Can’t get pregnant, it’s time to check the sex hormones

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Infertility is a class of common clinical diseases, and about 15%of couples in the world suffer from infertility.Nowadays, the success rate of women who have obtained conception and fertility for infertility treatment have greatly improved.Infertility diagnosis and treatment requires a wide range of clinical assessment, including laboratory and imaging examination.During the treatment and monitoring of infertility, the laboratory detection of female hormone levels plays an important role.We review the clinical application value of female infertility diagnosis and treatment and auxiliary reproductive hormone testing.

1. Folliclestimulatinghormone (FSH)

Women have a considerable amount of oocytes at their birth, but they gradually decreased due to apoptosis after birth. After adulthood, there are only about 100,000 oocytes.A series of ovarian mother cells have begun to develop in the January period of childcare, but usually only one cell can be fully mature and excreted from ovarian.Although there are certain individual differences, the number and quality of female oocytes usually start to fall rapidly at the age of 37 until the menopause is completely exhausted.

Judging the relative ovarian reserves of women is the key to early fertility assessment.Although the detection schemes in different laboratories are different, most of the internal fertilization (IVF) centers combined with laboratory examinations and ultrasonic imaging examinations to determine the patient’s ovarian reserves in order to guide maternity treatment.

In the early days of the menstrual cycle, the increase in serum FSH levels was an important prediction indicator for decline in fertility in childcare in child talk age.Therefore, clinicians use the FSH test as an important project to evaluate the ovarian reserve function of patients.Clinicians need to detect the minimum value of FSH in the 2nd to 3 days of the patient’s menstrual period (early during the follicle period) to judge the ovarian reserve function.However, the level of FSH is closely related to the age of fertility and continues to fluctuate in the normal menstrual cycle of women.In view of this significant mutation, many studies have shown that compared with the FSH level, combining the age of the mother can accurately predict the success rate of IVF [1].FSH> 10IU/L predicts that the specific specificity of ovarian stimulation is high, and the sensitivity is low, unless the FSH level is extremely elevated.High -level FSH predicts poor prognosis of pregnancy.SCOTT et al. [2] research shows that women with FSH> 18IU/L cannot be able to take birth of babies.Therefore, many medical centers do not provide IVF services to high -level FSH women.

2. Estradiol (E2)

E2 is a steroid hormone that secretes from developing follicles in the development of follicles.Clinicians also often use E2 levels as part of the evaluation of female ovarian reserve function.The E2 level in the menstrual cycle of childbearing age generally fluctuates in the range of 10 ~ 300pg/ml [3].In the ovarian reserve function test, clinicians usually detect the minimum value of E2 on the 2nd to 3rd days of menstrual period (early follicle period).

At the same time point of the menstrual cycle, several hormone levels can help clinicians to comprehensively judge the test results of clinicians.The rise in the basic level of FSH and E2 suggests that patients have abnormal ovarian parent cell development in the early days of menstrual cycle, indicating that patients have poor ovarian reserve function and reduced reproductive function.In addition, because E2 will negatively feedback to regulate the parablarized secretion of FSH, high E2 level (> 100pg/ml) will inhibit FSH secretion, which will lead to a reduction of secondary FSH levels.

Although E2 is a simple, cheap and effective screening indicator, it is not possible to accurately predict the prognosis of IVF at the level of E2 alone.Kosmas et al. [4] systematically reviewed 3352 patients with IVF treatment. The results of the research were controversial.Some studies have shown that the low IVF success rate is related to the low or high level of E2; other studies also show that the success rate of IVF has nothing to do with the basic E2 level.BUYALOS et al. [3] research found that women’s basics E2 levels> 75pg/ml are related to poor prognosis and decreased pregnancy rate.Recently, some studies have found that changes in E2 level after using human chorionic gonad hormones have nothing to do with the live production rate of the baby, but it is negatively related to the percentage of mature follicles on the day of the use of human chorionic gonad hormones [5].In view of the above -mentioned inconsistent research results, clinicians generally use the basic E2 level and FSH level to determine to start the appropriate drug dose for the IVF cycle or the possibility of the success of IVF is very low.

