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All You Need To Know From Puberty To Menopause

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From Puberty To Menopause, Comforting Care For Every Cause

Puberty, Reproductive and Infertility Stage


FSH (Follicle Stimulating Hormone)

• Stimulates follicular growth & seminiferous tubules

LH (Luteinizing Hormone)
• Stimulates ovulation, production of estrogen & progesterone
• Controls the production of testosterone by leydig cells
• Diagnosis of gonadal, pituitary & hypothalamic disorders


Bone Mineral Density (BMD)

• Bone Mineral Density (BMD) estimates the true mass of bone
• Helps predict the risk of osteoporosis & future fracture so that a treatment program can be optimized
• BMD test results are estimated on the basis of:
• The patient’s bone mineral density as compared to the peak bone mass in normal young adult
• A score of 0 means BMD = norm of a healthy young adult
•The diagnosis of osteoporosis or low bone mass is based on T-score

• The patient’s bone mineral density as compared to the peak bone mass in age-sex matched adult
• Z-Score is useful for determining whether an underlying disease or condition is causing bone loss


FT (FT3, FT4 & TSH)

• Free T3, Free T4 & TSH (Thyroid hormones) have profound effects on reproduction and pregnancy
• Thyroid dysfunction is implicated in a broad spectrum of disorders, ranging from:
• Abnormal sexual development
• Menstrual irregularities
• Infertility
• Assessing true metabolic status
• Diagnosing Hyper & Hypothyroidism
• Autoimmune Thyroiditis (ATAB)


Histopathology (Expertise for detailed diagnosis)

Core specialities include:
• Gross examination procedure by dedicated histopathologist
• Application of stringent diagnostic criteria/protocols for reporting (CAP)
• Application of special stains and IHC markers whenever necessary
• Interaction with concerned doctors before reporting critical reports
• Use of Cytospin 4 for Fluid cytology


Anti Mullerian Hormone (AMH)

Auto Magic Hormone( AMH)
• Evaluating the fertility potential
• Better response to ovarian stimulation for IVF
• Assessing Polycystic Ovarian Syndrome
• Measuring ovarian ageing
• Predicting onset of menopause
• Early and Delayed Puberty
• Guide for Contraception
• Endometriosis diagnosis and prognosis
• Testicular (Gonadal) Function

5.5% cancers missed by PAP+HPV Together
Cervical cancer screening with greater assurance


HPV DNA Detection & Genotype

Rapid and sensitive test for detection of HPV DNA
• Detect 40 HPV types involved in causing precancerous lesions and cervical cancer
• Detects all 14 High Risk (HR) types and other Low Risk (LR) types
• HR types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 or 68
• HPV 16/18 is the most carcinogenic HPV genotype and accounts for 75 – 85% of all cervical cancers
• Approximately 10 other HR HPV genotypes cause the remaining 15 – 25% of cervical cancers



• Progesterone levels vary throughout the menstrual cycle
• Decreases in follicular phase
• Increases in luteal phase
• Progesterone is vital in continuation of pregnancy
• Serial measurements of Progesterone are used to determine whether ovulation has occurred, or to monitor the success of induced ovulation
• Increases in:
Ovarian tumors | Adrenal Tumors | Molar pregnancy
• Decrease in:
Amenorrhea | Fetal death | Gonadal agenesis


BRCA 1&2

• Once in a lifetime test for detection of hereditary Breast and Ovarian cancer risk
• BRCA1 mutations confer more than 80% lifetime risk for breast cancer
• In-depth analysis by NGS and confirmation by Sanger sequencing (Gold Standard Technique)
• If patient is positive for mutations, relatives and children can be screened for high risk
• We provide pre-test and post-test counselling


DHT (Dihydrotestosterone)

• Endogenous potent male sex hormone
• More potent than Testosterone
• During embryogenesis, DHT has an essential role in the formation of male external genitalia
• In the adult, DHT acts as the primary androgen in prostate and hair Follicles
Helps identify:
• In males:
• Infertility • Decreased libido • Erectile dysfunction • Hypogonadism


