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Hormonal Study of Primary Infertile Women

Authors:
  • University Technology Brunei; University of Sulaimani; Karolinska Institutet; and Stockholm University,
Journal of Zankoy Sulaimani- Part A (JZS-A), 2013, 15 (2)   - A
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Hormonal Study of Primary Infertile Women
Ban Mousa Rashid*, Tayfoor Jalil Mahmoud**, Beston F. Nore***
* Department of Biochemistry, Faculty of Medical Sciences, School of Pharmacy, University of
Sulaimani, Sulaimani, Kurdistan Regional, Iraq. bany_m_rasheed@yahoo.com
** Department of Medical Biochemistry, College of Medicine, Hawler Medical University,
Erbil, Kurdistan Regional, Iraq.
*** Department of Biochemistry, Faculty of Medical Sciences, School of Pharmacy, University
of Sulaimani, Sulaimani, Kurdistan Regional, Iraq.
Abstract:
Approximately (15 %) of couples attempting their first pregnancy meet with failure.
Most authorities define these patients as being primary infertile if they unable to achieve a
pregnancy after one year of unprotected intercourse. The aim of this study was to evaluate
the serum levels of Luteinizing hormone, Follicle stimulating hormone, Prolactin and
Testosterone in (410) primary infertile women in Sulaimani city. The results obtained
compared with that of (240) age matched fertile women. The results showed, higher
incidence of primary infertility was in the age range (26-37) years and hormonal
imbalance plays an important role in primary female infertility.
Keywords: Primary female infertility, LH, FSH, PRL, Testosterone.
INTRODUCTION:
Conception normally is achieved
within (12) months in (80-85) of couples
who use no contraceptive measures.
Females presenting after this time should
therefore be regarded as possibly infertile
and should be evaluated .Data available
over the past (20) years reveal that in
approximately (30%) of cases, pathology
found in the women alone, and in another
(20%) both the man and woman are
abnormal [1-2].
The women reproductive years begin
when she starts her menstrual cycle during
puberty (about the age 13) years, and the
ability to have a child usually ends around
the age (45) years, although it is
potentially possible for a women to be
pregnant until her periods end with
menopause (about the age 51) years [3].
Born girl already carries in her body
about (400000) immature eggs (oocytes).
These are stored in her ovaries in tiny
fluid-filled sacs called follicles. Once she
enters her reproductive years, she starts
having monthly one egg (or, less
commonly, more than one), which may
join with a male motile sperm cell during
fertilization and being a pregnant [4].
The development and release of the egg
depend largely on a delicate balance of
hormones (chemicals that signal the body
organs to do a particular task). Some of
these hormones are produced in the
ovaries, others from the two glands in the
brain, the hypothalamus and the pituitary
[5].
Primary infertility is a term used to
describe a couple that has never been able
to conceive after a minimum of one year
of attempting to do so through unprotected
intercourse. Causes of primary infertility
include a wide range of physical as well as
emotional factors [6]. The principal causes
are:
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1. Ovulatory or hormonal abnormality:
Failure of ovulation is the single most
common cause of infertility in females.
The normal ovarian cycle is so complex
that even small deviations may disrupt
the cycle and prevent ovulation [7].
Ovulatory disorders are most often
caused by abnormality in one of the
controlling hormone. However,
problems can also arise if the ovaries
themselves are resistant or non
responsive to normal levels of
hormones. In addition, absent, damaged
or diseased ovaries will prevent
ovulation [8]. The principal symptoms
associated with ovulatory disorders are:
Amenorrhea, Oligomenorrhoea,
Irregular menstrual cycle, Obesity,
Excessive weight loss Galactorrhoea,
Hirtism and Acne [9].
2. Anatomical disorders: Disorders of the
female sex organs are much more
common than those of the male. This is
especially true of infection and
inflammatory conditions [10].
3. Chromosomal disorders: Infertility can
arise when there are abnormal
chromosomes or abnormal numbers
[11].
4. Unexplained infertility (Idiopathic):
This is a diagnosis of exclusion.
FSH is synthesized and secreted by
gonadotropins in the anterior pituitary
gland; it is a glycoprotein that regulates
the development, growth, pubertal
maturation and reproductive processes of
the human body. In females, it initiates
follicular growth, specifically affecting
granulose cells. With the concomitant rise
in inhibin B (a complex protein that down
regulates FSH synthesis and inhibits its
secretion). FSH levels then decline in the
late follicular phase. This seems to be
critical in selecting only the most
advanced follicle to proceed to ovulation
[12].
