They are responsible for a woman’s ability to get pregnant normally, carry a baby to term and give birth to it.
The doctor is obliged to do not only a female hormonal profile in case of infertility. The role of the girl's partner is important. It is necessary to know what hormones men give in case of infertility, because the reason for the impossibility of conception may lie not only in the woman. Their background may also change due to certain diseases of the reproductive system.
It is also important to know what day is the best time to take hormones for infertility. So, a woman will have to undergo the following tests:
- estrogen;
- luteinizing hormone and FSH;
All of them are produced in both men and women, only in different concentrations.
Function OK
One hormone is responsible for the process of sperm maturation and male strength, the other stimulates lactation and ensures the normal development of pregnancy. All hormones must be contained in the body within normal limits. For example, testosterone is responsible for the process of sperm maturation and male strength, but its excess disrupts these body functions.
Estrogen levels
Estrogens are hormones responsible for conception and pregnancy preservation. Estradiol plays an important role here. It prepares the endometrium of the uterus for pregnancy. It is produced by the ovaries and adrenal glands. Most estradiol is secreted by the maturing follicle.
A day after reaching its maximum concentration, the woman ovulates. After the release of the egg, the amount of this hormone decreases significantly. This hormone must be in balance with testosterone. Below is a table with age-specific estradiol standards.
The test is not affected by the day of the menstrual cycle - estradiol is secreted all the time. Another hormone responsible for the normal course of pregnancy, maintaining optimal blood circulation in the uterus, and ensuring the flow of breast milk is estriol.
Progesterone norm
If it is important what tests are taken during certain periods of the menstrual cycle, then a study of progesterone levels is carried out on the 20th day. Normally, this hormone prepares the endometrium for the attachment of a fertilized egg. Below is a table of progesterone norms depending on the phase of the cycle and age.
Testing for progesterone is an important period during pregnancy, because it ensures its preservation and normal development. If a woman produces insufficient progesterone, she is guaranteed infertility.
Normal FSH and LH
LH (luteinizing hormone) is produced by the ruptured follicle, the corpus luteum of the ovary. Its amount strictly depends on the day of the menstrual cycle. The maximum level of LH in the blood is observed one day before ovulation. If conception has occurred, then during pregnancy the concentration of LH gradually decreases. Its concentration is determined on days 3-8 or 19-21 of the menstrual cycle.
The hormone presented is responsible for the formation of the corpus luteum. It concerns FSH, it controls the maturation of follicles, renewal of the endometrium in the uterus, and affects the production of estrogen. Blood testing is required on the 19-20th day of the cycle.
HCG is normal 
Chorionic gonadotropin indicates pregnancy. In the first 12 weeks, its level increases rapidly. Every day it doubles in relation to the previous amount. Thanks to this hormone, the development of the embryo occurs. It also controls the production of all other substances in the body, without which the normal development of pregnancy is impossible. At the beginning of the 2nd trimester, the necessary hormonal activity is provided by the placenta, so the level of hCG decreases.
What is prolactin for?
Prolactin is not only involved in the ovulation process, but is also responsible for the production of breast milk after childbirth. Its level changes throughout the day. Its highest concentration is during sleep. To determine its level, it is necessary to donate blood on the 3-5th day after the start of menstrual bleeding.
The male sex hormone in the female body is testosterone. It is produced by the adrenal glands and ovaries. If it is in balance with estrogens, then there should be no problems with pregnancy.
Hormonal changes
Hormone tests for infertility will help you quickly understand the causes of problems with conception. Moreover, they need to be taken not only by women, but also by men. Their results may be normal or show elevated (low) levels. It is important to know not only what hormone tests are necessary for infertility, but also what a deviation from the norm means.
Estrogens
The test may show increased or decreased estrogen levels. This provokes not only menstrual irregularities, which prevents a woman from becoming pregnant. They are the ones who take part in preparing the uterus for implantation of the fertilized egg. Women also develop pathologies of the reproductive organs: tumors, fibroids, fibroids.
With a critical decrease in estrogen levels after conception, premature birth occurs or there is a threat of natural termination of pregnancy. A woman's sex drive decreases and menstruation becomes irregular.
A decrease in levels during pregnancy indicates the development of Down syndrome in the baby and the presence of infection in the intrauterine space. The corpus luteum in the ovary does not develop enough.
Progesterone
Progesterone is the main sex hormone in the female body, so its deficiency negatively affects the possibility of conception. The cell cannot gain a foothold in the uterus because the endometrium is not prepared. A woman begins to have menstrual bleeding.
