IS THERE ANY CLINICAL UTILITY FOR 2ND or 3RD Day Menstrual cycle LH & FSH Test for Female Fertility Work-up? - Part 1.

IS THERE ANY CLINICAL UTILITY FOR 2ND or 3RD Day Menstrual cycle LH & FSH Test for Female Fertility Work-up? - Part 1.

One of the commonest request for female fertility work-up is hormonal assay. This entails test for 2nd or 3rd day LH & FSH, 14th & 21st day progesterone of menstrual cycle. I don’t think there is a clear indication for this request, to most of the professionals who are requesting for this test. Because the aim of requesting for this test has always been defeated since the result from this test is always being used for treatment in the next menstrual cycle. Reason being that many laboratories don’t release the all results until 21st progesterone test result is ready.

Requesting for basal FSH, if combine with E2, may be used for ovarian reserve measurement, or if FSH and LH are combined, it may be for initial diagnosis of PCOS. If this request for FSH and LH at follicular stage of menstrual period is done, this suggests that ovarian reserve testing is in view. Then is there any clinical utility for this test in diagnosis of female infertility?

FSH level is not direct testing for ovarian reserve because of its significant inter and intra variability, that limit the reliability of single measurement. So asking patient to go for 2nd or 3rd day menstrual cycle FSH, has no clinical significant if ovarian reserve is being measured, rather AMH should be ordered.

Ovarian reserve testing can be done by biochemical tests and ultrasound imaging of ovaries. Biochemical testing can be measured by (I). Early follicular measure of FSH, E2 and inhibin B. (ii). Measurement of cycle-day independent AMH. (iii). Clomiphene-citrate challenge. All these tests are to directly /indirectly measure oocyte or follicular pool. Out of these 3 methods, only AMH is more sensitive measure of ovarian reserve than FSH.

AMH is primarily secreted by the granulosa cells of antral follicles in the ovaries which is gonadotrophin independent. Ovarian reserve test is only quantity, not quality of the remaining oocytes pool.

AMH tends to decline before FSH rises, thus High FSH which is a specific marker for diminished ovarian reserve (DOR), but fail to detect a more decline in ovarian reserve. So a normal or abnormal FSH might not really correlate with ovarian reserve of the patient. AMH has largely replaced basal FSH and E2 level testing as a biomarker for ovarian reserve. It is more of clinical utility to run AMH, which is more stable throughout menstrual cycle for the assessment of ovarian reserve than 2nd day menstrual cycle FSH.

It is important to know that AMH and Antral Follicle Count have shown to have good correlation and equivalent when the ultrasound is performed by highly skilled professional.

Ovarian reserve tests are not infallible and should not be the sole criteria used to deny patient access to Assisted Reproductive Technology (ART) or other treatments. Evidence of DOR, don’t necessarily equate with inability to conceive.

REFERENCE:

Testing & Interpreting measures of ovarian reserve: A committee Opinion. (Fertility and Sterility, Vol 114, No.6 December 2020. ASRM)

Written by WOJUADE KEHINDE SAMUEL. (FAMLSN), the fertility Scientist/Andrologist at ABIMS FERTILITY & GAMETES BANKING SERVICES. 08023026235, 08077047724. [email protected] www.abimsunique.com