Evaluation of serum prolactin, FSH and LH in infertile females with thyroid disorders :Vibha Sushilendu, Kalpana Singh, Uday Kumar, Rekha Kumari, Journal of Indira Gandhi Institute Of Medical Sciences

ORIGINAL ARTICLE
Year : 2020 | Volume : 6 | Issue : 1 | Page : 18--20

Evaluation of serum prolactin, FSH and LH in infertile females with thyroid disorders

Vibha Sushilendu¹, Kalpana Singh², Uday Kumar³, Rekha Kumari⁴,
¹ Senior Resident, Dept. of Biochemistry, IGIMS, India
² Associate Professor, Dept. of Reproductive Medicine, IGIMS, India
³ Professor, Dept. of Biochemistry, PMCH, India
⁴ Additional Professor & Head, Dept. of Biochemistry, IGIMS, India

Correspondence Address:
Kalpana Singh
Associate Prof. & Head Reproductive Medicine, IGIMS, Patna
India

Abstract

Background: Infertility represents a common condition, with important medical, economic and psychological implications. Thyroid dysfunction interferes with human reproductive physiology. It reduces the likelihood of pregnancy and adversely affects pregnancy outcome, thus becoming relevant in the algorithm of reproductive dysfunction. Aims and objectives: To estimate serum prolactin, FSH and LH in hypo, hyper and euthyroid female subjects and find their association with thyroid status. Material methods: a cross-sectional observational study was done . 100 infertile females of age group 20-40 years, who were then subdivided into euthyroid, hypothyroid and hyperthyroid cases Serum Prolactin, FSH, LH,TSH,TotT3,TotT4 were estimated by Chemi-luminescence immunoassay method Results: The infertile women with hypothyroidism had significantly higher prolactin levels than the other groups Conclusion: TSH has a positive correlation with serum Prolactin level.Assessment of serum TSH and prolactin levels should be made mandatory in the work up of all infertile women, especially those presenting with menstrual irregularities

How to cite this article:
Sushilendu V, Singh K, Kumar U, Kumari R. Evaluation of serum prolactin, FSH and LH in infertile females with thyroid disorders.J Indira Gandhi Inst Med Sci 2020;6:18-20

How to cite this URL:
Sushilendu V, Singh K, Kumar U, Kumari R. Evaluation of serum prolactin, FSH and LH in infertile females with thyroid disorders. J Indira Gandhi Inst Med Sci [serial online] 2020 [cited 2023 Mar 27 ];6:18-20
Available from: http://www.jigims.co.in/text.asp?2020/6/1/18/300732

Full Text

Introduction:

Infertility is defined as the inability of the couple to conceive after one year of regular intercourse without contraception^[1]. The problem of infertility has increased over past 30 years with prevalence estimated to be between 12 and 14%. It thus represents a common condition, with important medical, economic and psychological implications^[2],[3].

Among the various causes of infertility are underlying medical condition, that may damage the fallopian tubes, interfere with ovulation, or cause hormonal complications. Some of these medical conditions include pelvic inflammatory disease, endometriosis, polycystic ovarian syndrome, premature ovarian failure, uterine fibroids and environmental factors. Ovulatory problems, tubal blockage, age-related factors, uterine problems, previous tubal ligation and hormone imbalance are some other causes of infertility^[4].

The physiology of reproduction in females depends upon a complex interplay of the Hypothalamo-Pituitary-Ovarian (HPO) axis. Gonadotropin releasing hormones (GnRH), resealed from hypothalamus controls the pituitary gland which directly or indirectly controls most other hormonal glands in the human body. Thus, alterations in the chemical signals from the hypothalamus can affect the pituitary gland, ovaries, thyroid, mammary gland and hence is a cause of hormonal abnormalities. Hormonal imbalance is an important cause of anovulation^[5],[6]. Hormones from pituitary gland like TSH, prolactin or growth hormone may act synergistically with FSH and LH to enhance the entry of non-growing follicles into growth phase. In addition to this, thyroid hormones may be necessary for maximum production of both estradiol and progesterone.^[7] Hormones of thyroid gland play important part in carbohydrate, protein and fat metabolism. They also regulate gene expression and has role in sexual and reproductive function^[8].

Thyroid dysfunction interferes with human reproductive physiology. It reduces the likelihood of pregnancy and adversely affects pregnancy outcome, thus becoming relevant in the algorithm of reproductive dysfunction.^[9] However it has been seen that many infertile women present with normal menses despite a raised serum prolactin level. Morphological changes observed in the follicles in hypothyroidism can be a consequence of higher prolactin production that may block both secretion and action of gonadotropins^{[10],[11],[12]} Hyperprolactinemia also adversely affects the fertility potential by impairing the pulsatile secretion of GnRH and hence interfering with ovulation^[13].

