Department of Physiology, Ibrahim Medical College, Shahbag, Dhaka, Bangladesh
Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh
and objectives: Infertility is a global
health problem including Bangladesh. Altered prolactin, follicle (FSH) and
luteinizing hormones (LH) levels have been implicated as a cause of
infertility. The present study was undertaken to find out the serum prolactin and
gonadotropin levels in women with primary and secondary infertility.
Methods: The study involved a total of 100 women of which 50
had primary (Group A) and another 50 had secondary (Group B) infertility. Fifty
fertile age-matched women were included as control (Group C). All
the study participants were selected from women attending the infertility unit
of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Serum prolactin, FSH and LH hormones were
measured by radioimmunoassay with blood collected on the 2nd day of
Results: The mean serum
prolactin level was significantly higher (<p0.01)
while the mean serum FSH and LH levels were significantly(p< 0.01) lower in women
with primary and secondary infertility compared to fertile women. However, the
mean serum prolactin, FSH and LH levels were not significantly different from
each other among the women with primary and secondary sterility. High
prolactinemia was observed in 16% and 14% women in Group A and B respectively.
women with secondary sterility, significantly (p<0.05%) higher number of
cases with primary sterility (30% vs. 54%) had FSH level below the normal
range. On the other hand, 28% cases with secondary sterility had LH level below
the normal range compared to 10% in primary sterility group (p<0.05).
Conclusion: The study has
demonstrated that there was alteration of serum prolactin, FSH and LH levels in
women with primary and secondary sterility.
IMC J Med Sci 2018; 12(1): 01-05
Address for Correspondence:Dr. Shamima Bari, Assistant Professor,
Department of Physiology, Ibrahim Medical College, 122 Kazi Nazrul Islam
Avenue, Shahbag, Dhaka. E-mail: firstname.lastname@example.org
Infertility is a worldwide reproductive health issue
including Bangladesh. It affects approximately 10 to 15% couples and more than
80 million people worldwide [1-3]. In Bangladesh, the rate of infertility has
been reported as 4% to 15% [4-7]. The causes of infertility include ovarian (30
– 40 %), cervical (5%), and male (25–40%) factors while 10–15% has unexplained causes
disorders of female reproductive system occur due to aberrant dysfunction of
hypo-thalamic-pituitary-ovarian axis and are relatively common disorders leading
to infertility. The increased or decreased levels of
prolactin, FSH and LH hormones may cause infertility [8-10]. High level of prolactin
may cause infertility affecting FSH and gonadrotropin releasing hormone (GnRH)
. High prolactin level inhibits GnRH and follicle stimulating hormone leading
to infertility [12-16].
the present study was undertaken to measure the serum prolactin, FSH and LH levels
in women with primary and secondary infertility.
This cross sectional study was carried
out in the department of Physiology, Dhaka Medical College, Dhaka from July
2010 to June 2011 and the protocol was approved by Ethical Review Committee of
Dhaka Medical College.
Study design: Women with infertility,
attending the Infertility Unit of Bangabandhu Sheikh Mujib Medical University
(BSMMU) were included in the study. Women with infertility were further divided
into primary and secondary infertility groups. Primary and secondary
infertility groups were denoted as Group A and B respectively. Equal number of
age matched apparently healthy fertile women were enrolled as control and
denoted as Group C. Infertility was defined as the inability of couple to
achieve conception after one year of frequent unprotected intercourse without contraception
. Primary infertility denoted those women who had never conceived.
Secondary infertility or sterility was defined as the same condition developing
after initial phase of fertility that means conceived previously but failed to
conceive subsequently . The fertility was defined
as the capacity to conceive.
Infertile women having husbands with normal
semen analysis results and normal genitalia, uterus and adnexa were included. Women with tubal
factor, congenital anomaly of urogenital tract and any obvious organic lesion
or pelvic inflammatory diseases, and lactating women were excluded from this
study. The purpose and benefits of the study were explained to each participant
and informed written consent was taken from each of them. A detailed personal,
medical, family, socio-economic and drug history were recorded in a predesigned
Anthropometric measurements: Body weight and height were measured in
kilogram (kg) and in centimeters respectively. The Body Mass index (BMI) was
calculated by using the formula: weight in kilograms / (height in meters).
Biochemical parameters and collection of
5 milliliter of blood was collected from medial cubital vein from each participant
in the 2nd day of menstrual cycle. Blood was allowed to clot for 30-60 minutes
at room temperature and then centrifuged at 3000 rpm for 5-10 minutes and serum
was separated and preserved at -20°C for estimation of serum prolactin, FSH and
LH. Prolactin, FSH and LH were measured by radioimmunoassay at the Centre for
Nuclear Medicine and Ultrasound, Dhaka Medical College.The analysis was done within 2 weeks of
blood collection. The normal
range for prolactin, FSH and LH were 2 -25 ng/dl, 3.1-7.9 IU/L and 1.9 -12.5 IU/L respectively.
