Download Follicle Stimulating Hormone, Luteinizing Hormone and Prolactin

Mohan & Sultana
ISSN 0976-2272
J. B io s c i. Re s ., 2010. Vol. 1(4):279-284
Follicle Stimulating Hormone, Luteinizing Hormone and Prolactin
Levels in Infertile Women in North Chennai, Tamilnadu
K. MOHAN AND MAZHER SULTANA
PG & Research Department of Advanced Zoology & Biotechnology,
Presidency College, Chennai-5.
Abstract
The aim of the study was to determine the studies follicle stimulating hormone,
luteinizing hormone and prolactin levels in infertile women in north chennai,
Tamilnadu, India. The present investigation was carried out at JPM Diagnostic Centre in
Chennai, Tamil Nadu the data were collected from 70 women patients and grouped them
into infertility (n = 30) and control (n = 40). The patients referred by a Gynecologist for
infertility investigation. The details pertaining to the patients regarding age, height, weight,
no of years after marriage is furnished. The blood was collected during mid cycle 14 – 16
day on a fasting by venipuncture. The blood was allowed to clot, the serum was decanted
and used for analysis. FSH, LH and Prolactin were estimated by Immuno enzymatic assay
by Elisa Reader. FSH hormonal levels of the infertile women when compared to control
groups statistically significant were found to be lower level of serum FSH mean±SD
3.46±0.73 (P<0.001) in the infertile group. serum LH concentration was lower in the
infertile group than in the control group. The LH mean±SD 2.97±0.64 (P<0.001), serum
Prolactin concentration was increased in infertile group compared with control group. The
serum Prolactin mean±SD 55.80±23.44 (P<0.001). Regression analysis revealed obese to
be strongly associated with infertility observed. BMI mean ± SD 29.05±1.80 (P<0.001).
The level of FSH on 3rd of the cycle is with in the normal range. However they are on the
lower side. This reflect a decrease in the ovarian reserve.The decrease level of LH in the
midcycle clearly indicates that there is a possibility of anovulation, which results in
infertility. The elevated prolactin values in some of the infertile women clearly shows that
there is a mechanism operating at the anterior pituitary level which shows an abnormal
distribution of FSH and LH which may further explain the abnormal /delay ovum
maturation. The present study indicates obese associated with infertility.
Key words: Infertility, hormones, obese, ovulation, hyperprolactinemia
*For correspondence: [email protected]/ [email protected]
Abbreviation FSH-follicle stimulating hormone ; LH-luetinizing hormone; PRL- prolactin
Introduction
Infertility is generally defined as one
year of unprotected intercourse without
conception. Approximately 85-90% of
healthy young couples conceive within one
year. Infertility affects 10 -15 % of couples,
is an important part of investigation and
helps the couple to have children (Mosher,
et al., 1991). Many people may be infertile
JOURNAL OF BIOSCIENCES RESEARCH 1(4):279-284
279
during their reproductive years. They may
be unaware of this infertility. Many
parameters are outlined for the cause of
infertility like age, lifestyle and physical
problems etc.
Greater focus on education and
careers among women has triggered other
trend in modern society, less frequent, early
and late marriages and more frequent
divorce are among the most striking cases
of
delayed
childbirth.
Expanding
contraceptive options and access to family
planning and legalized abortion services
have markedly contributed to the declined
birthrate (Norton, et al., 1992).
The infertility problems are more
common phenomenon among the women
now a days and has increased over past 30
years (Stephen and Chendon, 2000). An
ongoing epidemic of sexually transmitted
infection, associated with increased risk of
subsequent infertility of chlamydial
infection and 650,000 gonorrhea infections
was recorded in the US each year (Cates, et
al., 1999).
The major causes of infertility
includes ovulatory dysfunction (15%), tubal
and peritoneal pathology(30-40%), and male
fact(30-40%) and uterine pathology. To
some extent the prevalence of each varies
with age. Ovulatory dysfunction is more
common in younger than old couples, tubal
and peritoneal factors have a similar
prevalence (Miller, et al., 1999).
Life style choice and environmental
factors can influence fertility and deserve
consideration.(Stillman, et al., 1986, Hnghes
and Prennan 1996 and Angoo et al., 1998
and Hakim, et al, 1998). Other potentially
harmful
occupational
environmental
exposure,
pesticides,
chlorinated
hydrocarbon
fumicides
have
been
associated
with the increased link of
spontaneous
miscarriage in women
(Hruska, et al., 2000). The female infertility
evaluation revealed the medical history like,
Mohan & Sultana
tobacco, alcohol, other drugs, birth defects,
thyroid disorder, galactorrhoea, and physical
examination (weight body mass index,
breast secretion, thyroid enlargement,
vaginal abnormality etc., (ASRM,2000).
An
elevation
in
prolactin
(hyperprolactinemia) levels may also
indicate the presence of a pituitary tumor.
