Data shows that 8% to 15% of married couples of childbearing age are troubled by infertility. One of the important reasons is the lack of progesterone, which accounts for 34% to 35% of infertile patients. Among patients with recurrent miscarriage, 29% to 60% are caused by the lack of progesterone.
In the TV series \”Things Between Couples\”, the female architect Lin Jun played by Chen Shu and her husband played by Huang Lei paid great attention to diet and exercise in order to prepare for pregnancy. Unexpectedly, they were diagnosed with excessive male hormones. Infertility. The heroine couldn\’t laugh or cry: \”I worked so hard to recuperate, but how could I produce male hormones?\”
Androgens are the main hormones that maintain male sexual characteristics, but women\’s ovaries and adrenal glands both produce small amounts of androgens. Hormone function. The functions of androgens in women include: providing a synthetic substrate for estrogen, stimulating the growth of armpit hair, etc., promoting protein synthesis and bone marrow hematopoiesis, and is related to sexual desire. Under normal circumstances, the daily secretion of androgen in an adult female body accounts for only 1%, which is about 1/20 of that of a male. The content in the blood is about 1/10 of that of a male. If it exceeds this value, it can be determined as a male. Excessive hormones, medically known as \”hyperandrogenism\”, can cause infertility, but many women can become pregnant successfully after treatment.
So, I suggest that couples who have been preparing for pregnancy for a long time should first go to the hospital to check the six reproductive hormones. The six-item reproductive hormone examination is a routine basic examination in the reproductive department. It is also called the six-item sex hormone. It mainly includes follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, progesterone, testosterone, etc. However, there is currently no complete and unified measurement value of endocrine hormones in China, and due to the sources of various reagents, measurement methods, data calculations, and units used, even for the same hormone sample, the results obtained by each laboratory are not exactly the same. .
For women, it is best to take a blood test on an empty stomach at 9 a.m. on the 3rd to 5th day after menstruation for the most accurate effect. This period belongs to the early follicular phase and can reflect the functional status of the ovary. However, for those who have not had menstruation for a long time or are infertile and are eager to know the test results, they can check at any time. This time will default to the time before menstruation, and the results will refer to the test results of the luteal phase. As long as men do not exercise strenuously and live a regular life, they can be tested on an empty stomach between 8:00 and 11:00 am.
Follicle-stimulating hormone (FSH)
Follicle-stimulating hormone is a sugar secreted by the basophils of the anterior pituitary gland. For women, its main function is to promote the development and maturation of ovarian follicles. The concentration of blood FSH is 1.5 to 10 mIU/ml in the pre-ovulation period, 8 to 20 mIU/ml in the ovulation period, and 2 to 10 mIU/ml in the late ovulation period. ml. Generally, 5 to 40 mIU/ml is used as the normal value. Low FSH values are common during estrogen and progesterone treatment, Sheehan\’s syndrome, etc. High FSH values are common in premature ovarian failure, ovarian insensitivity syndrome, primary amenorrhea, etc. High FSH values If it is less than 40mIU/ml, it is ineffective for ovulation induction drugs such as clomiphene.
For men, the growth of the vas deferens and the maintenance of sperm production are often regulated by FSH. The normal value is 1.42~15.2U/ml. L, if it is too high or too low, it is abnormal. The FSH level in men with azoospermia and oligozoospermia is usually elevated. FSH elevation is also seen in primary testicular failure and seminiferous tube hypoplasia (ie, Klinefelter syndrome) ), hunger, renal failure, hyperthyroidism and liver cirrhosis; testicular tumors generally reduce FSH concentration. FSH can stimulate supporting cells to secrete androgen-binding protein and increase local androgen concentration in the seminiferous tubules.
luteinizing hormone (LH)
Luteinizing hormone prepituitary A glycoprotein hormone secreted by leaf basophil cells. For women, its main function is to promote ovulation. Under the synergistic effect of FSH, it forms the corpus luteum and secretes progesterone. The concentration of blood LH is 2 to 15 mIU/ml in the early stage of ovulation. , 30-100mIU/ml during ovulation, 4-10mIU/ml in the late ovulation period. Generally, the normal value in the non-ovulatory period is 5-25mIU/ml. Lower than 5mIU/ml indicates insufficient gonadotropin function, which is seen in Sheehan\’s disease Syndrome, if high FSH is combined with high LH, ovarian failure is very certain, and there is no need to do other tests. LH/FSH ≥ 3 is one of the basis for the diagnosis of polycystic ovary syndrome. In addition, LH is also used to determine Menopause, ovulation time, and monitoring of endocrine therapy.
