Hormonal status of patients with infertility and post-traumatic stress disorder

Abstract

Post-traumatic stress disorder (PTSD) is a mental disorder that occurs after a psychologically or physically traumatic event, and characterized by three main clusters of posttraumatic symptoms, as well as chronic and significant disturbances in emotion regulation, identity, and relationships. PTSD is more common in women, which suggests a role for the regulation of female sex hormones in its development.The objective: to study the hormonal status of women with infertility and PTSD.Materials and methods. 112 women with infertility were examined, who were divided into groups depending on the PTSD criteria. The I group included 36 women with PTSD criteria, who were diagnosed with infertility before the onset of the traumatic factor, the II group – 31 patients with fertility disorders which were diagnosed on the background of PTSD, the III group – 45 women with infertility and without signs of PTSD, the control group consisted of 50 healthy women who applied for a routine preventive examination.In all patients, on the 3rd–5th day of the menstrual cycle, the concentrations of prolactin, estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone were determined in the blood serum, in the saliva – cortisol, on the 21st day of the cycle – in the blood serum progesterone.Results. It was established that in women with infertility that was developed after the traumatic factor, the prolactin content is significantly higher (59.5±18.9 ng/ml) than in other groups of patients with fertility disorders (36.9±12.3 ng/ml in I group, 34.3±17.9 ng/ml – in the III group) and in the group of healthy women (13.5±5.6 ng/ml). The concentration of estradiol in the I group was within the reference values for the follicular phase of the cycle, but significantly lower (23.4±3.6 pg/ml) than in women of the other groups (from 87.6±14.6 pg/ml in the III group to 103.5±27.8 pg/ml in the group of healthy women). The average concentration of progesterone in the I (3.4±2.7 pg/ml) and II (4.1±2.9 pg/ml) groups was within the reference values, but was probably lower than that of healthy women (23.6±4.9 pg/ml), as well as women with infertility without signs of PTSD (19.4±5.1 pg/ml).In this study the patients with infertility which has developed on the background of PTSD had LH values within the reference normal range (2.0±0.5 U/L), but several times lower than in women with other reasons of infertility (12.0±3.6 U/l – in women with infertility before the development of PTSD, 6.0±1.9 U/l – in women with infertility without PTSD criteria) and in healthy women (9.2±3.4 U/l).An increased level of testosterone beyond the reference values was found only in women of the II group (3.3±1.9 nmol/l), in the other groups the average testosterone concentration ranged from 1.3±0.6 nmol/l in healthy women to 1.5±0.9 nmol/l in the I group and 1.8±0.7 nmol/l in women with infertility without signs of PTSD. Patients with PTSD are characterized by an increased level of cortisol in saliva, which indicates a prolonged reaction of the body to the trauma (8.8±0.3 ng/ml – in the I group, 10.3±0.4 ng/ml – in the II group), in groups without PTSD the level of this hormone in saliva was almost twice as low (5.4±0.2 ng/ml – in the III group and 5.9±0.3 ng/ml – in healthy women).Conclusions. 1. The patients with PTSD and infertility are characterized by high concentrations of cortisol in saliva and a decreased progesterone level in blood serum.2. In patients who had fertility disorders before a stressful event, a decreased estrogen concentration and an increased luteinizing hormone level were found in blood serum, which indicates endocrine disorders as a cause of infertility.3. Prolactin and testosterone levels were found to be higher in the patients with infertility that was developed after a traumatic event than in other women with reproductive function disorders. Both factors are pathogenetically related to the pathological reaction to stress.