In addition to understanding basic ovarian functions, clinicians often evaluate the development of follicles through E2 horizontal monitoring in the Controlled-Ovarian-Hyperstimulation (COH).With the development of follicles, the level of E2 has gradually increased.During the spontaneous physiological cycle of women, the peak of E2 generally appears before ovulation, about 250 ~ 300pg/ml; and during the COH period, when the ovulation releases multiple mature eggs, the E2 level of female patients can significantly rise significantly rising significantly.High, see Figure 1.

Figure 1 After the ovary stimulation, the level of E2 and the diameter of the follicles changes

During the COH and IVF cycles, clinicians use E2 horizontal evaluation of the risk of Ovarianhyhypers-TimultSyndrome (OHSS).OHSS is manifested as an ovarian cystic, thoracic and abdominal effusion, local or systemic edema.In a retrospective analysis of patients with IVF, researchers defined OHSS high -risk people based on E2 level [6], and 637 patients with IVF patients did not occur <3500pg/ml.The incidence of OHSS between/ml is 1.5%, and the incidence of OHSS in patients with E2 peak> 6000pg/ml is 38%.Although many factors help monitor the reproductive cycle and prevent OHSS, studies have shown that monitoring the level of E2 can reduce the incidence of OHSS.Although the upper limit of the E2 of high -risk OHSS reported in different documents is inconsistent, most researchers recognize that when the E2 peak <3000pg/ml is <3000pg/ml, the patient’s OHSS risk of OHSS is lower [1].

3. Anti-Müllerianhormone (AMH)

AMH is a di-polycogen protein that belongs to the conversion growth factor-β super family.Like E2, AMH is secreted by the particle cells of small sinus follicles and sinus follicles in the ovaries.Because serum AMH levels can reflect the overall follicle level, multiple research teams believe that AMH can be used as a symbol to evaluate the ovarian reserves, and it is more reliable than FSH [7].In general, high AMH levels indicate that the ovarian reserve function is good, and low AMH levels indicate that the ovarian reserve function is not good.In addition, AMH cannot be detected after 3 ~ 5D in bilateral ovarian resection.Studies have shown that AMH levels are low and there are related to menopause [8].

In addition to the evaluation of ovarian reserve functions, researchers have also found that AMH can be used as predictive factors in the process of ovulation.In the normal ovarian stimulus, AMH levels gradually decreased.Exogenous injection FSH can increase women’s follicle size and E2 level (both are regulatory factors secreted by AMH).The results of laarca et al. The results of [9] showed that during the IVF period, the height of the basic AMH level and the number of ovarian parent cells (the basic AMH level obtained ≥ 11 oocyte patients was 2.5 times that of patients obtained ≤6 patients).Compared with the patient’s age, the 3rd day of the patient’s age, the 3rd FSH level and E2 level of the E2 (Inhibinb, INHB) level, AMH and AntralFollicleCount (AFC) are better ovarian stimulus reaction prediction factor.Broer et al. [10] for 9 studies showed that in terms of predictive ovarian stimulus reactions, AMH levels and AFC are good predictive factors, and there is no difference between the two.But the latest research shows that AFC has the best predictive value compared to AMH [11].

About 2%to 30%of patients with IVF have poor ovarian stimuli response.Although not all IVF centers use the same judgment standards, most of them are based on the number of follicles (<3 ~ 5) or the number of ovaries obtained (<3 ~ 5) to define the poor ovarian stimulus response, and cancel the cancellation and cancel it.cycle.Lamarca et al. [9] for the first time evaluated the role of AMH in predicting the poor reaction of COH. The study found that AMH’s sensitivity was 80%and the specificity was 93%.However, the accuracy of AMH predictions reported by different documents is not consistent.These studies show that poor response cannot reject patients for IVF.On the other hand, AMH may also have a predictive effect on OHSS.This assumption is based on excessive adenoma reactions.Two forward -looking studies indicate the basic AMH level> 3.5ng/ml related to OHSS [9, 12].It is necessary to further study whether it should be clear whether different levels of stimulus treatment should be performed according to the AMH level to avoid the occurrence of OHSS.

In addition, AMH levels can be used to evaluate the success rate of conception.The success rate of IVF conception with high AMH levels is higher [13].