The following study was undertaken to estimate serum prolactin, FSH and LH in hypo, hyper and euthyroid infertile female subjects and find their association with thyroid status.

Material and Methods:

This observational, cross-sectional study, was conducted in the Department of Biochemistry, IGIMS, Patna in collaboration with Dept of Reproductive Biology. The study period was of one year from August 2017 to July 2018.This study consisted of 100 infertile females of age group 20-40 years, who were then subdivided into euthyroid, hypothyroid and hyperthyroid cases base on their thyroid status. 2ml of venous blood was collected after an overnight fast between 3rd - 5th day of menstrual cycle for hormonal assay.Serum Prolactin, FSH, LH,TSH,TotT3,TotT4 were estimated by Chemi-luminescence immunoassay method after proper quality control both internal and external.

Inclusion criteria : Infertile females ,20-40years Exclusion criteria -medication for thyroid disorder or any hormonal supplementation, tubal factor, any congenital anomaly of the urogenital tract, or any obvious organic lesion, unwilling patients Institutional Ethical clearance was obtained and written informed consent was taken from the participants.

Statistical Analysis:

All the biochemical datas are expressed as mean and standard deviation. Student’s t test(unpaired) is used for analysis .p value <0.05 is taken as statistically significant.

Results

In this study ,the 100 infertile females were divided into three groups based on their thyroid status-euthyroid, hypothyroid and hyperthyoid .Subjects included cases of both primary and secondary infertility. There were 37 cases of secondary infertility while 63 females were of primary infertility. Prevalence of hypothyroidism was higher than hyperthyroidism.The mean age of patients were 30.5 ± 6.2 years.

The infertile women with hypothyroidism had significantly higher prolactin levels than the other groups (35.90 8.72ng/ml, p value <0.05)

Even in the euthyroid infertile females, mean Prolactin level was in the higher side of normal range(2.6-26.7ng/ml){Figure 1}{Table 1}{Table 2}

Discussion:

Evaluation of hormones is an important aspect in infertility diagnosis and is also an area of active research which forms a basis for the designing of the effective treatment protocols. In this study, serum levels of thyroid and pituitary hormones were evaluated in infertile female patients in order to find out a possible relationship between thyroid disorders and LH, FSH and Prolactin.

Prolactin inhibits the hormones which are necessary for ovulation i.e. GnRH. So, when there is hyperprolacti’nemia, ovulation is inhibited and thereby contributes to infertility. Moreover when the secretion of GnRH becomes low, LH and FSH secretions also fall. So, gamete production is not stimulated and gonadal steroidogenesis is hampered^{[14],[15],[16]}.

Serum TSH was found to be significantly high in hypothyroid grp vs euthyroid (p <0.001).Similarly TSH was significantly low in the hyperthyroid grp(p<0.01). Serum prolactin was highest in the hypothyroid grp.(35.90± 8.75ng/ml). It is well documented that in primary hypothyroidism, the level of serum thyroxine levels are low and there is decreased negative feedback on the hypothalamo-pituitary axis. The resulting increased secretion of thyrotropin releasing hormone (TRH) stimulates the thyrotrophs and lactotrophs, thereby increasing the levels of both TSH and prolactin and thus there is ovulatory dysfunction due to hyperprolacti’nemia.

Similar results were obtained in other studies. Fupare et al found that the mean serum prolactin concentration in the infertile cases with euthyroid was significantly higher (p<0.001) than the control fertile group with euthyroid. The infertile women with hypothyroidism had significantly higher prolactin levels than those with euthyroid and hyperthyroidism (p<0.001).

In this study 38% of hypothyroid infertility cases had hyperprolacti’nemia as compared to 21% in euthyroid cases(p value<0.01).S Fupare et al observed a greater percentage of infertile women with hypothyroidism exhibiting hyperprolactinemia (40.7%). In yet another study, a significant positive correlation between the TSH and prolactin levels in the infertile females was seen.

Serum FSH, LH were decreased in all thyroid disorders, however the change in LH was not statistically significant(p<0.2). In one study by Rakhee Y et al, it was found that the levels of LH and FSH were low in the infertile patients group; FSH more than LH and that too in hypothyroid patients The results by Reham D. et al , showed high incidence of prolactin abnormalities in both primary and secondary infertile women (90% and 92%, respectively). They found positive correlations between the levels of prolactin and TSH in primary and secondary infertility. Similar observations were seen in this study also.

