The profile is designed for females who have irregular cycles or fertility issues, who have been trying to get pregnant without success, or who would like a baseline screening for their preconception planning. Women are encouraged to have testing performed is they:
- have symptoms of infertility
- are under the age of 35 and have tried for 1 year to become pregnant
- have had more than 1 miscarriage
- are over the age of 35 and have tried for 6 months to become pregnant
The Fertility Profile includes Cortisol, Estradiol, Progesterone, Testosterone, SHBG, DHEAs, LH, FSH, Free T4, Free T3, TSH, and TPOab.
Hormone-related causes for infertility in females routinely involve the following five scenarios:
Ovarian Insufficiency
The average age of menopause is 51, with some women having their last period in their forties and others later in their fifties. A cessation of ovulation prior to the age of 40 is rare and is usually referred to as premature ovarian failure. Declining ovarian function is the main reason for the age-related decline in female fertility. As the number of available follicles starts to fall, estrogen is still being produced but ovulation does not occur, and progesterone levels are low in the absence of a corpus luteum. High FSH and LH levels on day 3 of the menstrual cycle typically confirm premature ovarian failure and the onset of menopause. A typical pattern of day 21 hormone levels indicating signs of ovarian insufficiency would consist of low estradiol, low progesterone, and low testosterone. LH, DHEA-S, cortisol and thyroid hormones may or may not be normal.
Luteal Phase Deficiency
In some patients who are infertile, ovulation may occur normally, but levels of progesterone are inadequate following ovulation (luteal phase). This luteal progesterone deficiency means that even if the egg is fertilized, implantation either does not occur, or if it does, the progesterone level is not high enough to sustain the pregnancy. Luteal phase deficiency can be caused by a number of problems, including endometriosis and abnormal follicular development, but most commonly it is a result of inadequate progesterone production by the corpus luteum, which can result from excessive stress (high or low cortisol) and/or thyroid imbalances. A typical finding is low progesterone levels in the luteal phase, usually with normal estradiol levels.
Polycystic Ovarian Syndrome (PCOS)
PCOS is the most common endocrine disorder affecting women of reproductive age and is closely associated with insulin resistance, metabolic syndrome and future risk of developing diabetes and cardiovascular disease. Among women presenting with infertility in one study, PCOS was found to be present in 81% of women who were anovulatory, in 50% of those with tubal disease, and in 44% of those with unexplained infertility. Hormonally, it is characterized by low progesterone, normal-to-high estradiol, high testosterone and normal to high DHEA-S during the luteal phase; also, LH often is elevated 2-3 times relative to FSH. Cortisol and thyroid hormones may or may not be normal, although women with PCOS have been found to have a three-fold higher prevalence of autoimmune thyroiditis compared to healthy women.
Hypometabolism/Thyroid Deficiency
Thyroid dysfunction, including subclinical hypothyroidism (elevated TSH with normal fT3 and fT4 levels), has been implicated as a cause of infertility. Thyroid hormone treatment can be a simple solution to restore a regular menstrual pattern. In one study, levothyroxine treatment resulted in pregnancy in 44% of infertile patients diagnosed with subclinical hypothyroidism. In patients with thyroid dysfunction, the sex hormones, (estradiol, progesterone and testosterone), and adrenal hormones (DHEAs, Cortisol) may be normal in the presence of hypothyroid symptoms and one or more of the thyroid hormones out of balance. High TPO antibodies indicate an autoimmune thyroid disease (e.g., Hashimoto’s Disease), which is associated with fertility-related problems. It is important to rule out thyroid autoimmunity in women attempting to conceive because of the increased risk of miscarriage.
Stress
Stress raises the stress hormone cortisol, which can severely affect a woman’s ability to conceive, probably because of its direct negative impact on the endocrine glands ability to produce sex hormones (estradiol, progesterone, testosterone) and thyroid hormones (TSH, Free T3, Free T4, TPOab). The diurnal cortisol variation measured in saliva samples collected throughout the day is an index of the adrenal glands’ ability to cope with stressors (emotional, physical, dietary, chemical, pathogenic) that can impact a woman’s ability to conceive. Endometriosis is found in more than 50% of women with unexplained infertility, and the high cortisol and prolactin levels induced by stress have been implicated in the development of this condition.
