Female Infertility Hormone Panel

What is infertility?

Infertility refers to a reduced ability to conceive and bear children. More specifically, it's the inability to conceive after one year of regular sexual intercourse. Sterility, on the other hand, is permanent.

Primary sterility occurs when, after a year of regular sexual intercourse (two or three times a week) without contraception, a couple hasn't achieved pregnancy.

Secondary sterility occurs when a couple has had at least one pregnancy but is unable to conceive again or carry a pregnancy to term.

Finally, it's considered "idiopathic*" when its cause remains unidentified after thorough medical examinations.

Female infertility, accounting for 35 to 40% of infertility cases in couples, can stem from various causes:

• hormonal imbalances;
• fallopian tube damage;
• uterine pathologies;
• the patient's age;
• systemic or genetic diseases;

In some cases, it may result from the inability to have sexual intercourse due to vaginismus, a psychosomatic sexual disorder that hinders intercourse.

Most forms of female infertility are unpredictable and unpreventable.

However, some contributing risk factors can be managed to prevent infertility through lifestyle changes. These include moderate alcohol consumption, smoking cessation, maintaining a healthy weight, exercise, and stress reduction.

What is a hormonal infertility panel?

Diagnosing infertility involves assessing hormone levels and conducting instrumental examinations.

Gynecologists commonly request FSH, LH, estradiol, and prolactin levels (tested on days 2-3 of the menstrual cycle) and progesterone (on day 21). TSH, fT4, and AMH (anti-Müllerian hormone) can be tested regardless of the cycle.

Common instrumental examinations include:

• pelvic ultrasound: essential for evaluating female fertility, checking follicle count, ovulation, and uterine/adnexal lesions;
• hysterosalpingography: a minimally invasive radiological exam assessing uterine morphology, pathology, and fallopian tube patency using a contrast medium or saline solution. This helps diagnose causes of female sterility;
• hysterosonography/salpingography: transvaginal ultrasound with saline solution and air introduced into the uterine cavity to visualize passage through the fallopian tubes and assess permeability. It also improves visualization of the endometrium and uterine cavity;
• hysteroscopy: a minimally invasive endoscopic technique for assessing the uterine cavity, identifying endocavitary pathologies, and evaluating the endometrium;

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What happens after the hormonal panel?

Treatments for female infertility can be medical or surgical, depending on the cause. About 25% of cases involve hormonal dysfunctions causing anovulation.

Polycystic ovary syndrome (PCOS), affecting 5-10% of women of childbearing age, is a frequent cause of anovulation. Treatment begins with lifestyle changes and weight loss for those who are overweight or obese (40-80% of women with PCOS).

Endometriosis (affecting approximately 10% of women of childbearing age), characterized by endometrial tissue outside the uterus, is another common infertility-related condition. Mild cases are treated medically, while severe cases often require surgery.

Anovulation can be treated with medications (clomiphene citrate and gonadotropins), often monitored with ultrasound. Timed intercourse or intrauterine insemination may follow. Risks include ovarian hyperstimulation syndrome and multiple pregnancies.

Forty percent of women with PCOS have impaired glucose metabolism and insulin resistance. Metformin, an insulin-sensitizing drug, can improve metabolic balance and response to clomiphene citrate and gonadotropins.

Hyperprolactinemia, caused by pituitary adenomas, medication, hypothyroidism, or chronic kidney failure, can also cause anovulation. Cabergoline or bromocriptine can lower prolactin levels and restore ovulation.

Close collaboration between a gynecologist and endocrinologist is recommended for anovulatory infertility.

In 25-35% of cases, fallopian tube issues are the cause. Minor issues can be surgically corrected via laparoscopy, with good success rates (50-65% pregnancy within 12-18 months).

5-10% of cases involve congenital or acquired uterine pathologies (malformations, fibroids, polyps), often requiring surgical treatment.

The gynecologist determines the most appropriate medical or surgical treatment for each patient.

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