Conclusion:

Hyperprolactinemia is the most common hormonal abnormality in females with infertility. TSH has a positive correlation with serum Prolactin level. Assessment of serum TSH and prolactin levels should be made mandatory in the work up of all infertile women, especially those presenting with menstrual irregularities

Limitations:

Sample size is small, especially number of patients in hyperthyroid group freeT3 and freeT4 should have been preferably done along with total T3 and total T4.

Conflict of interest: None.

References

1	Hammond MG. Evaluation of the infertile couple. Obstetric and Gynaecology clinics of North America, 1987; 14(4): 821.
2	Stephen E.H., Chandra A. Use of infertility services in the United States: 1995. Fam Plann Perspect (2000) 32:132.
3	Nasima A., Sufi A. H. Sub-clinical hypothyroidism and hyperprolactinemia in infertile women: Bangladesh perspective after universal salt iodination. The Internet Journal of Endocrinology 2009; 5(1): 8 p
4	Alaa Shaker Al-Nahi, Ezzat Hasson Ajeena, Sanaa Hassan Al-Khafagi, Correlation of Prolactin and Thyroid Hormones levels with Menstrual Patterns in Infertile Women international Journal of Scientific & Engineering Research,2014, Volume 5, Issue 12, 1368-72
5	EniolaOW, Adetola AA,Abayomi BT. A Review of Female Infertility; Important Etiological Factors and Management. J Microbiol Biotech Res 2012; 2(3): 379-385.
6	Donfas AG, Mastorakos G. The Hypothalamic- Pituitary-Thyroid Axis and the Female Reproductive System. Ann N Y AcadSci 2000; 900: 65-76.
7	Wakim AN, Polizotto SL, Burholt DR. Influence of Thyroxine on Human Granulosa Cell Steroidogenesis in vitro. J Assist Reprod Genet 1995; 12(4): 274-7.
8	Veeresh T, Moulali D, Sarma DVH. A Study on Serum FSH, LH and Prolactin Levels in Women with Thyroid Disorders. International Journal of Scientific and Research Publications 2015; 5(3): 250-4.
9	Wang C. and Crapo L.M., The epidemiology of thyroid disease and implication for screening,Endocrinology and metabolism clinics of north America, 26, 189-218 (1992)
10	Mici?sk P, Wielgus E, Wojcieszyn M, and Pawlicki K. (2006). Abnormal ovarian reserve test reflects thyroid dysfunction. Pol J Gyn Invest.;9(1):30-4.
11	Armada-Dias L, Carvalho JJ, Breitenbach MM, Franci CR, and Moura EG. (2001). Is the infertility in hypothyroidism mainly due to ovarian or pituitary functional changes? Braz J Med Biol Res.;34 (9):1209-15
12	Rahman,D.Fatima,P.and Banu,J.(2008)Thyroid disorder in female subfertility.JCMCTA.19(2);46-50.
13	Zollner U, Lanig K, Steck T, Dietl J. Assessment of Endocrine Status in Patients Undergoing In- Vitro Fertilization Treatment. Is It Necessary? Arch GynecolObstet 2001; 265(1): 16-20.
14	Koutras DA. Disturbances of Menstruation in Thyroid Diseases. Ann N Y AcadSci 1997; 816: 280-4.
15	Cramer DW, Sluss PM, Powers RD, et al. Serum Prolactin and TSH in an In Vitro Fertilization Population: Is There a Link Between Fertilization and Thyroid Function? J Assist Reprod 2003; 20: 210.
16	Poppe K, Velkeniers B. Thyroid and Infertility. Verh K AcadGeneeskdBelg 2002; 64(6):389-99.
17	Santosh Fupare, Bina M. Gadhiya, Rajesh K. Jambhulkar, Archana Tale, Correlation of Thyroid Hormones with FSH, LH and Prolactin in Infertility in the Reproductive Age Group Women, International Journal of Clinical Biochemistry and Research 2015;2(4):216-222
18	Rakhee Yadav, Sanjiv Kumar Bansal, Busi Karunanand, Eram Hussain Pasha, Birendra Kumar and Smita Prasad Shastry , Association of Thyroid Disorders with the Hormones of Anterior Pituitary in Female Infertiltiy , Annals of Pathology and Laboratory Medicine, Vol. 03, No. 04, October - December 2016
19	Reham D. Alghonmeen,Correlation of prolactin with thyroid- stimulating hormone and female sex hormones in infertile women, Int. J. Adv. Res. 5(2),2017 1551-1557