19 August 2007

Hormones

As a patient you must have constantly heard the terms FSH, LH, E2 but have you ever tried to understand what they mean, to you or to your treatment? Lets try and understand them little better.
There is a centre called Pituitary at the base of the brain that produces two hormones FSH and LH besides various other hormones. FSH or Follicle Stimulating Hormone (as the name suggests), acts on a follicle which is still very small to helps to make it grow. These follicles are present in the ovary and ever month around the time of your periods, a few of them are recuited for subsequent growth. These follicles contain what will ultimately become a mature egg. Cells around the growing follicle produce the hormone E2 or Estradiol. Thus Estradiol levels are a measure of the growth of the egg. If this is understood, then its clear that in the beginning of the cycle (just when your periods start, maybe Day2), the Follicle is small therefore E2 is low and FSH is rising to flog the follicle into growing. As the follicle grows bigger, the E2 levels rise too and sometimes we use these values to find out if the medicines we are giving to make the eggs grow are adequate. By around Day 7 of your periods, the role of FSH in making the eggs grow, is supplemented by the hormone LH or Leutinizing Hormone. This hormone acts on the follicle and matures the egg and readies it for impending ovulation. We check the maturity of the egg again by E2 levels which is usually 250pg/ml per mature follicle. Around mid cycle (approx Day 14 of your cycle), the LH values rise dramatically and trigger a series of events that ultimately result in rupturing the follicle and releasing the egg contained within. We can also do this artificially by giving injections of HCG (Ovutrig, Pregnyl, Ovidrel). Once the egg is released, the follicle (empty shell) becomes a Corpus Luteum and secretes Progesterone. Therefore before follicle rupture, the Progesterone levels are <> 10ng/ml. This whole process is repeated every month and this simple physiology is utilized by us to manipulate the growth of the eggs and treat patients. I hope I have been able to make some aspects of this clear to you. Hope to hear some comments from you and ofcourse questions are always welcome.

4 comments:

Anonymous said...

Dear Dr. Rajeev Agarwal,

A very good friend of mine is suffering from infertility. Doctors whom she has consulted have diagnosed the problem as absence of X Chromosomes. Her menstural cycles are not regular and has haemoglobin defficiency. She has to take pills to induce her menstural cycle. On top of it, she has severe skin problem and has to be overly cautious of what she eats as it leads to itching and blisters all over her body. She is very keen on having a baby and is on the verge of giving up her hopes altogether. She discussed this problem of hers with me recently and I want to help her in any possible way. Please HELP!

Dr Rajeev Agarwal said...

Dear Anonymous :)

Absence of X chromosome means she probably suffers from a condition called Turners Syndrome. Such women unfortunately do not have their own eggs and that is why their periods do not come on time unless they take medications for the same. Your friend needs to undergo the IVF process with Oocyte donation. In this process, eggs from another healthy, young, fertile woman would be taken, fertilized with your friend's husband's sperms and the resulting embryo put back into your friend's womb. She would be the one getting pregnant and going through the 9 months and delivering ultimately.

Anonymous said...

dear dr, kindly write about the cost of iui and ivf also so that we can plan for it aftr your consultation at your centre . Becos we need arrange finance for it in advance.

Tooshai said...

Sir,
It is nice to here you in detail.

Im a infertile women since last 5 yrs
Im 30yrs old. When I first realize the problem, Dr says its nothing but the PCOD & not to wory & I started take medicines like the contraceptive pills, & susten. After 2 year they said it is a left ovarian cyst & start Clomifine with susten. Then I have done HSG, Prolactin, Thyroid & other blood test but nothing wrong, even my hubbys semen analysis is also ok.
Then I change my Doctor & they do a Follicular studdy & proceed to the Timing Intercourse, No result found, Then I've done IUI 3 times but all in vain. Lastly I have done a Lap-Dye test & they told me that I have an Endometriosis along with one side (Choclate Cyst)blockage. They said now that it is difficult to be preagnant bcause there is no other treatment without Cut-Off. My
periods are always at time and very regular, & Im very slim but I don,t know is there anything can happen.