LH is produced also by the anterior
pituitary gland; it is a glycoprotein and
essential for reproduction. In females, at
the time of menstruation, LH initiates
follicular growth, specifically affecting
granulose cells [13].
Testosterone is a steroid hormone from
the androgen group. It is the principal
male sex hormone, produced by testes in
men and by thecal cells of the ovaries and
placenta in women.
Testosterone is also synthesized by
zona reticulais of the adrenal cortex in
both sexes. In general, Testosterone has
both anabolic and virilizing effects [14-
15].
Prolactin (PRL) is mainly synthesized
in the pituitary gland and involved in
many different biological functions
including behavior, immunology,
endocrinology, metabolism and
reproduction [16].
More than (300) different biological
functions have been attributed to PRL, the
major ones being induction of
differentiation and growth in mammary
epithelia and stimulation of milk protein
secretion [17].
PRL is secreted mainly by lactotrope
cells, breast deciduas and immune system
[18]. Hyperprolactinemia is one of the
most common endocrine disorders of the
hypothalamic pituitary axis. It is more
commonly diagnosed in women than in
men and if it persists, it usually causes
infertility, amenorrhea, galactorrhea,
oligomenorrhea, hyperandrogenism,
hirsutism, acne, regular menses; but with
anovulatory cycles [19].
In the light of these data and to extent
the understanding the hormonal effects on
female infertility, this study was
undertaken to investigate the serum levels
of LH, FSH, PRL and Testosterone in
primary infertile women and comparing
the results obtained with that of age
Journal of Zankoy Sulaimani- Part A (JZS-A), 2013, 15 (2)   - A
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matched fertile women in order to explore
the role of hormonal abnormality in female
infertility.
SUBJECTS AND METHODS:
Subjects: This study was conducted
over a period of two years, from January
2007 to July 2009 at the department of
chemistry/ College of Science/ Sulaimani
University/ Sulaimani/ Iraq. Informed
consent was obtained verbally from all
participants. All participants were
carefully screened to exclude evidence of
congestive heart failure hepatic and renal
diseases. The present study included (650)
females, which were divided into two
groups:
I. Control group (Fertile women group):
Included (240) apparently healthy fertile
women.
II. Case group (Primary infertile women
group): Included (410) primary infertile
women, diagnosed by gynecology and
obstetrics consultants. Details of the
number and age of the two groups are
illustrated in Table (1):
Table (1): Details of number, and age of the
studied groups.
Range of age
(years)
Number Groups
22-40 240
Control (Fertile
women) group
22-40 410
Case (Infertile
women) group
22-40 650 Total
Samples: Five ml of venous blood was
withdrawn from the cubital vein of each
participant using disposable syringes
during the second day of menstrual cycle.
The blood samples were allowed for
(15) minutes at room temperature to clot
and serum was separated by centrifugation
at 3000 rpm for (10) minutes. Serum
samples were either analyzed immediately
or stored at (-28 ̊C) until they were
analyzed.
Methods: The serum levels of LH,
FSH and PRL were determined by
immunoradiometric assay and that of
testosterone by a radioimmunassay as
described by Ban M.R. [20].
Statistical analysis: The means,
standard deviations, T-test and P-value
were used to compare the significance of
different data.
The overall predicted values for the
results in both studied groups were
performed using SPSS 16.0 program.
RESULTS:
The mean serum levels of LH, FSH,
PRL, and Testosterone in fertile women
are all within their normal means. On the
other hand there was a clear difference
between the primary female infertility
according to their age ranges. Those of the
age range between (26-37) years
represented the highest percentage.
The results indicated also highly
significant differences (P < 0.05) in the
mean serum levels of LH, FSH, PRL and
Testosterone between control and case
groups, Table (2).
Table (2): Serum levels (Mean ± S.E.) of LH,
FSH, PRL and Testosterone in control and
case groups.
