FSH and LH
Both Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) are those types of hormones which affect the reproductive organs of both male and female. FSH and LH do according to their name as it do for the ovaries of a female; also it affects the testes of the male. Guy’s will be deal first as compare to the complicated women’s.
Brain plays a major role in producing FSH and LH in order to restrict the production of sex hormones which includes oestrogen and testosterone. Both these hormones modulate the improvement, growth & generative process of human body.
During menstrual cycle these two hormones are released in the brain by pituitary gland. Blood levels of these hormones are being checked very frequently just to confirm how ovaries are working. When oestrogen levels goes down FSH is being secreted. FHS Levels begin to rise abruptly when you have regular mensuration periods, that too 1 or 2 days before ovulation. FSH stimulates the ovary to ripen a follicle, and, with the help of a spike in LH (luteinizing hormone), to release an egg. After this usually the levels of LH & FSH goes down and level of progesterone increases and the major reason behind this is preparation of uterus for another mensuration cycle or pregnancy.
Those men or women facing fertility issue If FHS & LH levels rises abnormally than it can intimidate the issues with testicles and ovaries.
FSH & LH are known as gonadotropins because it encourages the gonads in males and ovaries in females.
FSH & LH is imposed of alpha & beta subunits. Alpha subunit is identical for all 3 interior pituitary hormones and beta subunit is unique and increases each hormone to bind receptor on its own.
Between the ages of 12-50 FSH & LH get released through pituitary periodically. Woman’s body, breasts, bones, skins cause slight thickening of endometrial lining because of oestrogen which is a feminizing hormone after the first two week adenohypophysis increases at higher amount of LH which cause an egg to pop out. After the eggs pop out in fallopian tube the women could get pregnant and eggs could live three to five days. On 28th day LH stops to being released. On the first day women notice this and it should be considered as the 1st day of menstruation cycle and it starts all over again.
So FSH controls the release of oestrogen and LH controls the release of progesterone.
FSH and LH Test
What is FSH & LH Test?
For reproduction FSH & LH is very essential. FSH helps in producing sperm and LH helps the testes to release male sex hormone & testosterone. FSH & LH at very high level can cause the failure of testicular function which results into no response from hormone therapy. In the same manner FSH & LH at low level cause testes to not receive a proper stimulatory message from pituitary gland or hypothalamus which could help you to improve with hormone therapies.
FHS produced through pituitary gland and pea-sized gland near brain has a major role in sexual improvement. FSH helps in measuring the hormone level in bloodstream.
We find FHS level in kids in very low ratio because brain produces gonadotropin-releasing hormone between the ages of 10 to 14, which helps in changing the sexual maturity. Most often doctors always recommend a test for LH when he asks to take a blood test of FSH.
FSH & LH works together in boys because it helps testes to produce testosterone, hormone which is responsible for physical changes of puberty and which helps in producing sperm.
FSH and LH prompt girl’s ovaries to start producing the hormone oestrogen which makes girl’s body to get mature and prepared for menstruation.
When these test taken together than the result provides the clear picture of sexual maturation of a child.
These tests are helpful in investigating the sperm count, irregularities occur in menstrual, disorders in pituitary and the diseases which involve testes and ovaries.
For women FSH is essential for the cycle of menstruation and it stimulates the production of eggs.
Why PSH & LH test done?
These test is done to evaluate pituitary function, fertility issues, maturation concerns, pituitary tumour or for gonadal failure.
When boys and girls enters into puberty earlier or later than expected than at that point of time doctors ask for FSH test. At high level it associates with early puberty and at low level it indicates delay in sexual improvement.
If you have any disease or damage in testes or ovaries, in pituitary gland or hypothalamus than this teat is very useful to check it.
Preparation should be done before FSH & LH Test
These tests doesn’t require any special preparation, you only need to wear a half sleeve shirts so it will be easier for the doctors to take the sample blood.
First of all the doctor will clean your skin with antiseptic and tie an elastic band around the upper arm which puts pressure on your vein and it swells with blood. After that he inserts a needle in your vein to collect the blood sample in syringe or vial.
Once the above procedure is done, the doctor will remove the elastic band. And after collecting the blood the needle will get removed and the area will be covered with bandage or cotton to stop bleeding. To collect a blood for test just takes few minutes.
Interpreting Levels of Follicle Stimulating Hormone
3 mIU/ml - 10 mIU/ml is usually a normal FSH level. If the FSH level is more than 12mIU/ml than it is a worrisome and is suggested the impaired ovarian reserve. Level more than 25 founds in menopausal women and it confirms the ovarian failure. We can also raise the FSH level artificially by taking the drug clamed.
FSH level less than 2mIU/ml are generally found in a condition which is called hypogonadotropic hypogonadism. We can find a low level of FSH in women’s who take birth control pills or those who are pregnant.
