(A) Determination of hormones
By radioimmunoassay (RIA) can determine steroid hormone, but also determination of pituitary hormones. Specificity of immune response strong isotope sensitivity, accuracy is high, it has been widely used. Infertile women often measured against the following hormones.
1. Follicle-stimulating hormone (FSH) is a pituitary basophilic cells secreted a glycoprotein hormone, whose main function is to ovarian follicular development and maturation. The blood concentration of FSH in the preovulatory for the 1.5-10U / L, ovulation 8-20U / L, post-ovulation, 2-10U / L. Low values of FSH found in estrogen and progesterone treatment, such as Sheehan syndrome. High FSH values found in premature ovarian failure, ovarian insensitivity syndrome, primary amenorrhea and so on.
2. Luteinizing hormone (LH) is also a kind of pituitary basophilic cells, glycogen protein hormone secreted. Main function is to promote ovulation, the formation of corpus luteum hormone secretion. Serum LH concentration in preovulatory 2-15U / L, ovulation 20-100U / L, ovulation late 4-10U / L. Less than 5U / L more reliable reminder of gonadotropin dysfunction, seen in Sheehan's syndrome. Coupled with a high FSH, such as high-LH, the ovarian failure has been very positive. LH / FSH> = 3, then the basis for the diagnosis of polycystic ovary syndrome.
3. Prolactin (PR1) by the pituitary eosinophils, one of the trophoblastic secretion of lactation is a simple protein hormone whose main function is to promote the proliferation of breast milk production and milk row. In the non-breast-feeding period, blood PR1 normal for the 0.08-0.92nmol / L. Higher than 1.0nmol / L shall be high reminders hyperlipidemia.
4. Estradiol (E2) is secreted ovarian follicles. Main function is to make the uterus grow into the proliferative phase within the gland to promote the development of female secondary sexual characteristics. Serum E2 concentration in the ovulation period of 48-52lpmol / L, ovulation 370-1835pmol / L, ovulation late 272-793pmol / L. Low-value found in ovarian dysfunction, premature ovarian failure, Sheehan syndrome.
5. Progesterone (P) secretion by the ovarian corpus luteum. Main function is to promote endometrial proliferative phase transition from the secretory phase. Pre-ovulatory serum P concentrations of 0-4.8mnol / L, ovulation late 7.6-97.6nmol / L. Post-ovulatory serum P value is low, seen in luteal phase defect, ovulation dysfunctional uterine bleeding.
6. Testosterone (T) female body testosterone, 50% from the outside Zhou Xiong transformed from the ene-dione, 25% for the adrenal cortex of the secretion, only 25% from ovaries. Main function is to promote the clitoris, labia and mons pubis's development, there are antagonistic effects of male hormones on the body metabolism have an impact. Female plasma testosterone levels in 0.7-2.1nmol / L, T value is high, said Hyperandrogenism, can cause female infertility.
(B) hormone function tests
1. Progestin trial progesterone 20mg / day intramuscularly, for 3 consecutive days, or medroxyprogesterone acetate 4mg, 2 / day, and even served on the 5th. Within 7 days after stopping any bleeding, in order to test positive, suggesting that the body has enough estrogen, so that the growth into a proliferative phase endometrium, is a I-degree amenorrhea; if no bleeding, in order to test was negative, suggesting that estrogen levels is very low, endometrium can not grow, or congenital absence of uterus endometrium, such as naive-type, or due to tuberculosis, such as intrauterine adhesions of endometrial been destroyed.
2. Estrogen and progesterone test was negative test should be testing for estrogen. Oral administration of diethylstilbestrol 1mg / day, a total of 20 days or Premarin (Premarin) 0.625mg / day is a total of 20 days. Bleeding after drug withdrawal, belong to II degree of amenorrhea, suggesting that the hypothalamus - pituitary - ovarian axis dysfunction, caused by low estrogen levels; if no bleeding, then the prompt uterine amenorrhea.
3.GnRH stimulation test to GnRH (10 peptides) 50ug dissolved in 50ml normal saline, the intravenous injection. Note 25,45,90,180 minutes before and after the blood injection 2ml, radioimmunoassay LH, FSH values.
Test Results: ① normal reaction, LH values have increased three-fold higher than the base value of the peak in 15-30 minutes after injection; ② active response, LH values increased by more than the base value of 4 or more; ③ delayed response, the peak appears in the Notes 60-90 minutes after drug; ④ weak non-response or low response to LH values after GnRH injection did not change, or LH values have increased by 2 times the value is not Scientology.
Clinical Significance: ① hypothalamic dysfunction, FSH, LH base value low, GnRH stimulation test showed a normal reaction; ② pituitary dysfunction, FSH, LH-based low-, GnRH stimulation test showed a weak non-response or low response to surgery or radiation damage found pituitary tissue, and Sheehan's syndrome; ③ ovarian dysfunction, FSH, LH base value is high, GnRH stimulation test showed an active response; ④ polycystic ovary syndrome, FSH normal or low base value, LH base value was higher, GnRH LH stimulation test showed an active response, and FSH showed a normal reaction.
4. Clomiphene citrate test 5th day of menstrual cycle, clomiphene citrate 50-100mg / day, and continued for 5 days. 1,3,5 days before the test in the medicine of blood FSH, LH, menstrual cycle, the first 22 days of blood progesterone test.
Medication 3 days after the LH increased by 85%, FSH increased by about 50%, decreased after treatment, such as the LH peak occurred later and finally ovulation for ovulation-type reaction, B super-luteal phase progesterone monitoring and measurement can confirmed. If there are no LH peak, non-ovulation, that is, no response.
There is response to the GnRH stimulation test against Croatia, for the Finnish test non-response, suggesting that the hypothalamus lesions.
5.TRH stimulation test TRH500ug intravenous injection, 30 minutes after the determination of PR1 value, normal TSH, PR1 covering a peak. Base value, such as TSH high, the reaction increased, suggesting that hypothyroidism; base value is low, response to weakness in hyperthyroidism. PR1> 150ug / L, prompted a potential hyperprolactinemia. TRH test PR1 values increased, while no response to chlorpromazine, suggesting that the hypothalamus lesions.
6.ACTH intramuscular stimulation test ACTH20mg, injection 24 hours prior to drug injection and after 24 small forward, were detected in urine 17 - keto steroid excretion. Polycystic ovary syndrome respond to normal and abnormal function of the adrenal cortex 17 - keto steroids and 17 - hydroxy steroids were significantly increased.
7. Dexamethasone suppression test Dexamethasone 0.5mg, every 6 hours a time, and even served on the 2nd, before and after treatment were measured in urine 17 - keto steroids, 17 - hydroxy steroid value decreased. When the pituitary or adrenal cortex to secrete when hyperthyroidism, such as Cushing syndrome or adrenal tumor patients is not reduced. This test applies to ovulatory disorder with masculine patients.