P-
values
Case
group
Control
group
Studied
Hormones
< 0.05 8.79±10.01 3.18 ±1.34
LH
(mIU/ml)
< 0.05 12.95 ±17.53 4.99 ±2.6
FSH
(mIU/ml)
< 0.05 12.85±16.89 7.28 ±3.34
PRL
(ng/ml)
< 0.05 2.27 ±1.32 1.91 ±0.59
Testosterone
(nmole/L)
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DISCUSSION:
Female infertility may be either
primary (refers to the biological inability
of a woman to contribute to conception
after one year of unprotected intercourse)
or secondary (describes women who have
been pregnant at least once, but have not
been able to achieve a pregnancy again)
and the simplest evaluation of a female
infertility is the hormonal analysis.
The data obtained in this study for
serum levels of LH, FSH, PRL and
Testosterone in control group are all
within their normal means. Similar results
were obtained by Davis and Tran [14],
Scott and Ledenson [21], Griswold [22],
and Casanueva [23].
The results of the present study showed
also that among (410) infertile women,
there was a significant difference of
infertility according to age. Those of the
age range (26-27) years represented
(50.24%). This finding is in agreement
with other international studies which
showed that the number of infertile
couples rises with increasing age. The
same authors reported also that women are
born with a finite number of eggs. Thus, as
the reproductive years progress, the
number and quality of the eggs diminish.
The chances of having a baby decreased
by (3-5 %) per year after the age of (30).
This reduction in infertility is noted to a
much greater extent after age (40) [24-26].
The results of the present study
indicated a significant difference (P<0.05)
in the mean serum levels of LH, FSH,
between control and case groups. LH and
FSH in females are intricately involved in
the reproductive cycle. LH stimulates the
ovarian theca to produce several androgen
precursors of estradiol, whereas FSH, in
turn, induces the conversion of these
androgens to estradiol by the ovarian
granulose cells [27-28]. Serum
measurements of LH and FSH are
frequently used in the evaluation of
disorders of infertility and puberty, such
as, hypo-gonadism, ovulation timing and
infertility studies, monitoring ovulation
induction and the clinical administration
of gonadotropins. Generally, elevated LH
levels indicate ovarian dysfunction,
whereas that of FSH indicates poor
follicle development and consequently
anovulatory cycles [29-30]. The primary
function of PRL is the development and
maintenance of lactation. Several
physiological conditions induce the
release of PRL, the most notable being the
stimulation of the breast and nipple during
nursing [31]. Two other conditions giving
rise to PRL release are severe stress and
major surgery involving general
anesthesia. The release of PRL into the
blood stream is thought to be under the
control of a prolactin-inhibitory factor
produced by the hypothalamus [32].
Several other clinical conditions have
been associated with abnormal levels of
PRL in women, such as galactorrhea,
anovulation with amenorrhea,
hypoestrogenism and hyperprolactinemia
[33]. The results of the present study
indicated a significant (P> 0.05) difference
in the serum level of PRL in infertile
women compared to fertile women. This
finding is in agreement with the results of
other studies [34]. The data obtained
revealed also a significant (P < 0.05)
increase in the serum level of Testosterone
in primary infertile women compared with
fertile women. This finding is similar to
that obtained by Shirtcliff et al [35].
Testosterone is produced in small
quantities by the ovaries in women and
elevated levels can lead to infertility. The
commonest cause of hair growth in women
with abnormal periods is polycystic ovary
syndrome, which cause
hyperandrogenaemia. The appropriate test
for hyperandrogenaemia is estimation of
serum total testosterone [36].
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CONCLUSIONS:
The conclusions can be summarized as
follows:
1. The results of this study showed that
the higher incidence of primary female
infertility was in the age range between
(26-37) years.
2. The data obtained revealed also that the
serum levels of LH, FSH, PRL, and
Testosterone in primary infertile
women were significantly higher than
that of control group, so hormonal
imbalance plays an important role in
primary female infertility.
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... Pomegranate also makes the uterus lining stronger, which lessen the chances of miscarriages. [34][35][36]. ...
... Different problems of female-like endometriosis, amenorrhea (when there is the absence of periods) and uterine fibroids which are the causes of infertility can be treated by the use of cinnamon. A woman who is suffering from PCOS, cinnamon is used, which improve the female menstrual cycles [34][35][36]. ...
... As allopathic medicines, which are used have some side effects the same as if the herbal remedy is not taken in the correct amount then it will produce some harmful effects on health. Following side effects can occur such as heart attack, stroke, seizure, dizziness, headache, dry mouth, cramps, nausea and vomiting, diarrhea, elevated blood pressure, anxiety, irregular heartbeat and insomnia [36] ...
