Biochemical Study of the Influence of FSH, LH, and PRL Hormones in Infertile Female

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The best likelihood of conception is accomplished by having several sex sessions throughout the fertile time (Claes, A., & Stout, T. A. E. 2022).
Problems with sexuality might be the cause of infertility.Consequently, an assessment of the sexual conduct of the couple should be part of the infertility investigation (Saxena, S., et al., 2016).
The hormonal conditions hyperthyroidism, hypothyroidism, and hyperprolactinemia all impact ovulation (Alazawa, Z. F. R., and Barrouq, D. M. S. 2022).Hormonal abnormalities, such as those involving prolactin, luteinizing hormone (LH), and follicle-stimulating hormone (FSH), can have an impact on infertility (Murray, C. M., & Orr, C. J. 2020).These hormones are essential for controlling ovulation, the menstrual cycle, and general reproductive function (Berga, S. L. 2020).The main function of the hormone prolactin in breastfeeding mothers is to increase milk production (Haerifar, N., Vaezi, G., Samani, Z. G., and Lak, S. S. 2020).Hyperprolactinemia, or elevated prolactin levels in non-lactating, non-pregnant women, might interfere with ovulation and the regular menstrual cycle (Haerifar, N., et al., 2020).Prolactin levels that are too high can inhibit the production of GnRH, which in turn influences the release of LH and FSH (Nath, C. K., et al., 2019).Infertility can result from this disturbance, which can cause irregular or nonexistent ovulation.Ovulation, the process by which a developed egg is released from the ovary, is brought on by LH (Alazawa, Z. F. R., and Barrouq, D. M. S. 2022).Unusual or anovulatory cycles may be caused by an aberrant LH surge or by inappropriate timing of the LH surge, which might further the problem of infertility (Broekmans, F. J. 2019).Ailments including polycystic ovarian syndrome (PCOS) can cause ovulation to be interrupted and LH levels to rise.The formation and development of ovarian follicles, which house eggs, depend on FSH.A decreased ovarian reserve, which results in the ovaries not responding as effectively to FSH stimulation and perhaps causing problems with ovulation and conception, might be indicated by .Additionally, disorders including premature ovarian insufficiency (POI) have been linked to high FSH levels (Mohajan, D., and Mohajan, H. K. 2023).

MATERIALS AND METHODS
Patients who contacted the Infertility and Fertility Treatment Center, Al-Sadr City Educational Center Najaf city from Nov 25, 2022, and Mar 12, 2023, were the subjects of the research.64 patients, aged between (22 and 40) years, were included in the research and classification into two groups.Group as a control 46 women in health.Then, two groups were separated into two subgroups, normal weight and obese, based on BMI.Weight (kg), height (m 2 ), and body mass index (BMI) measurements.Infertile patients were selected based on their previous diagnoses of infertility after several failed attempts to conceive naturally.5 mL of venous blood was taken from each subject.Using enzyme-linked immune sorbet assay (ELISA) techniques, the levels of serum luteinizing hormone (LH), Prolactin (PRL), and Follicle Stimulating Hormone (FSH) were determined (Bioassay Equipment Laboratory-China).Data analysis was carried out with (IBM SPSS Statistics Version 26.Results were presented as mean (with standard deviation) ST.D), Stas.

RESULTS AND DISCUSSION
In the current study, T-test analysis was applied to the data obtained from patients and healthy people.The data was divided into groups based on the mass table for obese patients and patients with normal weight.The control group was also classified into obese healthy people and those with normal weight.In this investigation, 64 infertile patients and 46 controls were of reproductive age, as indicated in Table 1.BMI is an anthropometric measure for assessing obesity when it is between normal weight (18.5-24.9)and obese (more than 30), according to the WHO standard (Saadia, Z. 2020).The demographic information for the study groups is described in Table 1, and the findings were reported as means, with a conventional splitting of age and BMI between the patient and control groups.