In addition, some drugs can elevate levels of
prolactin, effects the ovulation, and
inhibition of hormones. Overall, disorders
of ovulation account for approximately 15%
of the problems identified in infertile
couples. The female infertility are caused by
ovulation disorders. Deficiencies in
luetinizing
hormone
(LH),
follicle
stimulating hormone (FSH) and elevated
prolatin level even slight irregularities in the
hormone system can affect ovulation.
The infertility causes due to
insufficiency or imbalance hormones.
Ovarian cyst may indicate advanced
endometriosis; it may cause rigid webs of
scar tissue between uterus, ovary, and
fallopian tubes. This may prevent the
transfer of the egg to the fallopian tube. The
ovaries are enlarged by many cysts beneath
by ovarian capsule. Small follicles that start
to grow but can’t mature to ovulation
remain with in the ovary. The lack of
ovulation may lead to mild enlargements of
ovaries especially in obese patient.
Fertility can be negatively affected
by obesity. In women, early onset of obesity
favours the development of menses
irregularities, Obesity in women can also
increase risk of miscarriages and impair the
outcomes
of
assisted
reproductive
technologies and pregnancy, when the body
mass index exceeds 30 kg/m2. The main
factors implicated in the association may be
insulin excess and insulin resistance. These
adverse effects of obesity are specifically
evident in polycystic ovary syndrome. Body
mass index (obese) affects reproduction by
causing
menstrual
disturbance
and
JOURNAL OF BIOSCIENCES RESEARCH 1(4):279-284
280
180
160
140
120
100
80
60
40
20
0
Infertile
I
BM
t
ei
gh
W
H
ei
gh
t
Control
Ag
e
anovulation. The obesity influences the
reproductive cycle by impaired estrogen
metabolism Norman. et al., The present
investigation evaluates the hormonal profile
of infertile women. The aim of the present
study was to estimate the mean value of
FSH, LH, and Prolactin levels of in infertile
women as compared to the control group in
the North Chennai area of Tamilnadu.
Materials and Methods
The present investigation was
carried out at JPM Diagnostic Centre in
Chennai, Tamil Nadu the data were
collected from 70 women patients as
referred by a Gynecologist for infertility
investigation. The details pertaining to the
patients regarding age, height, weight, no of
years after marriage is furnished. The group
of infertile women consisted of patient with
regular menstrual cycle lasting between 2830 days and with ovulation between the 12th
and 16th day of the cycle, the clinical
examination revealed that the women has
normal uterus, ovary and fallopian tube and
the semen analysis of their husband was
also normal.
An th ro p o m e tric m e as u re m e n ts
The physical examination of body
weight was calculated by taking weight in
kilogram(kg) (Verma et al., 1982) and height
was measured in centimeters (Frisancho et
al., 1984). The Body Mass index was
calculated from the formula; BMI = weight
in kilograms / (height in meters)2 Patients
were taken as obese if their body mass index
was 29.9 (Olefsky et al., 1992).
B io c h e m ic al p aram e te rs
The blood was collected during mid
cycle 14 – 16 day on a fasting by
venipuncture. The blood was allowed to
clot, the serum was decanted and used for
analysis. Haemolysis sera was discarded and
a fresh specimen was obtained. The serum
was stored at –20 oC and assay were
completed within three days.FSH, LH and
Prolactin were estimated by Immuno
Mohan & Sultana
enzymatic assay by Elisa Reader. The kits
were obtained from Fortrees Diagnostic
Limited, United Kingdom, Northern
Ireland.(Odell et al., 1981), (Saxema et al.,
1968)
Statis tic al An aly s is
Statistical analysis was done by
descriptive statistics, independent groups ttest between means, two sample t-test
between percent, chi-square test, compared
means by ANOVA. All analysis were done
using the windows based Statpac Statistical
package version 3.0.
Results
Table 1 gives the detailed
anthropometric parameters viz., age in
years, weight in kilograms (kgs), height in
centimeters(cms), body mass index(BMI) of
infertile groups and control
groups.
Infertile groups statistically increased the
age mean ± SD 28.401.57 (P<0.001),
weight mean ± SD 66.833.53 (P<0.001),
body mass index mean ± SD 29.05-1.80
(P<0.001).
Figure 1 : Anthropometric parameters of
the subjects
Table 2 showed the hormonal
characteristics of the infertile groups when
compared to control groups statistically
significant increase in the level of serum
FSH concentration was lower in the infertile
group than in the control group. The FSH
mean±SD 3.46±0.73 (P<0.001), serum LH
concentration was lower in the infertile
group than in the control group. LH
JOURNAL OF BIOSCIENCES RESEARCH 1(4):279-284
281
mean±SD 2.97±0.64 (p<0.001), and serum
PRL concentration was higher in the
infertile group than in the control group,
PRL mean±SD 55.80±23.44 (P<0.001).
Figure 2: FSH, LH, PRL levels in
infertile and control group.