... Pomegranate also makes the uterus lining stronger, which lessen the chances of miscarriages. [34][35][36]. ...
... Different problems of female-like endometriosis, amenorrhea (when there is the absence of periods) and uterine fibroids which are the causes of infertility can be treated by the use of cinnamon. A woman who is suffering from PCOS, cinnamon is used, which improve the female menstrual cycles [34][35][36]. ...
... As allopathic medicines, which are used have some side effects the same as if the herbal remedy is not taken in the correct amount then it will produce some harmful effects on health. Following side effects can occur such as heart attack, stroke, seizure, dizziness, headache, dry mouth, cramps, nausea and vomiting, diarrhea, elevated blood pressure, anxiety, irregular heartbeat and insomnia [36] ...
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Infertility is an inability to conceive for a couple after more than 1 year of regular unprotected intercourse. The study aims to review the current information and treatment strategies of infertility. Data were obtained from Google Scholar, Science Direct, Cochrane data and recently published articles on infertility. There are several causes of male and female infertility, i.e. Drugs, smoking, genetic factors and ejaculation dysfunction. Different therapies are effective in infertility. Here, concluded that early diagnosis and treatment could reduce the rate of infertility
... Female infertility is multi factorial, but primarily it is due to ovulation problems, blockage of Fallopian tube, uterine problem, stress, obesity, infectious disease and hormonal imbalance etc. [10] Scott et al., (1989) and Ban et al., (2013) found a significant association between hormonal imbalance and female infertility. [11,12] Fertility has been associated with various anthropometric parameters and socioeconomic conditions. This study was carried out to determine the levels of FSH, LH and Prolactin in infertile women. ...
... . [12,13] Scott MG et al., (1989) and Choudhury et al., (1995) reported that the elevated levels of Prolactin hormone are very common in infertile women as compared with fertile women. [11,14] In the present study FSH levels were significantly higher in infertile women compared with fertile women. ...
... Generally, increased LH levels are associated with ovarian dysfunction. [12,13] Aroma et al., (2014) emphasized that increased FSH, LH and Prolactin levels are significantly associated with infertile women. [13] The serum Prolactin levels were increased in infertile women as compared to fertile women. ...
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Background: Study of hormonal imbalance and its implications in female infertility are an interesting area that requires to be explored in recent time. Hormonal imbalance can associated with irregular menstrual cycle, Amenorrhea, obesity and infertility in women. Other medical conditions such as polycystic ovarian syndrome, Endometriosis, stress, sexually transmitted diseases and chromosomal anomalies may be responsible for infertility in females. Objective: The aim of the present study was to evaluate the serum levels of Follicle Stimulating hormone (FSH), Luteinizing hormone (LH) and Prolactin hormone in infertile women that were referred from different infertility clinics and centres. Materials and Methods: This study comprises total 176 female subjects with age ranging from 20 to 40 years and divided in two groups. The total number of 88 infertile women along with 88 fertile women as controls was included for the present study. Serum FSH, LH and Prolactin levels were estimated by enzyme-linked immunosorbent assay (ELISA) methods. Results: The results showed maximum infertile women were found between the age group of 30-40 years. The Serum FSH, LH and Prolactin levels among infertile women was 8.77±4.65, 7.64±5.16 and 18.59±7.50 respectively. Whereas, levels of FSH, LH and Prolactin in fertile women showed that 6.71±4.12, 5.66±3.17 and 13.44±5.82 respectively. Conclusion: In this study, we found that the hormone levels have statistically significant with female infertility. The elevated levels of FSH, LH and Prolactin may be one of the important causes for infertility in women.
... High prolactin levels (hyperprolactinaemia) recorded in this study might be as a result of some clinical conditions like galactorrhoea, anovulation etc, which might also be the reason for the very low vitamin B12 level in women. This work is consistent with the work of Ban et al. [18]. Follicle-stimulating hormone (FSH) was significantly lower in infertile female group as compared with the control; and lower test value of luteinizing hormone (LH) as against the control (p<0.05). ...
... Follicle-stimulating hormone (FSH) was significantly lower in infertile female group as compared with the control; and lower test value of luteinizing hormone (LH) as against the control (p<0.05). This finding is in agreement with the study carried out by Ban et al. [18]. In the study carried out on the principal reproductive male hormone testosterone there was a statistically significant decrease in the test subject against the control subjects (where the testosterone level of the infertile male was lower than the control group), this is similar to a study by Oladosu et al. [19] where the mean testosterone level was significantly lower among male partners of infertile couples compared to controls. ...