FSH and LH
The cause of improper ovulation is often a tumor of the pituitary gland (malignant or benign), ovarian wasting syndrome, polycystic disease, endometriosis, and chronic insufficient functionality of the reproductive organs. At the same time, an increase in LH levels is noted. It can be provoked by irrational diets and too much physical activity. If the eggs do not mature, the woman will not ovulate and will not be able to get pregnant.
Prolactin
If the amount of prolactin decreases sharply, then the woman does not ovulate, and without it pregnancy is impossible. An increased amount of it also leads to problems with conception. The patient experiences discharge from the mammary glands that is not associated with pregnancy. She may gain weight and develop secondary amenorrhea. Also, changes in prolactin levels contribute to the appearance of osteoporosis and mastopathy.
hCG
Abnormally altered hCG levels negatively affect a woman’s ability to bear a pregnancy. This hormone blocks the menstrual cycle and activates the synthesis of other substances necessary for the normal bearing of a child. In the absence of pregnancy, a tumor or ectopic location of the fertilized egg can provoke an increase in hCG levels.
Testosterone
If in women its amount in the blood exceeds the normal value, then ovulation will not occur. The woman's body will begin to change according to the male type. Excessive amounts of the hormone present inhibit the function of estrogen. If there is a low concentration of testosterone in a man, then he will be diagnosed with sexual impotence.
A pregnant woman with elevated hormone levels experiences a spontaneous miscarriage in the first trimester. With a significant increase in the amount of testosterone in a man, he becomes irritable and very aggressive.
Treatment
Correct diagnosis is very important for the correction and treatment of hormonal disorders. Before the study, you should not consume food or water since the previous evening.
To treat infertility caused by hormonal imbalance, appropriate medications are used. If the means are chosen correctly and the dosage is followed, then a positive effect can be achieved after a few months. Only a specialist has the right to prescribe medications based on the results of infertility studies.
During the therapy period, the patient must pay attention to her general well-being, mood, and changes in body weight. The drugs are used even before pregnancy occurs. However, after conception they are not always canceled. The safety and correct development of pregnancy may depend on them.
Stimulant therapy
It is intended to activate the work of the endocrine glands, which produce the necessary sex hormones. The time of therapy is strictly limited. It is also possible to treat infertility in courses with breaks between them.
Stimulating therapy is intended to restore the functionality of the ovaries or normalize the functioning of the hypothalamus. A woman may be prescribed medications based on the following substances:
- gonadotropic hormones;
- estrogens.
You cannot use hormonal medications on your own or change their dosage. This will further upset the delicate balance.
Replacement therapy
It is needed if a woman is diagnosed with infertility, in which the production of necessary hormones is inhibited. This therapy is most often prescribed for life. Treatment drugs contain synthetic or natural hormone.
To regulate the menstrual cycle and be able to get pregnant, a woman is prescribed the following medications:
- Folliculin;
- Sinestrol;
- Estradiol-Dipropionate.
Hormone replacement therapy for the treatment of infertility is carried out at least 3-5 cycles in a row. Hormonal therapy is prescribed very carefully so as not to provoke an even greater imbalance. The dosage is calculated so that there is no excess substance in the body.
Female infertility can be caused by anovulation, in which a failure occurs in the process of maturation of the egg and the ability of its release from the follicle.
The concept of “endocrine infertility” in women is a collective term that includes a variety of disorders. Regardless of the reasons that cause them, the basis is a dysfunction, which leads to a persistent absence of ovulation or its irregularity.
The causes of anovulation are endocrine diseases directly related to pathology of the brain, thyroid gland and adrenal glands. Endocrine disorders can also affect a woman’s reproductive system, causing so-called hormonal infertility.
Disorders
These disorders include:
- Hypothalamic-pituitary dysfunction. The hypothalamus and pituitary gland are responsible for regulating the menstrual cycle. Failure in the functioning of these parts of the brain leads to disturbances in the production of hormones. In particular, there is an increase in prolactin levels.
- Polycystic ovary syndrome. The ovaries produce too much male hormones, which leads to the inability to ovulate and the formation of cysts.
- Hyperandrogenism. In this case, the amount of male sex hormones in the woman’s body is higher than normal.
- Improper functioning of the thyroid gland.
- Early menopause(ovarian exhaustion).
- Resistant ovarian syndrome. The ovaries stop responding to the action of hormones that stimulate the timely maturation of the egg.