We can interpret the FSH level in best way with the combination of estradiol level. Estradiol is a kind of oestrogens which is produced by ovaries. If the estradiol level is above 75 pg/ml on 3rd day than it indicates a poor ovarian reserve. In some women, FSH Level can artificially supress because of poor ovarian reserve, so it appears normal, and thus it’s misleads the doctor to believe that the ovarian reserve is normal. Because of this it is a good idea to check the estradiol level also when we check the FSH level on 3rd day. The ovarian reserve cannot be consider as normal if estradiol level is high and FSH level is normal.
If FSh level & eestradiol level is normal than it indicates that you have good ovarian reserve.
To check FSH & LH ratio is very useful. If FSH:LH ratio is 1 than it is normal. If FSH level is higher than LH level than you have poor ovarian reserve. You can confirm it by checking your AMH level and also by taking clomiphene citrate challenge test.
FSH, LH or others measurements can be done on 2nd or 3rd day of menstruation cycle.
What is the Estradiol Test?
This test is performing to check the estradiol in blood stream.
In normal cycle estradiol level is low and it slowly increases with the follicle maturity level. Just before ovulation peak E2 levels are about 200-300 pg/ml, as calculated with a single follicle. Cervical mucus caused copious because of high E2 levels.
Estradiol levels during an IVF cycle
We firstly down regulate you before starting superovulation during an IVF cycle. For doing this we have to suppress you with medications containing Gnarl agonists, called Buserelin or Lupron. When Lupron is started in 21st day of preceding cycle than it could be a long protocol or it is called a shot protocol when Lupron start’s on 1st day of the treatment cycle. Short protocol is much preferable in clinics because it is easy and requires less tries. If you are down regulated normally and also your ovaries are quiet & the estradiol level is under 50 pg/ml, than in that case superovulation can be done. But if the level is more than 50 pg/ml than it means you have not been down regulated. This is because you have ovarian cyst or poor ovarian reserve. If the level is more than 50 than down regulation will be continued for another 4 days and we will re-check the estradiol level on 4th day. If the level comes under 50 than superovulation can be done but if not than cycle should be cancelled and the patient should be put on birth control pills to suppress the ovaries and we have to give it a try next month.
Estadiol levels grow with the follicles grow and matures during the IVF cycle and to take the growth of eggs many doctors check the estradiol levels frequently during IVF cycle. Follicle is always lined by granulosa cells which produce the hormone oestrogen. These cells produce more quantity of oestrogen as follicle becomes matured. A mature follicle produces about 200-300 pg/ml of oestrogen. Because some women have their granulosa cells are working fine they have good oestrogen levels, but their eggs will be poor and this is the reason their estradiol levels should always be interpreted carefully. If the estradiol levels are low, the doctors can declares the eggs quality to be poor and also he can decide to cancel the cycle.
Also some clinics can cancel the cycle at high estradiol level because they are worried about the risk of Ovarian Hyperstimulation Syndrome (OHSS).
SUMMARY AND EXPLANATION
In order to prepare the ovaries for ovulation the 2 major hormones, LH and FSH are released from the pituitary gland during the normal female reproductive cycle. In one or both of the ovaries FHS is particularly responsible for the simulation & swelling of the egg follicles.
If FHS level remains greater than equal to 25mIU/ml during the period, then it is proved that the pituitary gland is continuing to produce FSH because there has been an interruption or failure in normal egg follicle stimulation; i.e.: the system has failed to receive a successful ovulation "message". Therefore fertility has not occurred.
Note: A positive qualitative test for elevated levels of FSH does not, under any circumstance, confirm or deny a diagnosis of menopause or ovarian failure. Further tests and consultation with a healthcare professional are required.
WHEN TO TEST
The FSH test can be performed at any time except 8-15 days after menstruation bleeding ceases. FSH levels should normally be below 25 mIU/ml) except 8-15 days after menstruation bleeding ceases. Positive test results at times other than mid cycle should be discussed with a healthcare professional for reasons mentioned above.
DIRECTIONS FOR USE
We can perform the test in following ways:
- By placing the wick end of the device directly in a urine stream or by immersing the wick in a urine sample collection container.
- Before testing allow FSH test device to reach the room temperature i.e. 20 to 30 degree Celsius
- Expiration date on the package should be noted and Midstream test should be removed from the sealed foil. Before testing the pouch should not be opened.
- First remove the protective cap and for at least 6 seconds keep the wick end directly in a urine stream or immerse the wick in the collection cup.
- Lay the Midstream on a flat surface with the test panel facing up after replacing the cap.
- Observe lateral flow or sample migration across the test panel of the Midstream test device. If migration does not begin, return the test wick to a urine stream or the collection container.
- We have to wait for the 10 minutes for the test results to develop and we should not interpret the results after 10 minutes.
