Infertility laboratory findings: Difference between revisions
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{{Infertility}} | {{Infertility}} | ||
{{CMG}} {{AE}} {{NS}} | |||
====Basal body temperature==== | |||
* Basal body temperature is measured just on waking up in the morning. Usually there is a biphasic pattern in temperature in ovulatory cycles. There is no rise in temperature in anovuluatory cycles. <ref name="pmid7407311">{{cite journal| author=Royston JP, Abrams RM| title=An objective method for detecting the shift in basal body temperature in women. | journal=Biometrics | year= 1980 | volume= 36 | issue= 2 | pages= 217-24 | pmid=7407311 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7407311 }} </ref> | |||
* This is measured as a 0.2-0.5 degrees Celsius rise in temperature after ovulation which is sustained till the beginning of the next cycle. | |||
* There is a drop pf 0.2 degrees Celsius right before the rise in temperature. This coincides with the [[Luteinizing hormone]] surge. | |||
* Basal body temperature recording is a tedious process and involves recording of temperature at the same time everyday. | |||
* Temperature changes can also be attributed to other causes such as [[fever]], cold or hot temperatures and usage of air conditioners. | |||
====Hormone estimation==== | |||
# Serum [[progesterone]] is measured on day 8 and 21 in the cycle. | |||
#* Increase in serum level from >1 ng/ml-6 ng/ml suggests ovulation | |||
#* In anovulatory cycles and irregular menstrual cycles, this increase might not be appreciated. | |||
#Serum [[Luteinizing hormone]] is measured daily to look for a mid-cycle surge.<ref name="pmid20869180">{{cite journal| author=Mihm M, Gangooly S, Muttukrishna S| title=The normal menstrual cycle in women. | journal=Anim Reprod Sci | year= 2011 | volume= 124 | issue= 3-4 | pages= 229-36 | pmid=20869180 | doi=10.1016/j.anireprosci.2010.08.030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20869180 }} </ref> | |||
#*Ovulation occurs around 36 hours after LH surge. | |||
# Serum [[estradiol]] is measured around the same time as the LH surge | |||
#*[[Estradiol]] peaks around 24 hours before the LH attains its peak | |||
#* Therefore an increase in [[estradiol]] right before the [[luteinizing hormone|LH]] surge indicates the presence of an ovulatory cycle. | |||
====Hysterosalpingography==== | |||
* [[Hysterosalpingography]] is done to detect the continuity between cervical canal and fallopian tubes. <ref name="pmid15950625">{{cite journal| author=Baramki TA| title=Hysterosalpingography. | journal=Fertil Steril | year= 2005 | volume= 83 | issue= 6 | pages= 1595-606 | pmid=15950625 | doi=10.1016/j.fertnstert.2004.12.050 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15950625 }} </ref> | |||
* This test can detect the side on which obstruction is present, if any. | |||
* It can also detect congenital abnormalities, synechiae and presence of [[fibroid]]s etc. | |||
====Pelvic ultrasound==== | |||
* Pelvic ultrasound can predict ovulation with higher accuracy than basal body temperature. | |||
* It can also detect the cyclical changes in uterine [[endometrium]]. These changes are absent in anovulatory cycles. | |||
* The position of uterus, presence of fibroids, cystic changes in [[ovary|ovaries]], congenital anomalies in the genital tract can be detected via pelvic ultrasound. | |||
====Laparoscopy==== | |||
* [[Laparoscopy]] is the best method to detect any abnormalities in the fallopian tubes.<ref name="pmid24359039">{{cite journal| author=Hassa H, Aydin Y| title=The role of laparoscopy in the management of infertility. | journal=J Obstet Gynaecol | year= 2014 | volume= 34 | issue= 1 | pages= 1-7 | pmid=24359039 | doi=10.3109/01443615.2013.817981 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24359039 }} </ref> | |||
* Tubal potency, motility, [[adhesion]]s, etc can be visualised directly. | |||
* Changes in the [[ovary]] such as [[cyst]]s, [[endometriosis]] are also see. | |||
* If any adhesions or synechiae are present, adhesiolysis can be attempted during the diagnostic procedure itself. | |||
====Endocrinopathies==== | |||
* Serum [[TSH]], [[T3]], and [[T4]] must be done in all patients to check for [[hypo|hypothyroidism]] or [[hyperthyroidism]]. | |||
* [[Hyperprolactinemia]] is evidenced by an increase in serum [[prolactin]]. [[Prolactin]] is also increased in [[hypothyroidism]]. | |||
* Serum [[testosterone]], dehydroepiandrosterone sulphate may be elevated in some cases, pointing towards [[congenital adrenal hyperplasia]]. | |||
* Fasting and post prandial blood sugar levels must be done in cases where [[PCOS]] is suspected to rule out [[insulin resistance]]. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Sanjana Nethagani, M.B.B.S.[3]
Basal body temperature
- Basal body temperature is measured just on waking up in the morning. Usually there is a biphasic pattern in temperature in ovulatory cycles. There is no rise in temperature in anovuluatory cycles. [1]
- This is measured as a 0.2-0.5 degrees Celsius rise in temperature after ovulation which is sustained till the beginning of the next cycle.
