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Fertility Services For WomenHormonal
testing
for
women
is
recommended
based
on
medical
or
physical
examination. Clomiphene
citrate
challenge
test:
follicle
stimulating
hormone
(FSH)
level
is
obtained
on
the
third
day
of
the
menstrual
cycle.
Clomiphene
citrate
100
mg
is
then
administered
on
cycle
days
5
through
9.
A
repeat
FSH
value
is
obtained
on
the
10th
day
of
the
menstrual
cycle.
A
high
FSH
value
on
either
day
3
or
day
10
bodes
poorly
for
a
woman’s
ability
to
get
pregnant.
Medical
treatment
will
not
improve
fertility
in
women
with
an
elevated
FSH
level.
The
use
of
donated
eggs
is
a
treatment
option. Estradiol:
daily
measurement
of
estradiol
helps
determine
the
response
to
medications
which
stimulate
ovulation.
During
ovulation
induction,
we
use
these
results
to
determine
how
much
treatment
is
necessary,
and
for
how
long. FSH
and
LH:
FSH
is
often
elevated
in
women
whose
ovaries
are
less
likely
to
contain
healthy
eggs.
This
can
help
us
identify
women
who
are
unlikely
to
conceive
because
of
poor
egg
quality.
Low
levels
of
luteinizing
hormone
(LH)
and
FSH
may
indicate
a
malfunction
in
the
pituitary
gland
or
hypothalamus.
An
elevation
of
LH
may
indicate
the
presence
of
Polycystic
Ovarian
Disease,
which
may
be
a
cause
of
irregular
menstrual
cycles.
In
these
cases,
hormonal
treatment
with
ovulation
induction
medication
often
stimulates
ovulation. Insulin
resistance:
an
association
between
insulin
resistance
and
menstrual
irregularity
has
been
identified.
It
has
been
shown
that
in
some
cases,
treating
the
abnormality
in
glucose
metabolism
can
regulate
the
menstrual
cycle.
In
addition,
insulin
resistance
has
been
associated
with
the
development
of
diabetes
and
heart
disease.
Glucose
and
insulin
tolerance
testing
may
be
indicated
to
identify
those
women
who
would
benefit
from
this
treatment. Progesterone:
progesterone
is
measured
after
ovulation
has
occurred
to
determine
if
the
ovaries
are
functioning
properly.
Consistently
low
findings
indicate
that
the
corpus
luteum
is
not
working
properly.
This
condition,
known
as
a
luteal
phase
defect,
is
often
treated
with
progesterone
or
medication
to
induce
ovulation. Prolactin:
this
hormone
prepares
the
breasts
to
produce
milk.
In
non-nursing
women,
high
levels
can
interfere
with
ovulation.
High
prolactin
levels
can
usually
be
treated
with
medication. Thyroid
Function
Tests:
women
with
abnormal
ovulation
may
have
an
over
or
underactive
thyroid,
which
may
be
due
to
disease
or
age.
This
test
may
be
ordered
in
women
who
have
no
other
explanation
for
infertility. Testosterone
and
other
Androgens:
women
normally
produce
small
amounts
of
these
“male
hormones”
in
their
ovaries
and
adrenal
glands.
Overproduction
of
these
hormones
can
block
ovulation. For MenProblems
with
sperm
can
reflect
hormonal
changes
that
can
be
treated
medically.
We
recommend
obtaining
hormone
levels
in
men
who
have
persistently
abnormal
semen
analyses.
Hormonal
treatment
is
appropriate
only
in
men
with
specific
hormonally-caused
sperm
problems. Discussion
of
medical
and
surgical
history:
This
includes
a
history
of
systemic
diseases,
such
as
viral
infections
(particularly
postpubertal
mumps
and
venereal
disease),
fevers,
and
diabetes
mellitus,
previous
surgery,
especially
in
the
genitourinary
area,
during
of
infertility,
previous
pregnancies,
and
sexual
history.
Many
men
had
a
hernia
repair
as
babies
and
this
occasionally
causes
a
blockage
of
the
vas
due
to
scar
tissue
or
to
just
bad
surgical
practices. Physical
exam:
This
includes
an
examination
of
testicle
position
in
the
scrotum
(if
the
testicles
haven’t
descended
properly,
the
sperm
will
not
be
cool
enough),
an
examination
of
the
scrotum
for
varicocles
(varicose
veins
of
the
testicles),
and
an
examination
of
the
prostate
and
prostatic
fluid
for
signs
of
infection.
Also,
fat
and
hair
distribution
is
examined,
for
signs
of
hormone
imbalance. Urinalysis: Look for signs of a urinary tract infection, presence of sperm in the urine (which, in conjunction with a low sperm count, may indicate retrograde ejaculation), and signs of systemic disorders such as kidney problems or diabetes mellitus. Follicle
Stimulating
Hormones
(FSH)
and
Luteinizing
Hormone
(LH):
high
FSH
and
LH
occur
in
men
with
testicular
failure;
which
is
unlikely
to
be
helped
by
medications
and/or
surgery.
Low
levels
of
LH
and
FSH
may
indicate
a
malfunction
in
the
pituitary
gland
or
hypothalamus
gland.
In
these
cases,
hormone
therapy
may
improve
fertility. Prolactin:
an
elevation
in
prolactin
levels
can
cause
male
infertility
and
decreased
sexual
drive.
This
abnormality
can
often
be
treated
with
medication. Testosterone:
testosterone
is
important
for
sex
drive
and
performance
as
well
as
for
maintaining
sperm
motility. Thyroid
Function
Tests:
thyroid
gland
dysfunction
is
rarely
a
cause
of
male
infertility. Semen
Analysis:
This
is
done
at
least
three
times,
since
sperm
count
varies,
and
a
2-3
day
abstinence
is
required
before
each
analysis.
Normal
values
follow:
Ejaculatory
volume:
1.5-5.0
cc
Sperm
Density:
>20
million/ml
Motility:
>60%
Forward
Progression:
>2,
on
a
scale
of
1-4
Morphology:
>60%
normal
forms
(should
have
oval
head
&
long
tail) And:
1.
no
significant
microscopic
sperm
clumping, 2.
no
significant
white
or
red
blood
cells, 3.
no
increased
thickening
of
the
seminal
fluid
(hyperviscosity).
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