Diagnosis of hormonal infertility
Functional diagnostic tests are used in medicine to determine the hormonal activity of the ovaries. With their help, the presence of ovulation is also detected. The attending physician may prescribe a basal temperature chart calculation, ultrasound monitoring and an ovulation test. To determine whether a woman has problems with ovulation, a basal temperature chart is drawn up. Today this is the simplest and cheapest method, reflecting the production of progesterone by the ovaries, which should prepare the uterine mucosa for the further development of the egg. To create an accurate linear graph of basal temperature, the patient, immediately after waking up, measures the temperature in the rectum at the same time. The obtained data is recorded daily.
If the schedule is drawn up correctly, by analyzing its information, you can determine the beginning of ovulation (the first phase of the menstrual cycle with a temperature drop of 0.2/0.3 degrees C).
The temperature in the second phase of the cycle should differ from the first by 0.5/0.6 degrees C. The duration of the second phase of the schedule is at least 12-14 days. If there is no ovulation, then the graph will be single-phase. However, a two-phase basal temperature chart does not provide a 100% guarantee that ovulation has occurred. However, the same can be said about the negative result of a single-phase schedule. Basal temperature is greatly influenced by third-party factors: basic fatigue, colds, etc. The graph will show whether ovulation occurred or not. But, these results will already be past.
Ovulation can be confirmed by the level of progesterone in the blood, which is determined in the 28-day menstrual cycle from the 19th to the 23rd day. With normal ovulation, the maximum level of progesterone will occur on the seventh day after ovulation. Typically, your doctor will order several blood tests for progesterone during one menstrual cycle. Only an increase in progesterone levels will accurately determine whether ovulation occurred or not.
There are more accurate methods for determining the presence of ovulation.
Among them:
- – a urine test is prescribed for the presence of luteinizing hormone (LH);
- ultrasonic monitoring– Ultrasound helps determine the state of the dominant follicle and the possibility of its rupture (ovulation);
- endometrial biopsy.
The procedure takes about 10 minutes and is performed in a regular gynecologist's office. Changes in the endometrium occur in response to the production of progesterone. Therefore, their presence indicates the beginning of ovulation. Tissue for analysis is taken from the uterus before the start of the menstrual cycle. It is processed in a special way and examined under a microscope.
An endometrial biopsy can be performed on the 26th day of the normal menstrual cycle or on the 12-13th day, when the LH peak reaches its maximum. In case of hormonal infertility, tests reveal varying degrees of endometrial hyperplasia (proliferation of its structure with changes in the glands).
Additional examinations
To identify the causes of endocrine infertility in women, additional examinations are prescribed, including:
- Measuring hormone levels: LH, prolactin, testosterone, FSH, thyroid. The analysis is prescribed on days 5/7 of the menstrual cycle.
- Determination of progesterone levels. Using this examination, the functional abilities of the corpus luteum are determined. The analysis is prescribed on the 19th/23rd day of the menstrual cycle.
- Examination of the function of the adrenal cortex. The level of dehydroepiandrosterone sulfate is examined.
A single determination of the amount of hormones in the blood sometimes provides incomplete information. Therefore, if any deviations are detected, repeat tests are prescribed.
Doctors prescribe hormonal tests to diagnose hormonal disorders in the reproductive system. Their essence is that the patient takes certain hormonal drugs and by the reaction of her own hormones one can judge the state of the reproductive system. For analysis, blood is taken and the level of hormone production in the body is assessed.
Calculate dates suitable for taking tests
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Select gynecological ultrasound Progesterone FSH LH Testosterone Estradiol Prolactin T4 TSH Hysterosalpingography (HSG) EchoHSG Ultrasound of the mammary glands Regular smear Smear for latent infections Cultures from the uterine cavity
FSH. In 10% of patients, after treatment with this drug, pregnancy occurs with two fetuses. Three or more fetuses are extremely rare.
Treatment with clomiphene citrate does not always lead to ovulation. When it is not possible to get pregnant within three ovulation cycles, another drug is prescribed - gonadotropin. It can be used alone or in combination with other medications.
Types of gonadotropin can be different:
- human menopause (menogon and menopur);
- recombinant follicle-stimulating hormone (gonal-F and puregon);
- human chorionic gonadotropin (choragon and pregnyl).
Treatment with gonadotropin is more expensive compared to clomiphene citrate. In addition, there is a risk of side effects. Multiple pregnancies are also more likely when using this drug.