- There is a drop pf 0.2 degrees Celsius right before the rise in temperature. This coincides with the Luteinizing hormone surge.
- Basal body temperature recording is a tedious process and involves recording of temperature at the same time everyday.
- Temperature changes can also be attributed to other causes such as fever, cold or hot temperatures and usage of air conditioners.
Hormone estimation
- Serum progesterone is measured on day 8 and 21 in the cycle.
- Increase in serum level from >1 ng/ml-6 ng/ml suggests ovulation
- In anovulatory cycles and irregular menstrual cycles, this increase might not be appreciated.
- Serum Luteinizing hormone is measured daily to look for a mid-cycle surge.[2]
- Ovulation occurs around 36 hours after LH surge.
- Serum estradiol is measured around the same time as the LH surge
Hysterosalpingography
- Hysterosalpingography is done to detect the continuity between cervical canal and fallopian tubes. [3]
- This test can detect the side on which obstruction is present, if any.
- It can also detect congenital abnormalities, synechiae and presence of fibroids etc.
Pelvic ultrasound
- Pelvic ultrasound can predict ovulation with higher accuracy than basal body temperature.
- It can also detect the cyclical changes in uterine endometrium. These changes are absent in anovulatory cycles.
- The position of uterus, presence of fibroids, cystic changes in ovaries, congenital anomalies in the genital tract can be detected via pelvic ultrasound.
Laparoscopy
- Laparoscopy is the best method to detect any abnormalities in the fallopian tubes.[4]
- Tubal potency, motility, adhesions, etc can be visualised directly.
- Changes in the ovary such as cysts, endometriosis are also see.
- If any adhesions or synechiae are present, adhesiolysis can be attempted during the diagnostic procedure itself.
Endocrinopathies
- Serum TSH, T3, and T4 must be done in all patients to check for hypothyroidism or hyperthyroidism.
- Hyperprolactinemia is evidenced by an increase in serum prolactin. Prolactin is also increased in hypothyroidism.
- Serum testosterone, dehydroepiandrosterone sulphate may be elevated in some cases, pointing towards congenital adrenal hyperplasia.
- Fasting and post prandial blood sugar levels must be done in cases where PCOS is suspected to rule out insulin resistance.
References
- ↑ Royston JP, Abrams RM (1980). "An objective method for detecting the shift in basal body temperature in women". Biometrics. 36 (2): 217–24. PMID 7407311.
- ↑ Mihm M, Gangooly S, Muttukrishna S (2011). "The normal menstrual cycle in women". Anim Reprod Sci. 124 (3–4): 229–36. doi:10.1016/j.anireprosci.2010.08.030. PMID 20869180.
- ↑ Baramki TA (2005). "Hysterosalpingography". Fertil Steril. 83 (6): 1595–606. doi:10.1016/j.fertnstert.2004.12.050. PMID 15950625.
- ↑ Hassa H, Aydin Y (2014). "The role of laparoscopy in the management of infertility". J Obstet Gynaecol. 34 (1): 1–7. doi:10.3109/01443615.2013.817981. PMID 24359039.