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Background: Vitamin B12 has proven to have effect in fertility because it improves mature oocyte counts and embryo quality in women and helps in sperm quality in men, so it is efficient to carry out vitamin B12 analysis in addition to other hormone profile during routine infertility examination. Aim: The aim of this study was to evaluate vitamin B12, folate, some haematological parameters and some reproductive hormones in men and women attending fertility centres in Port Harcourt. Study Design: This study is a case-control and comparative study, and a random convenient sampling method was employed. A total of two hundred (200) apparently healthy participants within the reproductive age group of 18-44 years attending the fertility clinics of Rivers State University Teaching Hospital (RSUTH) Port Harcourt formerly Braithwaite Memorial Hospital (BMH) which is the only State Government owned teaching hospital in Rivers State located at Forces Avenue Port Harcourt and Save a Life Mission Hospital Port Harcourt a private owned fertility hospital located at Stadium Road, Port Harcourt were recruited for this study. Results: The result showed that there was no statistically significant difference in haematological parameters in cases of infertility in the female and male test groups as compared to control groups (p>0.05). The mean ±SD showed non-significant difference of serum folate in the male and female test and control groups of the study (p>0.05). This study however observed Vitamin B12 level to be statistically significantly lower in infertile females when compared with the controls (p=0.0078). There was also a statistically significant difference between the mean values of Vitamin B12 in the male test and control groups of this study (p<0.0001). Prolactin levels in the females showed a significant difference between the test and control group at (p<0.0001), with the mean (± SD) value higher in the test than the control which shows that the infertile female group were mostly having high prolactin levels. Follicle-stimulating hormone (FSH) and Luteinizing hormone (LH) were significantly lower in infertile female group as compared with the control (p<0.0001). In the study carried out on the principal reproductive male hormone testosterone there was a statistically significant difference between the test and control groups (p<0.0001). Conclusion: There was a significant fall in vitamin B12 alongside predominant fertility hormones like testosterone in the infertile male subjects. There was also significant reduction in the serum concentration of vitamin B12 with a corresponding fall in serum concentration of fertility hormones like; luteinizing hormone (LH) and follicle stimulating hormone (FSH) in the infertile females and a significant rise in the concentration of the female prolactin level. Therefore, Vitamin B12 should be included in the evaluation of infertility either primary or secondary alongside other vital conventional parameters usually considered in infertility cases.
... Data available over the past (20) years reveal that in approximately (30%) of cases, pathology found in the women alone, and in another (20%) both the man and woman are abnormal. [5][6] The women reproductive years begin when she starts her menstrual cycle during puberty (about the age 13) years, and the ability to have a child usually ends around the age (45) years, although it is potentially possible for a women to be pregnant until her periods end with menopause (about the age 51) years. [7] Born girl already carries in her body about (400000) immature eggs (oocytes). ...
... delays the onset of menopause and prolongs the reproductive lifespan because of the presence of antioxidants in fruits and vegetables that counteracts the adverse effects of reactive oxygen species on the number and quality of ovarian follicles [33 ]. g. Hormonal imbalance: Due to hormonal imbalance amenorrhea in women may result in serious consequences such as thyroid malfunction, polycystic ovary syndrome, tumor of pituitary gland sarcoids, premature menopause, premature ovarian failure, postpartum necrosis etc [34,35]. ...
... Other studies by (10, 19 and 20) found a significant association between hormonal imbalance and female infertility. The elevated levels of PRL hormone are very common in infertile women as compared with fertile women (20)(21)(22) . High levels of circulating PRL, in physiology and pathological situations, are known to cause infertility (23) . ...
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The prevalence of infertility is estimated to be between 12 and 14%. It thus represents a common condition, with important medical, economic and psychological implications. The aim of the study was to determine the studies follicle stimulating hormone (FSH), luteinizing hormone (LH) and prolactin (PRL) levels in infertile women. The study was carried out at the El-Beyda City, during the period from April to December 2017.The details pertaining to the patients regarding age, number of childbirth is furnished. The blood was collected during mid cycle, serum decanted and used for analysis. FSH, LH and PRL were estimated by Immuno enzymatic assay by Elisa Reader. The study involved (140) women. The results showed that the majority of studies women had normal hormonal levels according to the standard reference limits for FSH, LH and PRL. The study also showed that there was a significant positive correlation between the change in level of FSH, LH, PRL and the age of the studies infertile women. It was concluded that hormonal imbalance for (FSH, LH and PRL) is just an importance suspected etiologic factor in causing infertility.