Urine Culture

• Urine culture is the commonest sample received in microbiology laboratory
• Urinary isolate is identified and susceptibility is done using Vitek 2 Compact
• The susceptibility to various groups of antibiotics is deduced using MIC values
• The interpretation is based on the latest CLSI guidelines
• We use special boric acid containers which is a urinary preservative and it maintains the colony count of bacteria and avoids over growth


Pre and Post Menopause Stage


25-Hydroxy Vitamin D

80% of the Indian population have Vitamin D levels less than normal*
• Vit D2 is obtained from dietary sources
• Vit D3 is obtained from Early Morning Sunlight
• Both get metabolized in the liver to form 25-OH Vit D
• Helps in timely detection & management of Osteoporosis
• Helps in maintaining good bone mineral density which is important to prevent future fracture



• Evaluation of menstrual irregularities
• Predicting ovulation
• Evaluating infertility
• Evaluating patients with suspected hypogonadism
• Evaluating PCOS
• Evaluating Galactorrhea


HE4 + CA 125 (ROMA Index)

• HE4 is used as an aid in monitoring recurrence or progressive disease in patients with invasive epithelia ovarian cancer.
• CA125 is used to detect ovarian cancer and monitor therapeutic response
• CA125 + HE4 combination (ROMA)
• Increases sensitivity(75%) and specificity(94.9%) for ovarian cancer detection
• Accurately stratified 89% of all epithelial ovarian tumor and low malignant potential tumors as high risk and 75% of all benign disease as low risk



• Determine the timing of ovulation
• In males, Estradiol helps detect hormonal excess and its cause
• Is involved in development & maintenance of female phenotype
Helps identify:
• In females: Precocious puberty | Amenorrhea | Infertilty | Detection of ovarian failure | Monitoring of follicle development in ovary by serial measurements
• In males: Delayed Puberty | Infertility | Gynaecomastia | Signs of feminisation in pubertal boys



18.6% cancers missed by HPV-Alone

12.2% cancers missed by PAP-Alone

Performed on fully automated machine

• Screening Test to detect cervical cancer and precancerous conditions
• Cell enrichment process separates & removes blood, mucus & other cells reducing the risk of missed diagnosis
• Faster turnaround time
• Unsatisfactory rates have decreased from 0.98% in conventional smears to 0.24% in Sure Path Laboratories. (Multicentre large studies by various Laboratories)
• Same sample can be used for HPV test


Polycystic Ovarian Syndrome (PCOS)

• Apart from the known co relation of PCOS and increased risk of type 2 Diabetes, there is increasing evidence of link between PCOS and Thyroid disorders as well.
• Despite the high prevalence of PCOS, the diagnosis and differential diagnosis remains confusing.
• This is partly due to the lack of a specific single diagnostic test for the disorder
• Tests to detect PCOS:
FBS, PPBS | DHT | HOMA Index | Lipid Profile | Free testosterone | FT3, FT4, TSH | FSH, LH, | Prolactin | SHBG | 17-OHP | Cortisol | Androstenedione | AMH | DHEAS | USG Pelvis



• Diagnose several conditions in males and females
• In females the test is prescribed
• Infertility
• Amenorrhea
• Oligomenorrhea
• Hirsutism
• In males the test is prescribed
• In case of infertility
• Decreased sexual drive
• Lack of secondary sexual characters in males
• Only 2-3% of circulating testosterone is free



• About 1.3 lakh fresh cases of breast cancer are diagnosed in India every year
• The most efficient screening method to detect early breast cancer
• A mammogram is an X Ray that produces an image of the inner breast tissue on film
Complimented by sono-mammography
• The technique is used to visualize normal and abnormal structures like cysts, calcifications, and tumors within the breasts
• Mammography can be used to discover a small cancer in a curable stage


