6- Laboratory Challenges of Female Infertility Diagnosis - Part 6 (Laboratory Ovulation Disorders)

6- Laboratory Challenges of Female Infertility Diagnosis - Part 6 (Laboratory Ovulation Disorders)

Laboratory examination of ovarian disorders

1- Laboratory examination of ovulation

1-1- The appropriate criterion for ovulation (even in people who have regular menstruation) is the measurement of FSH and progesterone levels in the middle of the luteal phase or a week before the start. Be the next cycle.

For example, day 21 of the cycle in women who have a 28-day cycle.

If a woman's cycles are long and unpredictable, progesterone measurements continue once a week until the next cycle begins.

Progesterone above 3 ng ng / mL indicates ovulation. .

Note: Because many hormone tests performed by Closed methods, such as electromechanical luminescence, use antibodies labeled with biotin and mediate the binding of antibodies to streptavidin-coated magnetic microparticles. Connection to solid phase is used.

Biotin is also called vitamin B7‌ or vitamin H and plays an important role in the metabolism of carbohydrates, fats and amino acids as an enzymatic cofactor, as well as in the synthesis of vitamins B6 and B12. plays a role.

Biotin is found in whole grains, liver, egg yolks and milk.

If you take supplements containing biotin at a dose above 5 mg per day, it can interfere with the above test (at least 8 hours must have elapsed).

This test does not require fasting or special preparation.

It is stable in the refrigerator for up to 5 days and in the freezer for up to a month.
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1-2- Measurement of LH in the urine using Ovulation Predictor Kits (OPKs) kits with a high power of تشخیص 90% has the ability to detect ovulation.

Normally, a sharp increase in LH (LH surge) occurs 36 hours before ovulation. 12 hours later, the urinary level of LH is increased and can be detected by this kit.

However, in 5 to 10 percent of people, this test did not work, and as a result, an increase in LH levels in the blood on day 12 and 13 of the cycle (a 28-day cycle) must be used to prove the presence of LH surge.

A positive test if it lasts more than 2 to 3 days is a sign that ovulation is unlikely to occur, resulting in a normal negative feedback that should be released from the ovary after ovulation ‌ (due to a severe decrease in estrogen). It is not taken and LH ‌ (as well as FSH) remains high to stimulate the ovaries to ovulate.

Tip 1: The best time to take a urine sample is between 11 a.m. and 3 p.m.

It is usually recommended that this test be performed in the urine on the first day after the menstrual bleeding ends and continuously daily at a specific time until ovulation (mid-menstrual cycle). .

Note 2: Note that a positive test is a sign of LH surge in the serum (which is required for ovulation), but does not necessarily mean that ovulation has taken place.
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Tip 3: Any factor that raises LH levels can lead to false positives in this test, such as polycystic ovary syndrome, immature ovarian failure (POF), and those over 40 years of age. .

Tip 4: LH-enhancing drugs such as anticonvulsants, clomiphene, naloxone and spironolactone, as well as LH-reducing drugs such as estrogens, progesterone, testosterone, digoxin, OCPs and phenothiazines may interfere with test results. .

A steady increase in LH and FSH in the luteal phase indicates that there is no normal negative feedback following ovulation from the ovary, resulting in an increase in LH and FSH. .

Women with irregular menstruation are advised to take gonadotropins (FSH and LH).

Ovarian amenorrhea is seen as an increase in FSH and a decrease in estradiol. These people must use egg donation for treatment.

Amenorrhea due to hypothalamic disorders is characterized by decreased FSH (rarely normal) and decreased estradiol. These individuals must use exogenous exogenous gonadotropin-stimulating compounds for treatment.