Journal of Medical and Dental Science Research

Volume 11~ Issue 3 (2024) pp: 06-12

ISSN(Online) : 2394-076X ISSN (Print):2394-0751

Research Paper

HORMONAL PROFILE OF WOMEN WITH PRIMARY

INFERTILITY IN A TERTIARY HEALTHCARE SETTING
Kiyesi A. L., 1 Alabi K. O., 2 Owamagbe E. M., 1 Adeyanju T. B.3
1
Department of Chemical pathology, Faculty of basic clinical science Rivers state University,
Rivers state, Nigeria.
2
Department of Family Medicine, Afe Babalola University, Ado Ekiti, Ekiti state, Nigeria
3
Department of Obstetrics and Gynaecology, Afe Babalola University, Ado Ekiti, Ekiti state, Nigeria.

ABSTRACT
Background: Infertility affects a significant portion of women worldwide, with primary infertility
being a major concern. Hormonal imbalances involving Follicle-Stimulating Hormone (FSH),
Luteinizing Hormone (LH), Prolactin, and Progesterone are key factors in reproductive challenges. This
study aims to determine the female reproductive hormone profile and, if applicable, identify the
potential causes of any hormonal imbalances that may contribute to infertility.
Methods: This study analysed the reproductive hormone profiles of 114 women with primary infertility
at Afe Babalola Multisystem Hospital. Ethical considerations were addressed, informed consent
obtained, and hormonal levels measured through laboratory assessment of blood samples.
Results: The majority of participants were aged 20-29, with a significant number showing low levels
of FSH, LH, and Progesterone, and elevated levels of Prolactin. it was found that 45.6% had low FSH
levels, 15.8% exhibited high FSH levels, and 38.6% had normal FSH levels. Moving to Luteinizing
Hormone (LH) levels, 43.0% of participants showed low LH levels, 14.9% displayed high LH levels,
and 42.1% had normal LH levels. Interestingly, none of the participants had low Prolactin levels, while
24.6% had high Prolactin levels, and 75.4% had normal Prolactin levels. Correlations between age and
hormonal levels were significant, indicating potential age-related and inter-hormonal dynamics
affecting fertility.
Conclusion: The study highlights the importance of hormonal assessments in evaluating primary
infertility. Identifying hormonal patterns and their correlations with age can guide targeted interventions
to improve conception chances.

Keywords: Hormones, Infertility, Women, Hormonal imbalance,

1.0 INTRODUCTION
Reproductive hormones, such as Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH),
Prolactin, and Progesterone, play vital roles in coordinating the intricate processes of human
reproduction.1,2 The delicate balance and timely release of these hormones are crucial for the proper
functioning of the reproductive system. In the field of clinical research, comprehending the dynamics
of these hormones becomes paramount, particularly when investigating issues related to primary
infertility.3,4
Infertility stands as a significant global health concern, affecting 20-30% of women of reproductive
age. According to the World Health Organization (WHO), infertility is defined as the inability to
conceive after one year of regular unprotected intercourse. Recent studies have reported a global
infertility rate of 8-12%, with approximately 8-10% of couples facing difficulties in achieving
pregnancy.4,5 Infertility is categorized into primary and secondary types, with primary infertility
characterized by a couple's inability to conceive after a year of unprotected intercourse.6