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BACKGROUND: The excessive concentration of leptin has negative effects on all aspects of female reproduction. Despite this established relationship, the exact role of leptin in women’s fertility is not clear enough and needs more clarification. AIM: To evaluate the serum leptin levels in Sudanese women and to ascertain the relationship between serum leptin levels and unexplained infertility (UI). METHODS: A matched (age and body mass index) case-control study was conducted from March 2021 to February 2022. The study samples were 210 women with UI and 190 fertile women of reproductive age who were attending the maternity hospitals and fertility clinics in Khartoum state Sudan. The serum concentration of leptin and other serum biomarkers were determined using enzyme-linked immunosorbent assays. RESULTS: The results showed that there was a highly statistically significant difference between the two groups (P < 0.001) for all examined eight biomarkers. Whereby, leptin, luteinizing hormone (LH)/follicular stimulating hormone (FSH) ratio, prolactin hormone (PRL), and testosterone (T) were significantly higher in the UI group compared with the control group. In contrast, FSH and estradiol (E2)/T ratio were significantly lower in the UI group than in the control group and the effect size test for the difference between the two groups was very large (effect size > 0.80), for leptin level, LH/FSH ratio, PRL level, and E2/T ratio, and large (effect size 0.50- ≤ 0.80) for FSH and T. CONCLUSION: This study reveals that leptin could be a potential biomarker for UI in Sudanese women and it may be useful for identifying women with a high risk of infertility.
Article
Introduction: Infertility is very often observed in women. It is the failure to conceive after one year of regular unprotected coitus. Data from population based studies suggest that 10-15% couples in the western world experience infertility. Infertility can be caused by a number of factors. Hormonal problems are amongst the important factors contributing to female infertility. Aim: The aim of this study was to ascertain the FSH(Follicle Stimulating Hormone), LH(Leuteinizing Hormone), Prolactin, Testosterone, FT3(Free Triiodothyronine), FT4(Free Thyroxine), TSH(Thyroid Stimulating Hormone) and Oestradiol levels in infertile women. Methods: This observational study was carried out over a period of 1 year from June 2012 to May 2013 on 110 infertile women who reported to Gynae OPD(Out-Patient Department) in Border Guard Hospital, Dhaka. Blood samples of the subjects were taken on 2nd day of menstruation of regular menstrual cycle and on first visit of women having irregular menstrual cycle. Different hormonal studies were done by IMMULITE immunoassay. Semen analyses of their husbands were found to be normal. The results obtained were compared with the reference levels. Results: Among 110 infertile women, 86.37% cases were of primary infertility and 13.63% were 34 JAFMC Bangladesh. Vol 10, No 1 (June) 2014 of secondary infertility. In this study on infertile women majority (34.54%) of the cases of infertility were having PCODs(Polycystic Ovary Disease), others were of hypothyroidism (23.6%) and hyperprolactinaemia was found in 19.09% cases. Both PCODs and hypothyroidism were found in 6.36% cases and no abnormality was detected in 16.36% cases. The Mean ± SD of different hormonal levels were: FSH 2.58±1.63, LH 10.20±4.36, prolactin 61.17±1158 and testosterone 140±34.22 respectively. The mean ± SD of measured hormone levels were compared with reference levels of different hormones by using student t test. In case of FSH, LH, TSH, prolactin, testosterone, FT4 and Oestradiol the difference were statistically significant (P<0.01) but for FT3 was not statistically significant. Conclusion: In this study, PCOD was found to be the most common cause of infertility and other causes found were hyperprolactinaemia and hypothyroidism. DOI: http://dx.doi.org/10.3329/jafmc.v10i1.22902 Journal of Armed Forces Medical College Bangladesh Vol.10(1) 2014
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Infertility is a global health issue affecting approximately 8-10% of couples. It is a multidimensional problem with social, economic and cultural implications, which can take threatening proportions in countries with strong demographic problems, such as Greece. Lately, an increasing number of couples with infertility problems choose the artificial insemination. The purpose of the study was to investigate the causes of infertility in women of reproductive age. Material and Method: The study population consisted of 110 infertile women who sought medical help in a private Assisted Reproduction Center for a period of 2 months. Collection of data was performed by means of a specifically designed questionnaire, which apart from the demographic data, it included questions concerning the causes of infertility. Results: The sample studied consisted of 110 infertile women. Regarding marital status 94.4% (106) of the participants were married and 3.6% (4) unmarried. Regarding age, 64.5% were 20-29 years old, 20.0% were 30-39 years old, 11,8% were 40-49 years old and 3.7% were