ENDOCRINOLOGY

Our Endocrinology laboratory is an efficient, state certified laboratory operated by trained technicians.  Strict regulations governed by the New York State Department of Health must be followed in order to receive and maintain licensure. Currently, the testing that is performed at our center includes Estradiol, Progesterone, Human Chorionic Gonadatropin, Thryoid Stimulating Hormone, Prolactin, Qualitative Rubella IgG and Follicle Stimulating Hormone.

We are also a phlebotomy site for numerous send out tests that might be recommended as part of your infertility workup. Panels currently being used based on the patient’s current infertility factors are:

• Preconception Panel:  This may be ordered by the physician on an initial consult depending on the extent of infertility workup you have had in the past.  Included in this panel are: CBC (complete blood count) with a differential, ABO/RH and antibody screen, RPR, Hepatitis B Surface Antigen, Varicella Zoster IgG, Cystic Fibrosis, Thyroid Stimulating Hormone, Prolactin, Rubella IgG and HIV. When this is drawn you can expect 7 tubes of blood to be taken.  While this sounds like a large amount, it is about 50 ml or less. You will be asked to sign a consent form for the HIV as well as requisition forms for the Cystic Fibrosis and the remainder of the send out tests. 

• Preconception Panel with Recurrent Pregnancy Loss:  This panel includes all of the tests in the Preconception Panel along with Karyotype testing, Lupus Anti-Coagulant and Anti-Nuclear Antibody.

• Prenatal Panel:  This will be ordered once pregnancy has been achieved.  This panel includes CBC with a differential, ABO/RH and antibody screen, RPR, Hepatitis B Surface Antigen, Varicella Zoster IgG, Cystic Fibrosis, Thyroid Stimulating Hormone, Rubella IgG and HIV.  Not all of these tests need to be repeated if they have been done previously.

Other testing that may be ordered by the physician:

• Estradiol Level: This test will be done routinely when you have a baseline ultrasound for injectable gonadotropins for Intra-uterine insemination or Invitro Fertilization.  Estradiol levels will also be monitored approximately every 2 days during the stimulation stage of your cycle.

• Progesterone Level:  This test is performed when you have a baseline ultrasound for injectable gonadotropins for Intra-uterine insemination or Invitro Fertilization. It can also be performed during the midpoint of a patient’s cycle to help determine if the patient is pre-ovulatory or post-ovulatory.  Progesterone levels are monitored during early pregnancy to insure that the patient is producing adequate progesterone, or if supplements are required.

• FSH (Follicle Stimulating Hormone): This test is typically performed on Day 3 of the patient’s cycle to ascertain if the ovaries are functioning properly.  An increase of FSH could mean that the patient is perimenopausal. This test will also be done when you have a baseline ultrasound for injectable gonadotropins for Intra-uterine insemination or Invitro Fertilization.

• hCG (Human Chorionic Gonadotropin):  This test will be done when you have a baseline ultrasound for injectable gonadotropins for Intra-uterine insemination(IUI) or Invitro Fertilization(IVF).  It will also be ordered after an IUI or IVF cycle to assess whether pregnancy was achieved.  Once pregnancy has been established, hCG levels might be monitored the first 2-3 weeks depending on the levels of hormone present.

Terminology:

Endocrine Laboratory:  Laboratory where the levels of hormones are tested. Most of these hormones occur naturally in the body and are secreted by specialized cells that are produced in the endocrine glands.

Hormones: Chemical substances having a regulatory effect on the activity of certain organs.

Estradiol: A hormone synthesized mainly in the ovary.  The injectable gonadotropins stimulate the ovaries to produce estradiol.  We use this as an indicator of the follicular number and maturity within the ovary.

Progesterone: Produced in the corpus luteum, it stimulates growth of the uterine lining for implantation of an embryo.   It also prevents further follicular development.

Human Chorionic Gonadatropin:  A hormone produced by the developing placenta and by the fertilized egg after implantation in the uterine wall.  This level will be tested 14 days from the day of retrieval if an IVF cycle results in an embryo transfer.

Prolactin: A pituitary lactogenic hormone. Elevated levels are associated with ovulatory failure.  Stress, Polycystic ovaries and psychotherapeutic medication can cause high prolactin levels.

Thyroid Stimulating Hormone: Hormone secreted by the anterior pituitary gland that activates production in thyroid cells leading to the production and release of thyroid hormones T4 and T3.  This is a screening test for thyroid function; if abnormal a further workup will be done.

Follicle Stimulating Hormone(FSH): In women FSH stimulates the development of ovarian follicles(eggs) and stimulates the release of estrogens.  In men FSH stimulates the production of sperm.

Complete Blood Count (CBC): The number of red blood cells, white blood cells and platelets present in the patients blood sample.

RPR: Test for syphilis (a sexually transmitted disease caused by the spirochete Treponema Pallidum).

ABO/RH: The major blood group system which describes the antigens found on the surface of human blood cells. According to the type of antigen present, a person may be assigned a blood type of A, B, AB or O. A second type of antigen, the Rh factor, renders a positive or negative blood type. For example, O positive or A negative.

Antibody Screen: This is a test that will screen for any antibodies that are present in a patients blood sample.

Cystic Fibrosis: Generalized disorder of infants, children and young adults, characterized by signs of chronic pulmonary disease due to excess mucus production in the respiratory tract.  Although patients may not have the disease, they may possess the gene responsible for the disorder. If each partner carries the gene, a resulting child may be born with the disease, therefore screening the potential parents is important.

Anti-Nuclear Antibody: An antibody that reacts against components of the cell nucleus such as DNA, RNA, histone or non-histone proteins. These antibodies are present in a variety of immunologic or autoimmune diseases including systemic lupus erythematosus.  A serologic measurement for antinuclear antibodies can aid in the diagnosis of unexplained arthritis, rashes or chest pains. Lupus Erythematosus can cause infertility problems.

Lupus Anticoagulant: An immunoglobulin that interferes with blood coagulation and has antithromboplastin activity. This immunoglobulin can prolong blood clotting and occurs in approximately 25% of people with lupus.

Anti-Cardiolipin Antibody: Antibodies directed against cardiolipid, a phosphorylated polysaccharide ester of fatty acids found in cell membranes. Associated with immune-mediated illnesses, syphilis, and strokes; thought to be from a hypercoagulable state.

Rubella Virus: It is important to have immunity to this virus that causes German measles.  Having this while pregnant can cause birth defects.

HIV: A type of retrovirus (human immunodeficiency virus) that is responsible for the fatal illness acquired immunodeficiency syndrome. Two strains have been identified.

Type 1: the retrovirus recognized as the agent that induces AIDS.

Type 2: a virus closely related to HIV-1 that also leads to immune suppression. HIV-2 is not as virulent as HIV-1 and is epidemic only in West Africa.

Karyotype Analysis: This analysis tests for the complete set of chromosomes of a cell or organism. It will detect any abnormality in the number, form, or structure of chromosomes.

(Updated 2/7/06)