Hormone Evaluations
Day 3 Hormone Levels
The female reproductive cycle is influenced by the relationships between several hormones especially FSH, LH, and estrogen. The hypothalamus signals the pituitary to produce FSH which stimulates the recruitment and development of the ovarian follicles. As the follicles grow, they produce estrogen which signals the hypothalamus to regulate the pituitaries production of FSH.
When viable follicles are not developing, estrogen levels are low and more FSH is produced leading to elevated day 3 levels. A high FSH level on day three is one indication of reduced ovarian function or impending menopause. In general, diminished ovarian reserve is indicated by an FSH of >12, a high FSH/LH ratio (>2.5; even in the FSH level is normal), or a high E2 level (>80 pg/ml). An elevated estrogen level may also be caused by an ovarian cyst. In polycystic ovarian disease, the LH level is higher than FSH.
When the day 3 results are poor, and other tests such as the clomiphene citrate challenge test confirm diminished ovarian reserve, donor egg IVF or adoption should be pursued.
Other Hormone Evaluations
Many other hormone levels are evaluated in the infertility workup. Elevated levels of androgens (male hormones) can cause irregular ovulation and are seen in obese women and those with polycystic ovarian syndrome.
Thyroid hormone levels also influence fertility. Hypothyroidism (low levels) can cause anovulation and early pregnancy loss. Hyperthyroidism (high levels) is associated with irregular ovulation, fetal abnormalities, and premature labor.
Prolactin is the hormone responsible for stimulating breast milk production in pregnant women. Hyperprolactenemia is elevated prolactin in the absence of pregnancy and causes irregular or absent ovulation. This condition is usually caused by a benign tumor at the base of the brain that can be treated with medication (bromocriptine) or surgery.