Table 2: Utility of various hormonal
tests for primary infertility in the patient with ovulatory dysfunction.
UTILITY |
TEST |
INDICATION |
HIGH
Utility |
b-hCG |
To rule out pregnancy |
Early follicular FSH and
Estradiol |
To rule out primary
ovarian insufficiency |
|
PRL and TSH |
To rule out hyperprolactinemia and thyroid dysfunction |
|
17-OH Progesterone drawn
in the morning during the follicular phase |
To rule out non-classic
congenital adrenal hyperplasia in high risk populations (Ashkenazi Jewish,
Mediterranean, Middle eastern and Indian) |
|
Mid-luteal Progesterone |
To confirm ovulation if
the menstrual history is unclear. Can be deferred if the patient has grossly
abnormal cycle lengths |
|
LOW
Utility |
Free/Bioavailable
Testosterone, DHEA-S |
To identify biochemical hyperandrogenism.
However, androgen testing is neither sensitive nor specific for the diagnosis
of disorders of androgen excess such as PCOS and NCAH |
Early follicular serum LH
with FSH |
To calculate the LH/FSH ratio
as a marker of PCOS. This test is especially unreliable in obese patients
with suspected PCOS. |
|
Growth Hormone, 24 hour
urinary or serum Cortisol |
Only recommended when
other clinical features are suggestive of pathology |
|
Anti-mullerian
Hormone |
Not yet a validated test
for the diagnosis of PCOS |