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Old 06-28-2012, 04:22 PM   #1
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HELP!!! Here are my lab results... can anyone help decipher them?!?!

Here's a little background on my story before we get to the numbers. My DH and I have been TTC for about 7 months. However, I am not ovulating so my OB put me on Clomid. I started out on 50mg, second cycle 100mg, and I will be beginning my third cycle of 150mg (the highest dosage) in a couple weeks. Both the first and second cycles I did not ovulate. :/

I called today to get the numbers of my labs so that I can do a little more research on them. My OB says these are all 'normal' results. However, I don't know what they should be or if one thing is a little high or low. Can anyone help me decipher these results?

Dates are beginning with the most recent.

6/25
- Progesterone 0.7 (no ov.)

5/9
- Progesterone 0.7 (no ov.)

5/27
- TSH 2.98 (Scale Range 0.4-5.4)
- Prolactin - 11.6
- SHB 41.17 (I can't find anything about this online so I don't know what it is?)
- Total Testosterone - 44.5
- Free Testosterone - 3.75
- Insulin - 13.7

Any advice would be greatly appreciated! Thanks ladies!

 
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Old 06-29-2012, 05:42 PM   #2
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Re: HELP!!! Here are my lab results... can anyone help decipher them?!?!

Hi Sweetie,

Sorry no one has answered your question yet, I tend to hang out in the thyroid board more these days.

Can you please post the units and ranges of your results? (not TSH or progesterone, those are obvious)

I will post back again after you do but a couple of things stick out to me and make me feel really hopeful that there are some things you can/should fix before you take clomid again.

The first thing is your TSH. The average person with a healthy thyroid has a TSH of 1.2 (average range is 1-1.5). This TSH indicates sub-clinical hypothyroidism. TSH is not enough info though- you also need Free T4 and Free T3. You really should insist on all 3 tests- TSH, FT4, and FT3 all at the same time. It wouldn't hurt to also ask to be tested for thyroid antibodies- Anti-TPO antibodies and Tg Antibodies. This will tell you more definitively whether you have Hashimoto's thyroiditis.

I suggest you get thyroid treatment and get your TSH to around 1, with free thyroid hormones above 50% of range before you do another round of clomid. Hypothyroidism can not only prevent you from ovulating but it can also cause miscarriage if you get pregnant, not to mention cause developmental problems in the baby if your FT4 levels are not high enough. So, please insist that they check your thyroid status more completely.

Also, look up ATA's pregnancy thyroid guidelines, "Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum". I don't know if I am allowed to post it here due to forum rules. You will see that one of the recommendations for women with hypothyroidism is to get the TSH below 1.2 before trying for pregnancy because it will likely rise a lot during pregnancy if your thyroid is impaired.

Your insulin level (assuming the units are the ones I think they are) shows that you have insulin resistance. A level over 10 indicates IR. You should probably be on metformin, if you're not already and eating a very low carb/ high protein diet, something like South Beach diet would be perfect. I am guessing you have PCOS, based on your lab results. Has your doctor discussed this with you? It's possible that metformin and diet change alone will help you to ovulate on your own.

Your SHBG is low. This is Sex hormone binding globulin. Basically, it's a protein in the blood that binds sex hormones. Your testosterone level is not that high but since your SHBG is low, there is a lot of free testosterone swimming around (possibly causing some acne and hirsutism). I'm not sure of the range but I am guessing your Free testosterone is either at the top of the range or over. SHBG is lowered in PCOS.

You should also be monitored via ultrasound to see if your follicles are responding to clomid and that your lining looks good. I am guessing you are not going through a reproductive endocrinologist yet, as they would probably be doing ultrasounds. If you do choose to continue with fertility treatments (though I recommend thyroid treatment and metformin first), I suggest seeing an RE rather than an OBGYN.

Let me know if you have any other questions. Best of luck! I am starting fertility treatments again next month. Argh!

 
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Old 06-29-2012, 05:43 PM   #3
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Re: HELP!!! Here are my lab results... can anyone help decipher them?!?!

Oh, and your prolactin is fine, assuming it's the units I think it's in ;-)

I suggest looking at the thyroid boards, you will realise that most people on there have similar TSH to yours. http://www.healthboards.com/boards/thyroid-disorders/

 
Old 06-29-2012, 05:57 PM   #4
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Re: HELP!!! Here are my lab results... can anyone help decipher them?!?!