For men, LH can promote the development of interstitial cells and secrete testosterone, thereby promoting the development of seminiferous epithelium and spermatogenesis. Elevated LH concentrations are seen in Hypogonadism, primary testicular failure and seminiferous tube hypoplasia, renal failure, liver cirrhosis, hyperthyroidism and severe hunger. Insufficient secretion of hormones from the anterior pituitary gland can cause low LH levels. Low LH levels can lead to infertility in both men and women. Low LH values may suggest certain dysfunctions of the pituitary gland or hypothalamus. In the differential diagnosis of hypothalamic, pituitary, or gonadal dysfunction, LH concentrationsMeasurement is routine and occurs together with FSH.
Prolactin (PRL)
Prolactin is secreted by eosinophils in the anterior lobe of the pituitary gland. It is a simple protein hormone. The secretion of prolactin is regulated by two hormones secreted by the hypothalamus. One is prolactin inhibitor, which can inhibit the production of prolactin. Excessive secretion, the second is prolactin-releasing hormone, which can stimulate the eosinophils of the pituitary gland to secrete prolactin. For women, its main function is to promote mammary gland hyperplasia, milk production and milk discharge. During the non-lactation period, the normal value of blood PRL is 0.08~0.92nmol/L. Higher than 1.0nmol/L is hyperprolactinemia. Excessive prolactin can inhibit the secretion of FSH and LH, inhibit ovarian function, and inhibit ovulation. The measurement of PRL concentration is helpful in the diagnosis of hypothalamic-pituitary dysfunction. Pituitary tumors can cause hyperprolactinemia. High PRL levels are generally related to galactorrhea and amenorrhea. Menstruation can return to normal after drug treatment to reduce PRL.
For men, under normal physiological conditions, prolactin inhibitor controls the secretion of prolactin. The normal concentration of prolactin in men\’s blood is 0 to 0.84 nmol/L. If prolactin is measured higher than 0.84 nmol/L three times in a row, hyperprolactinemia can be diagnosed. Further CT or magnetic resonance imaging examination of the sella turcica should be performed to rule out the presence of pituitary adenoma. When hyperprolactinemia occurs, the function of the hypothalamic-pituitary-testicular axis is reduced, and the level of androgens is low, causing oligozoospermia or azoospermia. Some people have sexual dysfunction and impotence, which can cause infertility. The incidence is about is 4%.
Estradiol (E2)
For women, estradiol is secreted by the follicles of the ovary. Its main function is to promote the transformation of the endometrium into the proliferative phase and promote the development of female secondary sexual characteristics. The concentration of blood E2 is 48 to 521 pmol/L in the pre-ovulation period, 70 to 1835 pmol/L in the ovulation period, and 272 to 793 pmol/L in the late ovulation period. Low values are seen in low ovarian function, premature ovarian failure, and Sheehan\’s syndrome. Serum E2 measurement is a very useful indicator for evaluating various menstrual abnormalities, such as early or delayed puberty in girls, primary or secondary amenorrhea, premature ovarian failure, etc.
For men, E2 participates in the regulation of pituitary gonadotropin release, which can inhibit male pituitary LH and FSH, reduce the amount of T secreted by interstitial cells, and reduce serum E2, which can increase serum LH and FSH. and T concentrations increased. In men, E2 will also increase if you have feminization syndrome, breast feminization, and testicular cancer..
The pathological causes of increased estradiol value include: ovarian diseases, such as ovarian granulosa cell tumor, ovarian blastoma, ovarian lipoid cell tumor, sex hormone production tumor, etc., all of which show hyperovarian function and estrogen deficiency. Increased alcohol secretion; heart disease and other diseases, such as myocardial infarction, angina pectoris, coronary artery stenosis, systemic lupus erythematosus, cirrhosis, and male obesity can also cause increased estradiol secretion.