*Corresponding Author: Dr. Kiyesi A. L.: kiyesiadekemi@gmail.com

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Clinical research has played a pivotal role in unravelling the complex interplay between reproductive
hormones and fertility, shedding light on potential causes and therapeutic interventions for those
experiencing primary infertility.7 Disparities in primary infertility rates are evident worldwide, with
substantial differences between developed and developing countries.8 In regions like Nigeria, primary
infertility poses a significant challenge due to factors such as limited healthcare access, socioeconomic
constraints, and cultural beliefs. In comparison to advanced countries with well-established healthcare
systems, individuals in places like Nigeria may encounter additional barriers in diagnosing and
addressing the root causes of infertility9–11.
The causes of infertility vary across countries and social groups. While primary infertility is higher in
other regions of the world, secondary infertility is more common in Afrcia.3,9 Hormones like FSH, LH,
prolactin and progesterone play crucial roles in controlling reproduction and must be at optimal levels
for successful conception. Alterations in these hormones can result in infertility among women of
childbearing age.11,12 Consequently, this study aims to determine the female reproductive hormone
profile and, if applicable, identify the potential causes of any hormonal imbalances that may contribute
to infertility.
2.0 METHODS
2.1 Study Population
The study cross-section of 114 women diagnosed with primary infertility between January and
December 2022, all of whom sought medical care at the Afe Babalola Multisystem Hospital, a tertiary
healthcare center located in Ado Ekiti, Ekiti state in Southwest Nigeria. These women represented a
diverse range of backgrounds, ages, and socio-economic statuses, forming a comprehensive sample to
investigate the prevalence and potential causes of primary infertility in the region.
2.3 Specimen Collection and Assessment
Laboratory assessments were conducted on each participant to analyze the levels of Follicle-Stimulating
Hormone (FSH), Prolactin (PROL) Luteinizing Hormone (LH), and Progesterone (PROG) according
to established standard for biochemical assessments of these hormones on the specified time periods
during the menstrual cycle of the women as previously described.3,13 Specimen collection involved
blood samples which were collected aseptically, immediately centrifuged and stored in the refrigerator,
and meticulous procedures were followed to ensure accuracy and reliability of the hormonal
measurements.
2.4 Data Collection and Analysis
Data collection involved recording demographic information, and the laboratory results of FSH, LH,
PROG, and PROL assessments for each participant with a structured PROFORMA data collection
sheet. The collected data underwent thorough analysis, employing statistical methods to identify
patterns, correlations, and potential associations between hormonal levels and primary infertility. The
categorization of low, normal and high levels of the different hormones was done according to reference
values previously published.13
2.2 Ethical Consideration
Prior to the commencement of the study, ethical considerations were rigorously addressed to ensure the
well-being and confidentiality of the participants. Informed consent was obtained from each participant,
outlining the nature of the study, the procedures involved, and the potential implications. The study
adhered strictly to ethical guidelines, and the research protocol was approved by the ethics committee
overseeing human research in Afe Babalola Multisystem Hospital.
3.0 RESULTS
The study population comprised 114 women diagnosed with primary infertility in a tertiary healthcare
center in Southwest Nigeria. The average age of the women was 28.5 ±8.4 years with the age
distribution showing that 63.2% of participants were in the 20 - 29 age group, 23.7% were in the 30 -
39 age group, and 13.2% were in the 40 - 49 age group, providing insights into the demographic
composition of women seeking assistance for primary infertility in the specified region (Table 1).

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Table 1: Age distribution of participants
Age groups Frequency Percent

20 - 29 72 63.2
30 -39 27 23.7
40 -49 15 13.2
Total 114 100.0

Table 2 provide a comprehensive overview of the hormonal levels observed in the study population.

Table 2: Summary of hormonal profile of patients

Std. Std.
Hormone Mean Error Deviation
FSH 5.9 1.0 10.8
LH 5.5 0.7 7.7
PROL 18.3 2.6 27.5
PROG 5.1 1.1 11.4

Table 3 shows the assessment of Follicle-Stimulating Hormone (FSH) levels among the 114
participants, it was found that 45.6% had low FSH levels, 15.8% exhibited high FSH levels, and 38.6%
had normal FSH levels. Moving to Luteinizing Hormone (LH) levels, 43.0% of participants showed
low LH levels, 14.9% displayed high LH levels, and 42.1% had normal LH levels. Interestingly, none
of the participants had low Prolactin levels, while 24.6% had high Prolactin levels, and 75.4% had
normal Prolactin levels. Finally, concerning Progesterone levels, a significant proportion, 73.7%, had
low Progesterone levels, 6.1% exhibited high Progesterone levels, and only 20.2% had normal
Progesterone levels. These findings provide valuable insights into the hormonal profiles of women
diagnosed with primary infertility in the specified healthcare centre, highlighting potential hormonal
imbalances that may contribute to reproductive challenges.

Table 3: Distribution of Hormonal Profile of patients

Hormone Frequency (n=114) Percent (%)

FSH (mUI/ml)
Low (<4.5) 52 45.6
High (>21.5) 18 15.8
Normal (4.5 – 21.5) 44 38.6
LH (ng/mL)
Low (<1.6) 49 43.0
High (>15) 17 14.9
Normal (1.6 – 15) 48 42.1
Prolactin (ng/mL)
Low 0 0.0
High(≥25) 28 24.6
Normal (<25) 86 75.4
Progesterone (ng/mL)
Low (<3.3) 84 73.7
High (>22.5) 7 6.1
Normal (3.3 – 22.5) 23 20.2

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The correlation matrix in Table 4 indicates the relationships between different variables, including age
and various hormonal levels (FSH, LH, Prolactin, and Progesterone) among the study participants.
Notably, age demonstrates a significant positive correlation with FSH levels (r = 0.343, p < 0.01),
suggesting that as age increases, FSH levels also tend to rise. Additionally, FSH and LH exhibit a strong
positive correlation (r = 0.711, p < 0.01), indicating a close relationship between these two hormones.
Conversely, age displays a significant negative correlation with Prolactin levels (r = -0.191, p < 0.05),
implying that as age increases, Prolactin levels tend to decrease. Furthermore, there is a significant
negative correlation between Prolactin and Progesterone levels (r = -0.188, p < 0.05), suggesting an
inverse relationship between these two hormones. The correlations observed in this study provide
valuable insights into potential age-related and inter-hormonal dynamics among women diagnosed with
primary infertility in the specified healthcare centre. These findings contribute to a better understanding
of the complex interactions within the reproductive endocrine system in this particular population.