Four, inhb

INHB is a β subunit of diocrin inhibitory.Like AMH, INHB is also produced by small sinus follicles and early sinus follicles.Inhb continues to fluctuate with the menstrual cycle during the childbearing age.In addition, the changes in INHB in the process of reproductive aging are similar to FSH and AMH.As women grow older, the level of FSH increases, and INHB and AMH have decreased.The INHB level decline is a advanced sign of poor ovarian reserve function.Therefore, INHB level cannot be used to predict ovarian failure or menopausal. [14]At present, INHB cannot be regarded as a reliable symbol to evaluate ovarian reserve functions [8].

Injecting exogenous gonad hormones for COH can lead to increase in INHB.SEIFER et al. [15] research shows that patients with poor adrenal hormone response are generally low.In fact, the response of the serum Inhb <45pg/ml and the adenoma is not good, the cycle cancellation of high incidence, the decrease in IVF success rate, and the decrease in clinical conception. [15]

Five, progesterone

Welon is a convenient indicator of detection of ovarian function.The level of progesterone is maintained at a low level (<1ng/ml) at the follicle period, and the peak of the secretion (1 ~ 2ng/ml) in LuteinizingHormon (LH) has risen steadily until the peak value of one week after ovulation reaches its peak value 1 week after ovulation.EssenceExcluding immediately after ovulation or is about to go through pre -detection, progesterone level <3ng/ml prompts ovulation without ovulation.If you want to evaluate whether the patient has ovulation, clinicians should detect patients’ progesterone levels about 1 week before the expected menstruation start. [8]

Clinical doctors usually use gonadotropin-regsinghormone (GNRH) analogs to induce ovulation and inhibit the pituitary to prevent premature LH secretion peaks and subsequent ovulation.However, the analysis of Venetis et al. [16] showed that 5%to 30%of patients had premature luteinization of follicles.Although patients have injected GNRH analogs, the patient’s serum progesterone level is higher than the reference interval (0.9 ~ 1.2NG/ml) when the follicles are prematurely lutein.Some researchers believe that female patients’ increased serum progesterone levels on the day of ovulation will affect the success of IVF.Although this view has been argued for many years, Venetis et al. [16] The analysis of the 12 studies found that on the day of injection of chorionic gonad hormone, the elevated progesterone level and the normal crowd of the IVF cycleThere is no statistically significant difference (P> 0.05).Recently, there are studies [17] indicate that the ovarian stimulus is poor (1 ~ 5 oocytes) or the reaction is normal (6 ~ 18 oval mother cells) in the injection of the human chorion -promoting gonadotropin, and the progesterone> 1.5NG/ml is reduced in terms of conception, while the difference in ovarian stimulus reactions (> 18 oocytes) is not statistically significant.

Six, LH

The premature LH secretion peak during ovarian stimulation is the clinical standard for IVF for many years.Many studies have focused on the relationship between the LH concentration and the quality of the oval cells and the endometrium.Two forward -looking studies [18, 19] show that the higher the level of endogenous LH in the middle of follicles, the lower the probability of successful pregnancy through IVF.The study of Lyu et al. [20] also showed that when FSH is at normal level, the higher the ratio of FSH/LH on the third day of the menstrual period, the lower the ovarian reserve function, and it also indicates that the lower IVF pregnancy success rate.However, the analysis of Kolibianakis et al. [21] indicated that the low LH level was not related to the reduction of the probability of successful pregnancy through IVF.

Seven, Summary

Today, more than 1%of newborns were born through assisted reproductive technology.Statistics show that as the average age of maternals continues to increase, this proportion will rise.The work of treatment of infertility will continue to expand. Laboratory examination helps preliminary diagnosis and evaluate ovarian reserve functions.See Table 1, the main points of hormone testing introduced in this article.

With the continuous improvement of testing technology, laboratory testing will undoubtedly become a more accurate and sensitive method for predicting COH reactions and IVF conception power, and will also make the treatment of female infertility more secure and effective.

Reference (slightly)

Source: "Inspection Medicine" magazine, the original title "The Clinical Application of Hormonal Test in the diagnosis and treatment of female infertility"

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