over 50 years old. As to occupation status, 35% of the participants were employees in the private sector, 27% were employees in the public sector, 24% were self employees and 14% dealt with the household. Regarding educational status, 3.6% had finished primary school, 31.8% had finished high school, 56.4% were University graduates and 8.2% were graduates of another school. Concerning the causes of infertility, 27.4% of the problems were due to fallopian tubes dysfunction, followed infertility of «unknownraquocause in 24.5% of the cases, 20% were due to disorders of menstruation, 9.1% due to problems of the uterus, 2,7% due to sexual disorders, another 2,7% because of age and in a very small percentage, infertility was caused by ovarian failure.egarding the daily habits of the participants, 45.5% were smokers. Conclusions: The causes of female infertility are problems in the fallopian tubes and the uterus, disorders of menstruation, sexual disorders, age and ovarian failure. Female infertility is a complex problem that should be considered carefully by the government and stakeholders in each country and especially by those countries with demographic problems, in order to find effective interventions and solutions.
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Specialist infertility practice was studied in a group of 708 couples within a population of residents of a single health district in England. They represented an annual incidence of 1.2 couples for every 1000 of the population. At least one in six couples needed specialist help at some time in their lives because of an average of infertility of 21/2 years, 71% of whom were trying for their first baby. Those attending gynaecology clinics made up 10% of new and 22% of all attendances. Failure of ovulation (amenorrhoea or oligomenorrhoea) occurred in 21% of cases and was successfully treated (two year conception rates of 96% and 78%). Tubal damage (14%) had a poor outlook (19%) despite surgery. Endometriosis accounted for infertility in 6%, although seldom because of tubal damage, cervical mucus defects or dysfunction in 3%, and coital failure in up to 6%. Sperm defects or dysfunction were the commonest defined cause of infertility (24%) and led to a poor chance of pregnancy (0-27%) without donor insemination. Obstructive azoospermia or primary spermatogenic failure was uncommon (2%) and hormonal causes of male infertility rare. Infertility was unexplained in 28% and the chance of pregnancy (overall 72%) was mainly determined by duration of infertility. In vitro fertilisation could benefit 80% of cases of tubal damage and 25% of unexplained infertility--that is, 18% of all cases, representing up to 216 new cases each year per million of the total population.
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Performance of the male and female reproductive systems reflects the orderly operation of the hypothalamic-pituitary-gonadal axis. Aberrant operation of this axis can result in many different reproductive disorders, including various forms of infertility. Proper evaluation of these disorders involves a multifaceted diagnostic approach, which includes a critical contribution from the clinical laboratory. This adjunctive testing, involving the measurements of peptide and sex-steroid hormone concentrations, allows the clinician to biochemically "dissect" the hypothalamic-pituitary-gonadal axis and ascertain the presence as well as location of the specific defect. In practice, the specific tests utilized during the evaluation of a patient depend upon the underlying disorder. Typically, in evaluating the reproductive disorders discussed in this review, a primary battery of tests is obtained that reflects the initial clinical presentation and physical examination. The results of these initial studies then dictate any secondary testing required to complete the evaluation. Such an approach, in use at our institution, is provided in Table 5. Although this discussion has concentrated on the laboratory assessment of the female reproductive system, it is important to remember the special case of infertility, where couples, in general, are evaluated together by the clinician. The cause of infertility can reside with the female, the male, or, in the cases of immunological "incompatibilities," a combination of the male and the female. As such, rigorous schemes for evaluating male reproductive disorders (1, 3, 89-94) and immunological incompatibilities (95-98) have been developed, and the information derived from such testing represents a critical contribution to establishing the etiology of a couple's infertility. Although the laboratory assessment of peptide and sex-steroid hormone concentrations clearly plays a pivotal role in the evaluation of reproductive disorders, these diagnostic tools probably will continue to change and improve in the years to come. Such changes will probably occur as the finer details of the operation of the hypothalamic-pituitary-gonadal axis become known. With this improved knowledge, we should have the capacity to design assays that will allow more clinically refined and biochemically precise means of diagnosing and treating specific reproductive disorders.
