EVALUATION OF HORMONAL TESTING IN THE SCREENING FOR IN-VITRO FERTILIZATION (IVF) OF WOMEN WITH TUBAL FACTOR INFERTILITY

Purpose: To evaluate the frequency of abnormal prolactin and thyroid s timulating hormone (TSH) test results in ovulatory women with tubal fa ctor infertility who were screened for in vitro fertilization (IVF). M ethods: Charts were identified from 112 ovulatory women with follicle stimulating hormone (FSH) <20 mIU/ml who were diagnosed with tubal fac tor infertility and were screened for IVF with thyroid stimulating hor mone (TSH) and prolactin levels. Women previously diagnosed with thyro id disease were subsequently excluded and 98 subjects remained. All su bjects were determined to be ovulatory by biphasic basal body temperat ure (BET) charts, luteal phase progesterone >4 ng/ml, or endometrial b iopsy revealing secretory endometrium. Results of cycle day 3 serum TS H and prolactin concentrations were recorded. The normal range for eac h test reflects the geometric mean +/- 2 standard deviations (i.e., 95 % interval), as obtained from the reference laboratory. Under this con struct, hypothesis tests were performed to determine whether or not ou r study population was consistent with the reference range of normal h ormone levels. Under the null hypothesis (normal levels), we expected 5% of the TSH rests to be abnormal (i.e., high or low levels), and 2.5 % of the prolactin tests to be abnormal (i.e., high levels). Exact bio nomial confidence intervals and P-values were calculated. We also test ed for age trend in the proportion of abnormal results. Results: Study subjects had an age range of 25-43. In the study group, 4 (0.041) out of the 98 women screened had abnormal TSH levels. Of these four abnor mal TSH results, three were elevated (i.e., TSH>4.6 mu IU/ml) and one was low (i.e., TSH <0.6 mu IU/ml). The frequency of an abnormal TSH va lue was not significantly different from that expected from the refere nce laboratory normal values (95% CI 0.011, 0.101). Of the 98 subjects , 7 (0.071) had abnormal prolactin levels, which was significantly dif ferent from that expected from the reference laboratory normal values (95% CI 0.029, 0.142; P = 0.023). When stratified by age, there was no observed trend of abnormalities for TSH or prolactin levels with incr easing age. Conclusions: In ovulatory women presenting for IVF with tu bal factor infertility, our results show that routine screening with a TSH test does not yield a significantly higher proportion of abnormal results than that expected from the reference laboratory normal value s. However, prolactin level screening was found to yield a higher inci dence of abnormal tests than expected from the reference laboratory no rmal values.