Without a doubt, hormone analysis gives us a lot of information and is a fundamental tool in the study of fertility. Most scientific societies recommend the evaluation of ovarian reserve in patients over 35 years of age or in younger women with suspected low response (irregular cycles, previous ovarian surgery, chemotherapy or radiotherapy treatments, infertility of unknown origin) or a history of early ovarian failure in the family.
Currently, the most widely used and reliable ovarian reserve tests are the anti-Müllerian hormone (AMH) and the antral follicle count (AFR). Anti-Müllerian hormone is produced by the granulosa cells of the preantral and antral follicles of the ovaries throughout a woman's reproductive life, so its measurement in the blood will indicate the number of eggs a woman has at any given time.
Elevated FSH values (> 10-20 IU/I) are also indicative of low ovarian reserve. The combination of age, along with RFA and AMH or FSH, are good markers for predicting ovarian response to IVF treatment, however, they do not predict the likelihood of gestation.
Ovulatory disorders are found in up to 15-25% of cases of infertility, including polycystic ovary syndrome (PCOS), central amenorrhea (hypogonadotropic hypogonadism), ovarian failure (hypergonadotropic hypogonadism), hyperprolactinemia and thyroid dysfunction.
The determination of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), thyroid hormone (TSH) and prolactin levels could help to identify the cause of this oligo/anovulation. This test should be performed in the early follicular phase, between the 2nd and 5th day of the cycle and is recommended especially in women with irregular cycles to make a differential diagnosis between anovulation and ovarian failure:
- FSH < 1 mUI/mL
- hypogonadotropic hypogonadism.
- FSH > 10 mUI/mL
- compromised ovarian reserve.
- FSH > 20 mUI/mL
- exhausted follicle reserve.
- LH > FSH
- indicative of polycystic ovarian syndrome.
- Estradiol > 70-80 pg/mL
- poor response to ovarian stimulation.
If we want to check ovulation in a particular cycle, we can measure progesterone between the 20th and 22nd day of the cycle. A progesterone value above 10 ng/mL is an indicateion that you have ovulated, although the best indicator of ovulatoin is to have achieved pregnancy.