Because I just can't keep my 2 cents to myself, I think there is more bloodwork you need done- though it's pretty clear to me from your bloodwork that you are probably dealing with PCOS.
Day 3 estradiol
Day 3 LH and FSH (they should be roughly 1:1, LH much higher than FSH is another indicator of PCOS)
TSH, FT4, FT3, thyroid antibodies (TPO, tg)
Insulin and Glucose tolerance test (fasting and 2 hour)- this is more definitive for IR but based on your high fasting insulin, I would say you probably have it.
Ferritin and serum iron (is usually low in hypothyroidism and can impact fertility too)
Vitamin A retinol (is also low in hypothyroidism because of poor conversion from beta carotene to Vit A). Make sure your prenatal has Vit A palmitate (at least 5000 IU) as well as beta carotene.
Vit D- I guarantee this is low. It should be at least 50.
You should also make sure your prenatal has selenium in it because this mineral is necessary for conversion of T4 (storage thyroid hormone) to T3 (the active thyroid hormone). Your prenatal should also have the minimum RDA of iodine in it, you'd be surprised how many don't (don't take too much iodine though as this can cause thyroid problems to worsen)

Last edited by bee01; 06-29-2012 at 06:04 PM.

 
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Old 06-29-2012, 07:44 PM   #5
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Re: HELP!!! Here are my lab results... can anyone help decipher them?!?!

Thanks so much Bee. I am going to call next week and ask about the units and ranges. I guess I just assumed they should all be the same. I also asked the nurse when she gave me my results about my TSH because I had heard from a nurse friend that research shows it should be between 1 and 2. The nurse said that is not necessarily true because they all have different ranges. She said I was in the middle of the range so that's normal. I plan on meeting with my OBGYN next month when I finish up this last cycle of Clomid. I want to be educated and prepared when I go in there. I plan to take questions with me to ask so your responses will be VERY helpful. I also think I probably have PCOS. I have done a lot of research on that and the symptoms and I have several of those. Do I have to be recommended to an RE by an OBGYN or can I just take myself to an RE?

Good luck with your treatments! I know how stressful and trying it can be. Baby thoughts coming your way, Bee!!

 
Old 06-29-2012, 09:13 PM   #6
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Re: HELP!!! Here are my lab results... can anyone help decipher them?!?!

I had to laugh when I read what your nurse said about TSH being right in the middle of the range because my nurse said the same thing. It's not very scientific. 50% of the range is not the same as being 50% of the population. If anything, your level is more like 95% of the population. I can't remember the exact figures but something like 95% of people have a TSH under 2.5. I will have to try to find out the exact percentiles.
You would probably have to be recommended to an RE by your OB. Honestly, I wouldn't stay with your OB past this cycle (assuming you don't get pregnant). Best of luck, hopefully 150 mg will be the right amount. Keep posting back, I'm curious to see how you progress.

 
Old 06-30-2012, 07:15 AM   #7
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Re: HELP!!! Here are my lab results... can anyone help decipher them?!?!

That was my thoughts about the TSH too. Just because I am in the "normal" range doesn't mean its necessarily where it needs to be to conceive. I plan to find a credible source to print the TSH information from to take into my next appointment. I am then going to ask about her referring me to an RE. If she won't, I will probably switch to another OB because I just don't feel like I am getting the help I need from my current OB. My husband and I are both 25 and want to have at least 3 children so I want to get these things ironed out sooner, rather than later. I will keep you posted! Thanks for all of your kind words and insight. It's appreciated more than you probably know!

 
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Old 07-01-2012, 08:00 AM   #8
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Re: HELP!!! Here are my lab results... can anyone help decipher them?!?!

Thankfully, you are both young and you have some time to figure this out, without having to worry about your age. I know it's annoying to hear because you want a child NOW but it's a great advantage that you found out while you're young, rather than 35-40. You might want to search for thyroid "top docs" in your area, as that has been very helpful in my finding a doctor to recognise my thyroid issue.
I suspect that your OB has guessed you have PCOS, based on the tests that she ran. I'm not sure whether she recognises that your RESULTS likely indicate PCOS and hypothyroidism, that might take an RE.

 
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