Pregnancy Stage


Prenatal BoBs

• Confirmatory diagnosis for screen positive Trisomy by when 1st or 2nd Trimester screening has indicated a high risk of anomaly
• Detects changes of chromosome 13,18, 21 X & Y and also enables detection of 9 microdeletion syndromes
• There are no unknown clinical significant results as there is a clear genotype-phenotype correlation for the micro deletion syndromes detected by Prenatal BoBs
• High sensitivity and specificity (upto 99% detection rate with false positive < 1% & false negative rate of< 2%)
• Better TAT and additional information regarding the micro deletionAneuploidies
Trisomy 13: Patau Syndrome 13
Trisomy 18: Edwards Syndrome 18
Trisomy 21: Down Syndrome 21
Sex Chromosome Abnormalities X & Y

Microdeletion Syndrome
DiGeorge Syndrome 22q11.2
DiGeorge 2 Syndrome :10p14
Williams-Beuren Syndrome :7q11.2
Prader-Willi Syndrome :15q11-q12
Angelman Syndrome :15q11-q12
Smith-Magenis Syndrome :17p11.2
Wolf-Hirschhorn Syndrome: 4p16.3
Cri du Chat Syndrome :5p15.3-p15.2
Langer-Giedion Syndrome: 8q23-q24
Miller-Dieker Syndrome :17p13.3


Sex Hormone Binding Globulin (SHBG)

• Increased SHBG levels are seen in hormone replacement therapy (steroids & estrogen), pregnancy, hyperthyroidism
• Decreased SHBG levels are seen in obesity, PCOS, hypothyroidism
Helps identify:
• In males:
• Infertility • Decreased libido • Erectile dysfunction • Hypogonadism
• In females:
• Menstrual irregularities • Hirsutism • Infertility • PCOS


Integrated Test

• Dual Test + Quadruple Marker Test
• All maternal markers analyzed – âhCG, PAPP-A, AFP, Inhibin-A, uE3 on the AutoDELFIA® platform from PerkinElmer, are CE-marked
• Detection rate upto 95%
• Graphical interpretation of reports with PerkinElmer’s clinically validated LifeCycle™ screening management software


Antinuclear Antibodies (ANA)

• The Gold Standard technique to detect presence of antibodies
• Combination of HEp -2010 cells and primate liver cells provides
• Pattern differentiation which corresponds to particular disease type (centromere, nuclear dots)
• Provides additional information for ANA – ve cytoplasmic antibodies (liver disease-endomysium, ANCA)
• Patterns offer clue to which particular autoantibody may be present corresponding to particular disease type: Homogenous | SLE Speckled | Sjogrens Syndrome Centromere | Scleroderma Nucleolar | Scleroderma
• Confirmed by ANA Blot tests or monospecific ELISA


Dual Marker Test

• Risk interpretation based on MoMs of Indian population developed by screening more than 4 lakh pregnancies over the years years
• All maternal markers analyzed – âhCG, PAPP-A on the AutoDELFIA®
platform from PerkinElmer, are CE-marked
• Gestational age for performing the test
• Detection rate upto 91%
• Graphical interpretation of reports with PerkinElmer’s clinically validated LifeCycle™ screening management software
• Uses FMF (UK) approved PerkinElmer Dried Blood Spot (DBS) technology for first trimester aneuploidy screening


Anti Phospholipid Antibodies (APLA)

• Antiphospholipid antibodies is used to determine the cause of inappropriate blood clot formation (unexplained thrombotic episode, excessive clotting) and recurrent miscarriage
• APLA are found in Antiphospholipid syndrome & SLE
• In positive cases tests needs to be repeated 8 to 10 weeks later to determine whether their presence is persistent or temporary


Hb Electrophoresis

• Performed on automated HPLC technology for accurate reports
• Helps detection & quantification of Hemoglobin fractions
• Comprehensive test to screen common Hb variants Hb S, C, E and D in addition to beta Thalassemia
• Estimates Hb A2 and F levels, an important tool in the carrier testing• Anemia
• Causes of Anemia :
• Physiological Anemia
• Nutritional Anemia
• Hemolysis and Hemolytic Anemia
• Hemoglobinopathies



• Performed using Real Time PCR technology
• Tests can be performed on
• Pulmonary AFB smear negative
• Paucibacillary extra pulmonary TB (10-15% of all TB cases)
• Targets IS6110 gene more prevalent in Indian population hence specificity is higher even in case of 1 bacillus



• Prenatal Screening
• Diagnosis of pregnancy
• Detection of ectopic pregnancy
• Gestational Trophoblastic Disease
• Germ Cell Tumors
ßhcg becomes detectable 3 days post implant• Detection of ectopic pregnancy
• Slow increase in HCG (<66% in 48 hours during first 40 days of pregnancy) indicates Ectopic pregnancy in 75% of cases.


