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Female Infertility

Female Infertility
  • The most common cause of female infertility includes a problem with ovulation like a premature ovarian failure, PCOD, endometriosis, thyroid dysfunction, obesity, hormonal imbalance, blocked or damaged fallopian tube, fibroid or other abnormalities of the uterus and unhealthy cervical mucus.
  • Age can contribute to infertility because as a woman ages, her fertility naturally tends to decrease.
  • There are 30 % female factor responsible for infertility. Causes of female infertility can be difficult to diagnose.
  • A menstrual cycle that is too long (35 days or more), too short, ( less than 21 days) irregular or absent can mean that female are not ovulating.
  • To investigate female infertility following hormonal investigation is necessary.
  • It should be done day 3 to 5 during the early follicular phase.

 

FSH (follicle stimulating hormone)

  • It is synthesized and secreted by gonadotropic cells of anterior pituitary glands.
  • It is necessary for healthy ovulation.
  • The reference range is as follow.
  • FSH in follicular phase – 3 – 8 mIU/ml.
  • FSH in menopause – 30 – 170 mIU/ml.
  • FSH in Primary ovarian failure – 40 -100 mIU/ml.
  • FSH more than 20 mIU/ml indicates subfertility / infertility.
  • Very low- indicates Anovulatory cycle.

 

L H (luteinizing hormone)

  • It is produced by gonadotropic cells in the anterior pituitary gland.
  • In females, an acute rise of LH triggers(LH surge)ovulation and development of corpus luteum.
  • In the early follicular phase of the menstrual cycle, the normal range is  –  3- 8 IU/L.
  • For good hormonal balance, FSH & LH should be 1: 1.
  • On surge day it goes up to 20 -25 IU/L and in luteal phase it remains 0.5 to 15 IU/L.
  • Elevated LH is associated with PCOD/ premature menopause.

 

Prolactin hormone

  • It is secreted from pituitary glands.
  • Serum prolactin should remain lower than  25 ng/ml in the female who want to get pregnant.
  • Increased prolactin interfere in healthy ovulation.
  • Some woman with PCOS also has Hyperprolactinemia.
  • High level of prolactin also associated with loss of libido.

 

Progesterone

  • It is a hormone released by the ovaries.
  • Changing progesterone levels can contribute to abnormal menstrual periods and menopausal symptoms.
  • Progesterone is also necessary for implantation of the fertilized egg in the uterus and for maintaining pregnancy.
  • At day 3-5 of the follicular phase of the menstrual cycle progesterone level remains less than 1.5 ng/ml.
  • Elevate level may indicate low infertility.
  • 7 day after ovulation. (day 21 ) it normally remains more than 15 ng/ml.
  • In pregnant women in their first trimester, it goes to 15 to 90 ng/ml.

 

TSH (Thyroid stimulating hormone), T3- ( triiodothyronine ), T4 – ( thyroxine)

  • Disturbed thyroid function interfere ovulation.
  • Both gonadotropins and t4 are crucial to achieving the best fertilization and blastocyst development.
  • For expectant mother, TSH level should remain 0.3 – 2.5 mIU/L which leads to good hormonal balance.
  • The normal range for T3 is 100-200 ng/dl.
  • The normal range for free T4 is 0.7 – 1.9 ng/dl.
  • The normal range for total is 4 – 12 ug/dl.

 

Total Testosterone

  • Women create lower levels of testosterone and are more sensitive to androgen than men.
  • A normal range is 15 – 70 ng/dL.
  • More than 150 ng/dL in young female indicates PCOD.

Fasting insulin

  • Serum insulin level interfere ovulation.
  • It should remain less than 25 mIU/ml.
  • More than 25 mIU/ml indicates the possibility of PCOD.

 

Estradiol

  • Normal estradiol level is 20 – 400 pg/ml.
  • High estradiol indicates poor ovarian reserve.
  • Low estradiol is associated with poor ovulation & thin endometrium lining of uterus.
  • In menopause, it remains less than 20 pg/ml.

 

AMH (Anti-Müllerian hormone)

  • Normal AMH level – 1.5 – 4 ng/ml.
  • 0 – 0.3 ng/ml indicates– very low fertility.
  • 0.3- 2.2 ng/ml indicates– low fertility.
  • 2.2 – 4 ng/ml indicates – good fertility.
  • 4- 6.8 ng/ml indicates – optimal fertility.
  • More than 6.8 ng/ml AMH level indicates the possibility of PCOD.
  • Female with low AMH is not responding well with allopathic ovulation induction drugs.
  • AMH suggest no of egg, not quality. It suggests low ovarian reserve but not an indicator of the quality of ovum.
  • We concern about the quality of an egg so with low AMH level. There is a possibility to get pregnant with our homeopathic treatment.

 

To evaluate female infertility, ultra-sonography (USG) is necessary

We can get information about the following.

  • PCOD
  • Dermoid cyst/ endometrioma /choclate cyst.
  • Endometrial thickness- it is as below.
    • Early follicular phase – 4 -6 mm
    • By the time of ovulation – 8 – 10 mm.
  • In mid luteal phase – 14 mm
  • Triple line appearance is absent or if the preovulatory endometrial thickness is less than 7mm, it associated with reduced chance of pregnancy.
  • Endometrium can be identified with USG but endometriosis cannot be identified nicely by USG.

H S G (Hystero – Salpingography)

  • Hysterosalpingography is useful to find out tubal patency.
  • It does not provide any information about the functional ability of the fallopian tube.