4 - Laboratory Challenges of Female Infertility Diagnosis - Part 4 (Menstrual Cycle)

4 - Laboratory Challenges of Female Infertility Diagnosis - Part 4 (Menstrual Cycle)

Here are some tips to help you get started:
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- The bleeding period lasts 3 to 7 days.
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- The first day of bleeding is the first day of the menstrual cycle.
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In a woman, the length of the follicular phase can vary from one cycle to the next, but the luteal phase does not always change in a woman in different cycles in terms of duration.

- Due to the fact that ‌ FSH has an effect on ovarian granulosa cells and testicular cervical cells It naturally increases from the beginning of puberty, 3 to 4 years ago It causes LH to rise. And

Over time, the ovaries become increasingly resistant to FSH and LH stimuli.

- This reduces the chance of pregnancy, because these hormones are necessary for the successful preparation of the uterine wall, where the fetus must implant.

As the menopause approaches, the ovaries begin to resist the FSH hormone and produce more FSH pituitary gland to keep estrogen levels high, leading to irregular menstrual cycles. Heavy and unpredictable bleeding occurs during periods.

Without proper ovarian response (ie, increased estrogen production) to these hormones, the egg cannot grow and regular monthly ovulation will not take place. But higher amounts of LH and FSH may not produce a mature egg.

When the ovaries cannot respond to LH and FSH or do not respond to LH and FSH, estrogen and progesterone levels also decrease.

- Absence of menstruation in one year and FSH level above 30 to 40 units indicates menopause, given that the rate of FSH fluctuates around menopause, a FSH test result to diagnose menopause It is not.

- In menopause and after, the secretion of gonadotropins continues episodically. However, FSH levels are higher than those seen during the menstrual cycle, possibly due to a lack of inhibition of inhibin production by granulosa cells (which inhibits FSH production feedback).

FSH is increased in women with reduced ovarian function, as well as in women in their forties, as well as in young women who have reduced ovarian reserve.

Increased levels of LH ‌ and ‌ FSH in primary hypogonadism, anorexia, gonadal insufficiency, Klein filter syndrome, Alcoholism and castration are seen because LH ‌ and ‌ FSH are produced in the pituitary gland. They are also used to differentiate between primary and secondary causes of gonadal insufficiency.

- Of these two hormones to investigate the causes of impotence, gynecomastia, menstrual disorders such as oligomenorrhea, Amenorrhea and infertility are also used in both sexes.

- FSH levels in Klein's syndrome are filtered and in some cases higher than premature puberty, but if Premature puberty is reduced due to adrenal tumors or congenital adrenal hyperplasia. .

Some medications, such as cimetidine and levodopa, increase FSH and reduce corticosteroids and birth control pills.

In general, these two hormones increase when sex hormones are not produced, and are reduced in adenohypophysis dysfunction and hypothalamic insufficiency.

When one of these two hormones is high and the other is low, there is a possibility of a pituitary tumor producing one of the gonadotropins.

Measuring LH and FSH in the urine of children with precocious puberty is helpful because in this case their serum levels are normal while their levels in the urine increase.

- LH has a circadian rhythm. .

- Some medications, such as anticonvulsants, can increase LH, and some medications can lower LH. Such as estrogen, progesterone, testosterone and anti-pregnancy drugs.

- 24 to 36 hours before ovulation, LH levels in the urine increase and are used as a criterion for determining the time of ovulation.

Progesterone levels are low in the follicular phase and increase in the luteal phase, which is a reason for ovulation and is 7-3 days after ovulation at its maximum concentration and is high for another 6-3 days. The remainder is reduced exactly 24 hours before the end of the period.

Progesterone transport in the blood is 18% free of cortisol-binding globulin (CBG), 79% albumin-bound, and 3% free.

- The hormone AMH is involved in regulating and balancing the periodic effect of FSH and LH و in the ovaries and thus in the development and arrival of the egg. .

Obese women have lower AMH levels than their peers, which is unclear.

At a young age leading to menopause, a woman's ovulation remains regular, but the length of her cycle progresses progressively. .

- This phenomenon is due to a decrease in the duration of the follicular phase (2-3 days) without any change in the duration of the luteal phase. That is, ovulation occurs earlier. This is due to the faster and faster follicogenesis process. 

- With increasing age, FSH levels are significantly increased without any change in LH levels (monotropic FSH rise). This increase is especially noticeable in the early stages of the follicular phase (from the time of menstruation until the peak of FSH) with a decrease in Inhibin B. .

- Peak FSH peaks in these women in the early stages of the follicular phase earlier (most likely on the second day). This increase in FSH is probably predominant for mobilization and maintenance of normal follicle function.
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Physical signs of ovulation
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1- Feeling of slight pain and discomfort in the lower abdomen

2- Slight increase in body temperature

3- Increased mucus secretion in the vagina

4- Increasing sexual desire

5- Sensitivity of the breasts
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Factors affecting the time of ovulation
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1- Stress

2- Disease

3- Sudden changes and developments in lifestyle

- Usually the day of ovulation is 16-12 days (average 14 days) before the start of the next menstrual period.

After the egg is released, it has 12 to 24 hours to fertilize with sperm.

- To prevent pregnancy, you should avoid sexual intercourse at least 4-5 days before and 48-24 hours after ovulation. Because sperm can survive in a woman's body for 4-5 days.

- To be more sure, you should avoid having unprotected sex for 6 days before ovulation and 3 days after.