Infertility laboratory findings

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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]

Overview

Many laboratory tests such as hormone levels, checking basal body temperature and imaging are employed in the diagnosis of infertility.

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.
• 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

1. 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.
2. Serum Luteinizing hormone is measured daily to look for a mid-cycle surge.
   • Ovulation occurs around 36 hours after LH surge.
3. 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 LH surge indicates the presence of an ovulatory cycle.

Hysterosalpingography

• Hysterosalpingography is done to detect the continuity between cervical canal and fallopian tubes.
• 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.
• 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.