We have provided a brief historical review of developments in our understanding of the endocrine mechanisms underlying the expression of androgen action in women. An alternative to the free hormone concept is considered which proposes that, at least in some target cells, androgens bound to SHBG are the biologically relevant molecules. In nearly every instance, the changes in blood levels of SHBG that have been observed are consistent with this idea. At present there are only bits of direct evidence to support the hypothetical mechanism proposed. As already mentioned, control of androgen action at the level of cellular uptake would provide obvious advantages as well as a potential mechanism to explain the antagonism between androgens and oestrogens which is still a mystery. It is important to note that the proposed mechanism is not obligatory for androgen or other steroid hormone action. Synthetic steroids which do not bind to SHBG or CBG clearly can gain access to target cells by simple diffusion and bind to intracellular receptors. Compounds such as methyltestosterone and dexamethasone are metabolized much more slowly than their natural counterparts and therefore are cleared slowly from the circulation. It is possible that the well-known difficulties in selecting appropriate therapeutic regimens with such compounds is related to the fact that they bypass an important regulatory step in steroid hormone action-modulated entry into target cells. Hopefully, the recent development of powerful new tools of molecular endocrinology will hasten the answer to the question: What is the active androgen in blood?
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In a retrospective study of 163 women with endometriosis, 76% had a history of menorrhagia, a larger percentage than that which might be normally expected. Only 10% of the women complained of infertility, while 13% had used oral contraceptives regularly, a much smaller proportion than expected. These findings are discussed in terms of the pathogenesis of endometriosis and the possible prophylactic role of oral contraceptives. The authors suggest the possibility that increased sensitivity to estrogens may lead to the development of endometriosis in some women.
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During a 20-year period, 19 (9.1%) of 208 patients with uterine anomalies had primary infertility. Women with unicornuate uteri had the highest (15%) incidence of primary infertility, which was found in the other groups of uterine anomalies in 7% to 13% of the patients. The cause of infertility was a nonuterine factor in 12 cases: hormonal (8), endometriosis (2), tubal (1), or male (1). The reason for infertility remained unknown or the patient conceived during investigation in five cases. Malformation of the uterus was considered the sole reason for infertility, and metroplasty was performed in two cases. During the follow-up period, 14 patients (74%) achieved pregnancy: 6 spontaneously, 3 after curettage, 2 after metroplasty, 1 after clomiphene treatment, 1 after hysterosalpingogram, and 1 after conservative endometriosis surgery. Four of five cases without pregnancy had a nonuterine factor as the cause of infertility, and in one case it may have been a uterine anomaly--a unicornuate uterus with a rudimentary horn. The results indicate that uterine anomalies are rarely the reason for infertility. Nonuterine causes of infertility must be ruled out before metroplasty is performed, as a last resort.
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Hyperprolactinaemia may be associated with functional amenorrhoea. In order to evaluate the possible role of abnormal spontaneous LH secretion in hyperprolactinaemic amenorrhoeic women, plasma LH was measured at 15 min intervals for 300 min in 12 normal women during the early follicular phase of the menstrual cycle and compared to that observed in 11 hyperprolactinaemic amenorrhoeic subjects. Mean plasma prolactin was 9.1 +/- 3.6 ng/ml (X +/- SEM) in the euprolactinaemic and 168 +/- 32 ng/ml in the hyperprolactinaemic group. Sex steroids including oestrone, oestradiol, progesterone and 17-hydroxyprogesterone were similar in the 2 groups. Mean plasma LH levels over the 300 min sampling period were 9.4 +/- 1.6 mIU/ml in the normal subjects and 7.5 +/- 1.0 mIU/ml in the hyperprolactinaemic patients (P greater than 0.10). Every normal woman exhibited at least one LH spike in excess of 10 mIU/ml. Five hyperprolactinaemic patients failed to exhibit any LH spikes above 10 mIU/ml (P less than 0.02 compared to controls). Thus, hyperprolactinaemia was associated with an absence of LH spike activity in 45% of patients studied and this abnormality may play an aetiologic role in the hypogonadism observed in these subjects; in those hyperprolactinaemic subjects with pulsatile LH secretion, however, other explanations for their amenorrhoea should be considered.