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Ovulatory disorders can be seen in up to a quarter of all infertile women; as such, women with irregular or absent menstruations also warrant an endocrine evaluation.
What is typically drawn: This evaluation includes an assessment of thyroid function (with TSH) and serum prolactin (milk hormone) levels. Other complaints, such as excess hair growth or acne, may also require that the female partner be tested for male hormone levels (testosterone, DHEAS, etc) as well.
Thyroid dysfunction: Women with a history of infertility are at risk for thyroid dysfunction, and although some may present with signs and symptoms of disease, many have no symptoms at all. Signs of an under-functioning thyroid (hypothyroidism) include hair loss, dry skin, constipation, weight gain, and fatigue. Signs of an over-functioning thyroid (hyperthyroidism) include excess sweating, diarrhea, palpitations, and weight loss. It is important to diagnose and treat thyroid dysfunction prior to pregnancy as abnormal thyroid levels may increase the risk for miscarriage and pre term birth, and affect fetal development. Typically, the primary treatment is an oral medication.
Hyperprolactinemia: Women with irregular menses, absent menses, and shortened luteal phases may have elevations in a pituitary hormone called prolactin. Although this hormone is typically involved in the promotion of lactation, aberrant elevations may cause anovulation. If elevated, your doctor will next look for the cause of the elevation, which may include medications you may be on, or a prolactin secreting tumor within the pituitary gland. It is important to have this test done in a fasting state and follow your physician’s instructions, as eating, exercise, and recent sexual intercourse may cause false positives. Typically, the primary treatment is an oral medication.
Hyperandrogenemia: Women with signs and symptoms of excess male hormone (acne, excess hair, and hair loss) will be screened for male hormone levels. Causes of excess male hormone may include polycystic ovary syndrome, genetic disorders including enzymatic deficiencies, other hormonal disorders, medications, and (rarely) tumors in the ovary or adrenal gland. As such, the evaluation for hyperandrogenemia requires a muti-step approach to identify and treat the cause.
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