Day 3 FSH test:
According to laboratory the cut off values of egg quantity will be decided whether it is good, OK or poor. For e.g., the FSH of 11 is good ovarian reserve in one laboratory whereas level 11 may indicate a diminished ovarian reserve according to different assay in another laboratory.
Many number of women with normal FSH values also have a reduced egg supply. FSH value does not reflect the low egg supply. The more we do the ovarian reserve test more we find an ovarian reserve problem.
Day 3 FSH level
FSH interpretation for DPC Immulite assay
Less than 9
9 to 11
11 to 15
15 to 20
FSH interpretation for DPC Immulite assay
Fair. Response is between normal and somewhat reduced (response varies widely). Overall, a slightly reduced live birth rate.
Reduced ovarian reserve. Expect a reduced response to stimulation and some reduction in embryo quality with IVF. Reduced live birth rates on the average.
Expect a more marked reduction in response to stimulation and usually a further reduction in embryo quality. Low live birth rates. Antral follicle count is an important variable.
This is pretty much a "no go" level in our center. Very poor (or no) response to stimulation. "No go" levels should be individualized for the particular lab assay and IVF center.
Day 3 estradiol testing
A blood estradiol level between days 2 and 4 of the menstruation cycle is a way to potentially find some of those women with a normal 3rd day FSH that may in fact have reduced egg quantity and quality.
We want a low FSH level with considering a low estradiol level on 3rd day.
The idea to use 3rd day estradiol level is to figure out the recent egg quantity and quality. The 3rd day estradiol level should be lesser than equal to 80. If the results are on borderline or abnormal than we repeat the results in another menstruation cycle and try to get a correct FSH.
Clomiphene challenge test
This is a dynamic type of test that can figure out some cases of poor ovarian reserve that are still showing a normal 3rd day FSH.
This test is done by:
Getting a 3rd day FSH and estradiol
Take 2 tablets of clomiphene (100 mg) on days 5-9 of the cycle
FHS level should be repeated on the 10th day of the cycle.
Using the lab results the cut off values for the 3rd day & the 10th day FSH values should be determined.
In vitro fertilization - IVF
It is a treatment for infertility, and not a test. But it provides the useful information about egg and embryo quality. With the help of this we can get the clues that why pregnancy has not occurred last time.
For e.g.: The eggs may have problem with maturation, with fertilization or with proper cleavage.
What to Expect
Collecting a sample is the only temporarily uncomfortable thing and rest of the things like some mild bruising should go away in few days.
How is it used?
For both men and women LH is often used in co-ordinating with other tests like FSH, progesterone, testosterone and estradiol. LH levels are also useful to investigate the menstruation irregularities and to aid in the diagnosis of pituitary diseases or disorders involving the testes or ovaries.
After the baseline urine test is done, further urine test could be used to find the surge in LH which indicates that ovulation will occur in the next 1 or 2 days.
When is it ordered?
This test can be ordered when you face problem in getting pregnant, or have irregular menstruation periods or when you have a symptoms of ovarian or testicular disease or when a doctor comes to know that child has delayed or earlier than expected sexual maturation.
When the boy or girl enters into puberty either too late or too early than LH or FSH test is being ordered. Signs of early puberty may include:
- Breast enlargement in females
- Growth of pubic hair
- Genitalia growth in males
- Beginning of menstruation in females
Wrong timing of puberty indicates more problems which involves hypothalamus, the pituitary gland, the gonads (ovaries or testes), or other systems.
What does the test result mean?
In women, LH and FSH levels can help to differentiate between primary ovarian failure and secondary ovarian failure (. Increased levels of LH and FSH are seen in primary ovarian failure. Some causes of primary ovarian failure are listed below.
The blood sample will be processed by a machine. The results usually are available after a day or two.
- Defect in steroid production by the ovaries, such as 17 alpha hydroxylase deficiency
- Failure to develop ovaries (ovarian agenesis)
- Chromosomal abnormality, such as Turner's syndrome, Kalllmann's syndrome
Premature ovarian failure due to:
- Autoimmune disease
Chronic failure to ovulate (anovulation) due to:
- Ovarian tumour
- Thyroid disease
- Polycystic ovary syndrome (PCOS)
- Adrenal disease
LH levels will rise during menopause.
Low levels of LH and FSH are seen in secondary ovarian failure which indicates a problem with the pituitary or hypothalamus.
In men, high LH levels may indicate primary testicular failure. This can be due to developmental defects in testicular growth or to testicular injury, as described below.
- Viral infection (mumps)
- Failure to develop gonads (gonadal agenesis)
- Germ cell tumour
- Chromosomal abnormality, such as Klinefelters syndrome
- Testicular failure Chemotherapy
- Autoimmune disease
Is there anything else I should know?
Some drugs can cause LH to increase:
Some drugs cause LH to decrease:
- Oral contraceptives
- Hormone treatments.
A recent nuclear medicine scan may interfere with results of the LH test.