Statistical Analysis: The data were analyzed by
appropriate statistical tests namely, one way ANOVA, Tukey’s HSD post-hoc test
and student’s t tests and Z test.
A total of 150 women were included
in the study. Out of 150 enrolled participants, 50 had primary and another 50
had secondary infertility. Fifty age matched apparently healthy fertile women
were enrolled as control. Mean age of different groups of study population were
almost similar and no statistically significant difference was observed among the
study groups (Table-1). The mean BMI of women with primary (group A: 28.05±4.08 kg/m2) and secondary
infertility (group B: 27.62±3.68 kg/m2) were significantly higher
(p<0.01) compared to fertile women (group C: 25.35±3.48 kg/m2). There
was no significant difference of BMI between group Aand B.
Table-1: Age and
body mass index (BMI) of study population
The mean serum
prolactin, FSH and LH levels of group A, B and C are shown in Table-2. The mean
serum prolactin levels of women with primary (14.54±8.68 ng/dl) and secondary
(15.36±7.24) infertility were significantly (p< 0.01) higher than that of
women with normal fertility (10.58±5.01). However, the mean serum prolactin
level of women with primary and secondary infertility was almost similar. Overall
mean serum FSH and LH levels of women with primary and secondary infertility
were significantly (p<0.01) low compared to the control group (Table-2).
prolactin, FSH and LH levels of study population
of 50 cases of primary infertility, 84% had normal and 16% had high prolactin
level (>25 ng/dl). The rate was 86% and 14% respectively in secondary
infertility cases. Only 2 cases (4%) with normal fertility had high prolactin
level. In women with primary sterility, the serum FSH and LH levels were lower
than the normal levels in 54% and 10% cases respectively while in secondary sterility
the levels were low in 30% and 28% cases respectively. Compared to women with
secondary sterility, significantly (p<0.05%) higher number of cases with
primary sterility (30% vs. 54%) had FSH level below the normal range (Table-3).
On the other hand, compared to primary sterility group significantly higher
number of cases with secondary sterility (10% vs 28%) had LH level below the
of serum prolactin, FSH and LH levels of study population
primary sterility group, the mean serum prolactin level of women with normal
and hyperprolactinemia were 11.73±4.98 ng/dl and 31.73±6.58 ng/dl respectively
and in secondary sterility group the values were 13.12±3.7 ng/dl and 29.5±3.88 ng/dl
respectively (p<0.01; Table-4). The mean FSH and LH levels in those cases
were significantly low compared to women with normal fertility (p<0.05).
Table-4: Levels of
serum prolactin, FSH and LH in women with normal and high prolactinemia in
different groups of study population
levels in women with infertility have been evaluated by many researchers. High
prolactin level has been reported as the cause of female infertility [12,13]. In the present study,
the overall mean serum prolactin level was significantly higher in infertile
women than that of control fertile women. However, only 14-16% women with
primary and secondary infertility had prolactinemia above the recommended
normal range. Similar observation was also reported by other investigators from
different countries [16,19-24]. In the present study, the observation of high prolactinemia in 30%
women with primary and secondary infertility in our study is in agreement with
other studies elsewhere [15,25-29]. High prolactinemia is the commonest
biochemical abnormality observed in infertility . Furthermore, prolactin
may affect the ovaries by altering ovarian progesterone secretion and estrogen
synthesis leading to infertility [27,28]. Women with high level of prolactin
may ovulate regularly but may not produce enough progesterone during luteal
phase after ovulation. Deficiency of progesterone produced after ovulation, may
hamper embryo implantation in a uterine lining [30,31].
Higher than the normal range of FSH
and LH is rarely found in infertile women with a proper menstrual cycle but
lower concentrations of these hormones have been observed . In this study
low levels of gonadotrophins (LH and FSH) were observed in 84% and 38%
respectively among total infertile women. Similar observation has been reported
by others . Serum
FSH was significantly lower in primary infertile women than those of secondary
infertile women. On the other hand, serum LH was significantly lower in
secondary infertile women than that of primary infertile women. A serum level
of FSH and LH, below the normal range, during the follicular phase indicates
defect in factors that are responsible for their production leading to a poor
ovarian reserve and infertility. These could be due to defects in the pituitary
gland, GnRH or the hypothalamus .
Therefore, the present
study has demonstrated that a significant number of women with primary and
secondary infertility have altered prolactin, FSH and LH levels compared to fertile
are thankful to the Infertility Unit, Department of Gynecology and Obstetrics, BSMMU
for their cooperation. We acknowledge the support of Dr. Sanwar Hossain,
Director, Centre for Nuclear Medicine and Ultrasound, Dhaka Medical College, for
providing the laboratory facility for biochemical assays. Authors are thankful
to all the study participants for their active support.
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