Table 4: Pearson's correlation of age and hormones

AGE FSH LH PROL PROG

AGE 1 0.343** 0.167 -0.191* 0.021
FSH 0.343** 1 0.711** -0.109 -0.095
LH 0.167 0.711** 1 -0.127 -0.132
PROL -0.191* -0.109 -0.127 1 -0.188*
PROG 0.021 -0.095 -0.132 -0.188* 1
** Correlation is significant at the 0.01 level (2-tailed).
* Correlation is significant at the 0.05 level (2-tailed).

4.0 DISCUSSION
The findings from the assessment of Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH),
Prolactin, and Progesterone levels in women diagnosed with primary infertility in the specified
healthcare centre hold crucial clinical implications for understanding and addressing reproductive
challenges. These hormonal imbalances provide valuable insights into potential underlying mechanisms
contributing to infertility. Notably, low FSH and LH levels in a significant proportion of participants
(45.6% and 43.0%, respectively) it suggests a potential impairment in ovarian function and follicular
development. This aligns with existing literature linking low FSH and LH levels to common causes of
female infertility, such as anovulation and ovarian dysfunction.14,15 Moreover, elevated Prolactin levels
in 24.6% of participants are associated with hyperprolactinemia, a condition known to disrupt the
normal menstrual cycle and ovulation, negatively impacting fertility.16
The substantial prevalence of low Progesterone levels (73.7%) indicates luteal phase deficiency,
associated with inadequate progesterone production during the second half of the menstrual cycle. This
deficiency can compromise embryo implantation and contribute to early pregnancy loss.2,4Clinical
interventions may include administering exogenous progesterone to support the luteal phase and
improve the chances of successful pregnancy.4
Additionally, the observed positive correlation between age and FSH levels suggests an age-related
decline in ovarian reserve, emphasizing the impact of advancing age on female fertility. 5,7 This has
significant clinical implications for counseling and managing expectations in older individuals seeking
fertility treatments. Furthermore, the negative correlation between age and Prolactin levels may reflect
age-related changes contributing to fertility decline.10,17
The findings of the current study become even more pertinent when considering their implications for
individuals diagnosed with Polycystic Ovary Syndrome (PCOS). PCOS is a common endocrine
disorder characterized by irregular menstrual cycles, hyperandrogenism, and polycystic ovaries, often
leading to fertility challenges.18 The observed hormonal imbalances in FSH, LH, Prolactin, and
Progesterone levels in women with primary infertility may be closely associated with PCOS. Research
has consistently linked hormonal irregularities to PCOS, and understanding these associations is crucial
for both diagnosis and treatment.19,20 In the studied cohort, the prevalence of low FSH and LH levels
aligns with the characteristic anovulation and disrupted ovarian function commonly observed in
individuals with the syndrome.21,22 The hormonal dysregulation in PCOS often results in the formation

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of ovarian cysts, contributing to menstrual irregularities and infertility. Elevated Prolactin levels, as
observed in a subset of participants, can be associated with hyperprolactinemia. While
hyperprolactinemia is not a typical feature of PCOS, its presence can exacerbate menstrual irregularities
and disrupt ovulation, compounding fertility challenges in individuals already affected by PCOS.6,21
Clinical management strategies, such as the use of dopamine agonists, may be particularly relevant in
addressing the interplay between hyperprolactinemia and PCOS-related infertility.21
The prevalence of low Progesterone levels in a significant percentage of participants highlights luteal
phase deficiency, a concern that is not uncommon in individuals with PCOS. Luteal phase defects,
characterized by inadequate progesterone production, can further compromise fertility by affecting
embryo implantation and increasing the risk of early pregnancy loss.23,24 Addressing this deficiency
through interventions such as exogenous progesterone becomes crucial in the context of PCOS-related
infertility.25 The observed positive correlation between age and FSH levels in the studied population,
indicating an age-related decline in ovarian reserve, is particularly relevant when considering PCOS.
Aging individuals with PCOS may face an additional layer of complexity in fertility management, as
the combination of PCOS-related hormonal irregularities and age-related decline in ovarian reserve can
pose unique challenges.14,26
5.0 CONCLUSION
The assessment of FSH, LH, Prolactin, and Progesterone levels in women diagnosed with primary
infertility provides valuable insights not only into common causes of infertility but also into the
potential impact of conditions such as PCOS. Tailoring clinical interventions based on the specific
hormonal imbalances associated with PCOS is essential for effectively addressing reproductive
challenges in this population. The findings underscore the importance of a comprehensive and
personalized approach to fertility management, taking into account the complex interplay of hormonal
factors in individuals with PCOS.
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