60
50
40
ng/m l
30
iInfertility
20
Control
10
0
FSH
LH
PRL
Discussion
The level of FSH on 3rd day of the
cycle is within the normal range. But they
are on the lower side such a decrease in the
ovarian reserve causes infertility. The level
of FSH falls within the lower (2.064.28mIU/ml) limit of normal range (6.024.0mIU/ml). Among them 30 (42.9%)
patients are at lower side of the normal
range.
The LH results of 30 patients
(42.9%) were below normal (5.024.0mIU/ml). The decreased level of LH in
the midcycle clearly indicates possibility of
anovualation, causing infertility.
The serum Prolactin concentration
was increased (22.08 – 95.05 ng/ml) for
30(42.9%) patients. This present studies
indicated hyperprolactinemia as the cause
for infertility in female. The incidence of
hyperprolactinemia has reported to 42% by
Avasthi kukum (2006), 25% by Mishra et al.,
(2006 ), however in the present study the
incidence was 42.9%. Early studies indicated
hyperprolactinemia as the cause for
infertility in female. hyperprolactinemia was
recorded in 12% of the total women but
18% was reported by Awathi kumkum, et
al.,(2006) among infertile women. The
incidence of hyperprolactinemia in women
Mohan & Sultana
was found to be 62.16% (Rajan, et al., 1990)
and 90%(Avasthi kumkum, et al., 2002).
The levels of FSH, LH and
Prolactin gonodotropic hormones in
infertile women were evaluated by many
researchers. According to Moltz, et al.,
(1991) higher level of FSH, LH in infertile
women with a proper menstrual cycle is
rarely found. However lower concentration
of those hormones observed only in 8% of
cases. Moltz et al, (1991) also states that
65.5% of infertile women with proper twophase menstrual cycles suffered from luteal
phase defects but in 28.7% of cases lower
values of FSH and LH were noticed. Kohler
(Givens et al,1986)states that women with
higher values of prolactin and luteal phase
defects have lower levels of FSH, and LH
during their menstrual cycle.
Both luteinizing hormone (LH) and
follicle-stimulating hormone (FSH) are
required for follicle development and
oestrogen production. Due to elevated of
prolactin the follicle-stimulating hormone,
luteinizing hormone are decreased and
causes infertility. The obesity influences the
reproductive cycle by impaired estrogen
metabolism causing menstrual disturbance
and anovulation. The present study clearly
indicates all the obese patients increased in
serum prolactin level and decreased FSH,
LH levels.
Conclusion
The present study on FSH,LH and
Prolactin levels in infertile women evaluates
the hormonal profile of infertile women
with anovulatory menstrual cycle. The
hormone studied were pituitary derived
FSH, LH and PRL. The examination
involved a group of 70 women.
The level of FSH on 3rd of the cycle
is with in the normal range. However they
are on the lower side. This reflect a decrease
in the ovarian reserve. The decrease level of
LH in the midcycle clearly indicates that
there is a possibility of anovulation, which
JOURNAL OF BIOSCIENCES RESEARCH 1(4):279-284
282
results in infertility. The elevated prolactin
values in some of the infertile women
clearly shows that there is a mechanism
operating at the anterior pituitary level
which shows an abnormal distribution of
FSH and LH which may further explain the
abnormal /delay ovum maturation.
Both luteinizing hormone (LH) and
follicle-stimulating hormone (FSH) are
required for follicle development and
oestrogen production. Due to elevated of
prolactin the follicle-stimulating hormone,
luteinizing hormone are decreased and
causes infertility. The present study
indicates obese associated with infertility.
The study clearly indicates to understand
the hormonal levels in infertile women.
which caused the change in the levels of
FSH, LH and prolactin for a better
management.
Acknowledgement
We are grateful to the Director,
Mrs.D.Joyce Marlin, JPM Diagnostic
Centre, Chennai.for the opportunity and the
help rendered to carry out the investigation
in her Medical Laboratory.
References
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Hyperpro
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Table 1: Anthropometric parameters of the subjects.
Parameter
Age
Height
Weight
BMI
Control group
n = 40
26.73±1.68
153.35±3.08
48.85±2.65
20.79±1.34
Infertile group
n = 30
28.40±1.57
151.73±2.88
66.83±3.53
29.05±1.80
t-value
p-value
4.232
2.239
24.357
22.023
0.0001**
0.0285*
0.0000**
0.0000**
t-value
p-value
14.410
19.672
11.759
0.0000*
0.0000*
0.0000*
Values are mean  SD (Standard Deviation), * P<0.05, ** P<0.001
Table 2: The hormonal variables of the study groups
Parameter
FSH
LH
PRL
Control group
n = 40
7.53±1.41
17.82±4.09
11.47±4.03
Infertile group
n = 30
3.46±0.73
2.97±0.64
55.80±23.44
Values are mean  SD (Standard Deviation), * P<0.001
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284