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Fact Sheets from the American Society for Reproductive Medicine

Elevated Prolactin Levels  






Infertility Tests (Female)

Numerous tests will be ordered by the Reproductive Endocrinologist.
There are several biologic process that must occur in the female, and male, in order for a successful pregnancy and delivery of a viable baby to result.

These processes include the ability to produce (mature) an egg (s) which will fertilize, and the transport of the egg from the ovary to the end of the fallopian tube. Next, viable sperm must be ejaculated and "swim" successfully to the end of the fallopian tube. A sperm must be able to fertilize the egg and the resultant embryo must travel to the uterus. The embryo must implant into the endometrium (lining of the uterus), receive nutritional support, and be carried to term and delivery.

Female Fertility Tests


FSH-LH- Measurements of (FSH) follicular stimulating hormone, luteinizing hormone (LH) and others are conducted on day two or three of the menstrual cycle. FSH is responsible for stimulating the recruitment and development of eggs within the ovarian follicles. FSH levels above 10 usually indicate low ovarian reserve and if the FSH is very high (greater than 25) it could be consistent with approaching menopause. Usually, a level of less than nine indicates adequate ovarian reserve. The ratio of LH to FSH is also analyzed.

Progesterone- Progesterone is measured to document that "quality" ovulation has occurred. This hormone is produced by the corpus luteum which is formed from the "shell" of the ovarian follicle after ovulation. After implantation, the placenta begins to produce progesterone (between 7 and 9 weeks of pregnancy). Progesterone is routinely prescribed during assisted reproductive technology cycles (since there is no ovulation and thus no "shell" left).

Prolactin Levels- Prolactin is the hormone that stimulates breast milk production after pregnancy has occurred. Elevated prolactin levels can cause irregular or no ovulation (anovulation). Abnormally elevated prolactin levels in the absence of pregnancy are often caused by a small benign tumor on the pituitary gland. Prolactin may also be elevated in hypothyroidism (low functioning thyroid gland). Hyperprolactinemia (elevated prolactin) is a condition treated with the medication; bromocriptine (Parlodel) or through surgery to remove the tumor.
b-HCG- b-HCG is also known as the "pregnancy hormone" and is produced by the placenta. Rising levels of b-HCG indicates that pregnancy has occurred. It usually doubles (or at least increases by 67%) every 48 hours.

Ultrasound- Ultrasound is used to measure the size and number of follicles and the width of the endometrium (lining of the uterus). The endometrium increases in thickness and vascularity under the influence of estrogen and progesterone. This development is necessary for the embryo to implant and be adequately nourished during development. Ultrasound is also used to follow fetal development and it often times identifies masses such as fibroids, polyps, or endometriosis.

Hysterosalpingogram (HSG) - A hysterosalpingogram involves injecting die into the uterus and following its flow through the fallopian tubes into the uterus. This procedure is conducted in the office or at the hospital as an outpatient. The physician can see abnormalities in the uterine cavity such as fibroids and polyps. Obstructions in the tubes can also be visualized.

Hysteroscopy- The hysteroscope is used to visualize the uterine cavity. CO2 gas or water is introduced into the uterine cavity causing it to expand. The doctor then inserts a small "telescope device" and directly examines the inside of the uterus. Conditions such as fibroids, polyps, or congenital malformation are readily apparent.

Hydrosonogram or Sonohysterogram- In the hydrosonogram, saline is injected into the uterine cavity causing it to expand and vaginal probe ultrasound is used to examine the uterus. This test helps to visualize the relationship between the wall of the uterus and the cavity of the uterus.

Post coital test- A post coital test may be ordered to learn how the sperm interacts with the cervical mucus. The couple has intercourse at home and the female comes to the office within twelve to twenty four hours.
Once sperm are ejaculated, they swim through the cervical mucus, past the cervix and into the uterine cavity. The mucus must be of the right consistency and contain enough nutrients. Sometimes the female produces antibodies to the sperm. When this happens, her body mistakes the sperm for invading pathogens (virus or bacteria) and seeks to destroy it. A man may also make antibodies against his own sperm. If numerous dead or damaged sperm are seen in the cervical mucus it is indicative of incompatibility. Intrauterine insemination (IUI) is often a first choice treatment for this condition.

Estradiol- Estradiol (estrogen) levels rise as healthy follicles develop and low levels indicate poor development. If the ovaries produce adequate amounts of estrogen, the pituitary gland will produce its normal amounts of FSH. However, if ovarian function is compromised, the pituitary gland will send out more and more FSH in attempt to stimulate the ovaries to produce more estrogen. Thus an elevated FSH level is indicative of low ovarian function. Levels of male hormones, known as androgens, are also measured. Elevated androgen levels may indicate the presence of polycystic ovarian disease.

Clomiphene Citrate Challenge Test-(CCCT) - The CCCT may be ordered to further assess ovarian reserve. This test is performed by measuring the day 2 or 3 FSH and estradiol levels. The patient takes 100 mg of Clomid on cycle days 5 through 9, and her FSH is measured again on day 10. The test is abnormal if either the day 3 or day 10 FSH values are elevated or if the day 3 estradiol is greater than 80 pg/ml. A poor clomiphene citrate challenge test is indicative of poor ovarian reserve, and may mean that a stimulated cycle will most likely not be successful.

BBT and Urinary Test Kits- Basal body temperature (BBT) measurements can be used to predict or note ovulation. These measurements were used extensively prior to the availability of urinary test kits which are more accurate and convenient.
A woman's body temperature varies predictably during her ovulatory cycle and it increases at ovulation. A basal body thermometer is used daily to take the temperature immediately upon arising before leaving bed. These temperatures are charted on a basal body temperature graph. A pattern of temperature increases is established after several months of charting. Intercourse is timed according to the most fertile times when the temperature begins to rise preceding ovulation.
There are several disadvantages to using the BBT method. First, it is inconvenient to take daily measurements, especially for busy career women. Second, it takes several ovulatory cycles to adequately establish an ovulatory pattern. Third, daily measurements are a constant reminder of sub fertility.
Urinary test kits are very accurate and measure the surge in LH that occurs immediately prior to ovulation. LH appears in the urine and this is what is measured by the kits. Urine samples are tested around the time of predicted ovulation and intercourse is timed accordingly.

Laparoscopy- The laparoscopy allows the physician to directly view the reproductive organs and determine if conditions such as endometriosis are present. This is an outpatient procedure usually performed in an ambulatory center (at your doctor's office or at the hospital). The physician makes two small holes, one in or near the belly button and the other just above the pubic hair line. The abdomen is filled with gas causing it to expand making the internal organs visible. A device similar to a telescope is inserted through one opening and the surgical instruments are inserted through the other. Many times the specialist will treat conditions, such as endometriosis, during the laparoscopy.

Endometrial Biopsy- A small sample of the endometrium is taken using a small catheter. This procedure can be accompanied by mild discomfort and cramping after the procedure. The endometrium must develop properly (be in phase) by thickening and becoming more vascular to accept the developing embryo. Microscopic examination of the tissue determines if it is "out of phase" or "a luteal phase defect" is present. This condition is often treated with progesterone.


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