The pathological causes of decreased estradiol include: ovarian diseases, such as absence or hypodevelopment of ovaries, primary ovarian failure, ovarian cysts; pituitary amenorrhea or infertility, or hypo/hyperthyroidism, cystitis Hind syndrome, Addison\’s disease, malignant tumors, extensive infections, renal insufficiency, focal lesions of the brain and pituitary gland, etc., can all reduce plasma estradiol.
Progesterone (P)
For women, progesterone is secreted by the corpus luteum of the ovary, and its main function is to promote the transformation of the endometrium from the proliferative phase to the secretory phase. Its concentration is used to determine whether ovulation is occurring and the corpus luteum function in non-pregnant women. The blood P concentration is 0 to 4.8 nmol/L before ovulation and 7.6 to 97.6 nmol/L in the late ovulation period. Low blood P levels in the late ovulation period are seen in luteal insufficiency and ovulatory dysfunctional uterine bleeding.
For men, the normal value for adults is 0.10~0.84ng/ml. However, for male infertility clinics, the reference significance of increased progesterone is not great. If the P value increases for unknown reasons, it is recommended to go to a professional hospital for further investigation.
Testosterone (T)
Female 50% of testosterone in the body is converted from androstenedione, about 25% is secreted by the adrenal cortex, and only 25% comes from the ovaries. Its main function is to promote the development of the clitoris, labia, and mons pubis. It has an antagonistic effect on estrogen and has a certain impact on systemic metabolism. The normal concentration of T in female blood is 0.7~3.1nmol/L. High blood T value is called hypertestosteroneemia, which can cause infertility. When suffering from polycystic ovary syndrome, the blood T value is also increased. Depending on the clinical manifestations, other hormones may be measured if necessary.
For men, T is closely related to sperm quantity and activity. People with oligozoospermia and azoospermia have lower serum and semen T levels than normal people. Only free T combined with target cells can promote cell growth. Split and mature.
Elevated testosterone concentrations are common in testicular benign Leydig cell tumors, congenital adrenal hyperplasia, true precocious puberty, male pseudohermaphroditism, female virilizing tumors, polycystic ovary syndrome, and hypercortisolism. and use of gonadotropins, obesity, andIn late-term pregnant women, the concentration of testosterone in the blood may increase.
Reduced testosterone concentration is common in male sexual dysfunction, primary testicular hypoplasia, hyperprolactinemia, hypopituitarism, systemic lupus erythematosus, osteoporosis, cryptorchiditis, and men. Breast development, etc.
When many people hear about the six reproductive hormone tests, they generally think that it is a matter for women. In fact, maintaining male fertility also requires a suitable hormonal environment. The hormones related to male reproductive function mainly include gonadotropin-releasing hormone (GnRH) secreted by the hypothalamus, follicle-stimulating hormone (FSH) secreted by the anterior pituitary gland, luteinizing hormone (LH), prolactin (PRL), and the testicles themselves. Secretes testosterone (T) and dihydrotestosterone (DHT). These hormones can act on the Sertoli cells of the testis through the hypothalamic-open body-testis axis to produce sperm to ensure male fertility, and act on Leydig cells to maintain male fertility. Sexual characteristics and sexual function. Abnormal content of any of these hormones can indirectly or directly cause testicular spermatogenesis dysfunction, thereby affecting male fertility. It is reported that 10% of infertile men have endocrine dysfunction. In developed countries, endocrine examination has become the main means of detecting male infertility.
Therefore, for couples who have difficulty conceiving, not only the expectant mother needs to undergo hormone examinations, but the expectant father also needs to undergo these six examinations to understand the relationship between sex hormones and male reproductive function. It will be helpful to study the causes, pathogenesis, diagnosis and treatment of childbirth, as well as family planning.
This article is provided by Baidu Reading. It is excerpted from \”Very Good Pregnancy: You Can Get Pregnant by Doing This\” Author: Yu Yue\’e