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Overview - Evaluation - Treatment Options - Diagnosis

EVALUATION OF OVARIAN FUNCTION
Basal Body Temperatures (BBTs)
Recording basal body temperatures (BBTs) is often the first step in evaluating menstrual cycles. The detailed mechanics of proper BBT recording were discussed in Chapter 5. It involves taking your temperature every morning upon first awakening and before getting out of bed with a specially devised, very sensitive thermometer. Normal temperature charts are biphasic, with the temperature going up after ovulation as a result of progesterone. The BBT chart provides information about the length of the cycles, the regularity of the cycles, the timing of ovulation in those cycles and the length of the luteal phase. BBTs can also be very helpful in determining the adequacy of the timing of intercourse. Don=t record temperature charts for more than a few months; if there is information to be gained from them, it will be apparent within that time. And don=t try to interpret them yourself, particularly day to day. Either one of these things, let alone both, can make you crazy.

Progesterone Levels
Not all ovulations are the same. One woman may have twenty-
eight-day cycles with ovulation on day fourteen and excellent progesterone production in the luteal phase, while another may have twenty-eight-
day cycles with ovulation on day nineteen and very poor progesterone production. In other words, having regular menstrual cycles means
one is ovulating, but it doesn't necessarily mean she is ovulating well. Temperature charts will provide some information about the adequacy
of ovulation. Another more direct way to assess this is to measure progesterone levels in the blood in the middle of the luteal phase. Often a single, properly timed progesterone level will tell the physician a great deal about the adequacy of the cycle. A series of two or three progesterone levels obtained in the luteal phase is a very good way to assess the adequacy of the luteal phase.

Endometrial Biopsy
Another means by which the adequacy of a cycle may be assessed is by performing an endometrial biopsy in which a small piece of the lining of the uterus is removed from the uterus and examined microscopically. Endometrial biopsies are performed to diagnose a Aluteal phase defect,@ a problem in which the cells of the lining of the uterus (the endometrium) do not properly undergo the series of changes that allow implantation to occur. This will be discussed further under luteal phase defect below, but for now suffice it to say that endometrial biopsies probably aren=t necessary, since a serum progesterone will provide much the same information.

Pelvic Ultrasounds
Pelvic ultrasounds can be used to evaluate the development of the follicle (since it is fluid filled, it is easily seen on ultrasound). Ultrasounds are often used when any type of ovulation induction medication is taken, but may even be of some value in untreated cycles. Development of the follicle, the thickness of the endometrium and collapse of the follicle suggesting egg release can all be seen.

Measuring a Day-Three FSH
Measuring a day-three FSH and estradiol, and/or performing a clomiphene citrate challenge test provides information about a woman's ovarian reserves. As the number of eggs in the ovaries decreases, FSH levels rise as the pituitary attempts to further stimulate the ovaries in order to maintain regular ovulation and cycles. The FSH level on day three is very reflective of ovarian reservesCthe fewer the number of eggs remaining in the ovaries, the higher the FSH level will be. Levels vary depending on the laboratory, but in general a day-three FSH level over fifteen, and certainly over twenty, suggests a very poor chance of conception.

Clomiphene Citrate Challenge Test
The clomiphene citrate challenge test involves checking FSH and estradiol levels on day three of the cycle, administering 100 milligrams of clomiphene citrate on days five through nine, and checking the FSH and progesterone levels on day ten. This test provides information that is even more reflective and reliable than the day-three FSH alone.

Prolactin
Prolactin is a pituitary hormone that functions primarily to stimulate breast milk production. However, even minor elevations of prolactin can alter the functioning of the ovary and result in abnormal cycles. Any woman with cycles that are anything but perfect should have a prolactin level checked.

TSH Levels
TSH (thyroid-stimulating hormone) is the hormone produced by the pituitary that controls the functioning of the thyroid gland. Alterations in thyroid function can have profound effects on ovarian function. Measuring TSH levels will detect an abnormality of thyroid function. Any woman with cycles that are anything but perfect should have a TSH level checked. Unless the TSH level is abnormal, there is no need to check any other thyroid test, as a sensitive TSH assay will reflect both hyper- and hypo- thyroid conditions.