Anti Mullerian Hormone – this hormone has the advantage of sensitivity and specificity for determination of ovarian reserve and also can be done on any day of the menstrual cycle.
- TSH, Free T4
- Evaluation of thyroid function also plays an important role in infertile females, as altered thyroid function can lead to irregular cycles, ovulation and increased risk of miscarriage.
- Since we have the ultra-sensitive assay for TSH, it can be done even in fasting or post prandial state.
- Evaluation of prolactin is especially indicated in those women with galactorrhoea (discharge from nipples)
- Serum Total Testesterone, DHEAS, 17 hydroxy progesterone
- These are androgens (male hormones) which are when present in female body beyond a certain titre leads to abnormal hair growth, acne, irregular ovulation, deranged blood sugars, weight gain and in some cases even hoarsening of voice.
- So in certain women with these androgenic effects as mentioned above, serum androgen levels are measured.
- Day 3 serum FSH with estradiol level
- These were routinely performed a few years back to determine ovarian function is now considered obsolete with its high variability depending on day of cycle and less sensitivity and specificity than the serum AMH level
- In women with history of recurrent miscarriage a few more investigation are performed as a part of the diagnosis to guide further management
- ANA (Anti nuclear antibody)
- ACLA (Anti cardiolipin antibody) IgG, IgM
- Lupus anti-coagulant
- Chromosomal analysis
- These test help in determination of immunological factors for repeated pregnancy
- losses like Anti Phospholipid Antibody syndrome, SLE, thrombophilia like hyper-homocysteinemia which are quite common in Indian population, chromosomal translocation.