Table1. Data about the Demography Status of the Studies Group
Considered statistically significant when P-value < 0.05 whereas, BMI body mass index Matching was performed in this examination between patient and control groups to prevent changes in parameter findings that may have emerged as a result of the huge age variance, which is shown in Table 1 , that 64 infertile patients and 46 control healthy group in this study were of reproductive age.
The study found that there was no discernible difference between normalweight and obese individuals, that obesity had an effect on LH levels, and that infertility patients produced more LH than control.As can be shown in The obese patient groups and the healthy control group, respectively (Pvalue 0.01).The outcome supports that characters with infertility had lower serum FSH concentrations than people in the control group.The outcome was that individuals with infertility had higher serum PRL concentrations than women in the control group.According to Table 2, there was a significant difference (P-value 0.000) in the means of all groups, with the obese patient and control group means being (1.82±0.4),(0.91±0.12) respectively.and the normal weight groups control and patient had corresponding means (2.01±0.2),(0.63±0.11).The results of various earlier investigations, which revealed that there is a highly significant difference in LH between the patient and control groups, corroborated the findings of this study (Lunenfeld, B., (2019).Additionally, the findings are consistent with paper that discovered substantial changes in LH, FSH, and the LH/FSH ratio between obese and non-obese (normal weight) females (McCartney, C. R., et al., 2022).Increased gonadotropin secretion that favors the production of LH over FSH may be the cause of the rise in LH levels in individuals with infertility due to the GnRH pulse generator's lower sensitivity to feedback regulation by ovarian steroids.The outcome supports the fact that infertility patients' blood FSH concentrations are less than those of the control group (Koysombat, K., Abbara, A., and Dhillo, W. S. 2023), (Khmil, M., Khmil, S., and Marushchak, M. 2020).In fact, the FSH results from the current research agreed with those from earlier ones (Khmil, M., Khmil, S., and Marushchak, M. 2020).).
It shown that women with infertility had lower FSH levels (Antonio, L., Priskorn, L., Olesen, I. A., Petersen, J. H., Vanderschueren, D., and Jørgensen, N. (2020).revealed in their study that the level of FSH did not change considerably and that it was slightly elevated in PCOS women.further study that disagrees (McCartney, C. R., Campbell, R. E., Marshall, J. C., and Moenter, S. M. 2022).The outcomes of this study's findings are interpreted as indicating a malfunction in pulsing GnRH secretion, which results in decreased FSH concentration and increased LH, which results in high androgen and decreased estrogen.As shown in Table 3, the results for the LH/FSH ratio revealed a highly significant elevation in the patient group when compared to the control.This finding supports the theory that PCOS women have faster hypothalamic GnRH pulses, which increases the LH/FSH ratio (Ding, H., et al., 2021).
However, the correlation coefficients between FSH and LH/FSH in patients with normal weight are negative as Table 3, with (P-value 0.041, r = -0.19)and the correlation coefficients in patients with obesity are positive between LH and FSH (P-value 0.005, r = 0.64) and there is no significant correlation between FSH and LH/FSH.High levels of LH in obese women cause the generation of androgens in ovarian theca cells.only in patients who are fat were LH and FSH levels favorably associated.The LH/FSH ratio has been linked to PCOSrelated morbidities for example obesity, insulin resistance, and dyslipidemia.According to a previous study on infertile women, they noticed a decrease in both LH and FSH (Liu, Y., Li, Y., et al., 2023).This contradicts our results, and the reason is attributed to the fact that among the infertile women, there was a percentage of women with polycystic ovary syndrome.Likewise, its relationship with PRL is positive with LH and negative with FSH, as in Table 3.In previous investigations consistent with our research, they found that hyperprolactinemic women with primary and secondary infertility had a considerable drop in blood LH during the follicular, ovulatory, and luteal phases.Females who had been diagnosed with primary infertility had significantly reduced blood FSH levels during the ovulatory phase.In hyperprolactinemic women who had been diagnosed with secondary infertility, a similar substantial decline in serum FSH during the luteal phase was seen.

Conclusions:
The levels of prolactin and LH were improved in the serum of unproductive female compared to female healthy and were higher in those suffering from obesity compared to women of normal weight.

Table 2 ,
there is a substantial difference between the mean FSH levels of LH,FSH,PRLand LH.Correlations Levels of LH, FSH, and PRL with weight in Patients Group and Control Group.

Table 3 :
Correlation between PRL with LH, FSH and LH: FSH ratio.