KaryoLite BoBs (POC)

• Performed by BACs-on-Beads based molecular karyotyping, covering both p and q arms of all
chromosomes 1 – 22 X and Y• KaryoLite BoBs offers multiple benefits
• Rapid aneuploidy detection
• No requirement of cell culture
• Chances of Failure is less than conventional Karyotyping
• Faster TAT than Karyotyping

• Concordant results with
• Microarrays and conventional Karyotyping for aneuploidies
• More information than FISH
• Small amount of DNA sample required (50 ng to 240 ng)

References :
PKI Brochure: BoBs_Karyolite 1244-9957-01, November 2011 PKI Technical Note: BACs-on Beads-Molecular Karyotyping 1244-9915-01, June 2009 Rapid aneusomy detection in POC using KaryoLite(TM) BACs-on Beads assay


Pregnancy and infertility stage


Bad Obstetric History (BOH)

• Abortion affects 1-3% of fertile couples
• Bad Obstetric History (BOH) implies two or more consecutive abortions,
early neonatal deaths, stillbirths, intrauterine fetal death
Causes of Abortion :
• Genetic – Karyotyping for couple (Chromosome analysis evaluates the number and structure of chromosomes in order to detect abnormalities)
• Infections – TORCH
• Endocrine – Thyroid stimulating TORCH Hormone (TSH)
• Immunological – Anti-Phospholipid | Antibodies IgG & IgM | Anti-Cardiolipin | Antibodies IgG & IgM | Lupus Anti-coagulant (LA)


Triple Marker Test

Detection rate~65%
• Risk assessment test in 2nd Trimester to detect Trisomy 18, Trisomy 21 & Neural tube defect
• All maternal markers analyzed – âhCG, AFP, uE3 on the AutoDELFIA® platform from PerkinElmer, are CE-marked
• Risk interpretation based on MoMs of Indian population developed by screening more than 4 lakhs pregnancies over the years
• Graphical interpretation of reports with PerkinElmer’s clinically validated LifeCycle™ screening management software


Anti Cardiolipin Antibodies (ACLA)

• Plays an important role in the blood clotting process
• When antibodies are formed against cardiolipins, they increase the risk of developing recurrent blood clots in arteries and veins
• ACLA are found in Antiphospholipid syndrome & SLE
• Antiphospholipid syndrome is an autoimmune syndrome which presents with venous or arterial thrombosis, thrombocytopenia, recurrent abortions & eclampsia
• Used for identification of recurrent abortions


Quadruple Marker

• Inhibin A with Triple Marker increases detection rate upto 75%
• All maternal markers analyzed – âhCG, AFP, Inhibin-A, uE3 on the AutoDELFIA® platform from PerkinElmer, are CE-marked
• Risk interpretation based on MoMs of Indian population developed by screening more than 4 lakhs pregnancies over the years
• Graphical interpretation of reports with PerkinElmer’s clinically validated LifeCycle™ screening management software


Lupus Anticoagulant (LA)

• Test based on guideline by International Society of Thrombosis And Hemostasis (ISTH)
• Helps determine the cause of an unexplained – Thrombosis | Recurrent Miscarriages | Prolonged PTT
• Test based on two different principles: dRVVT | Sensitive aPTT
• LA considered positive if at least one of the two tests gives positive Results
• In positive cases, test needs to be repeated 12 weeks later to determine whether lupus anticoagulant is transient or persistent



N T Scan (11-13.6 weeks)
• Assesses risk of having Down’s Syndrome and other chromosomal abnormalities
• The minimum fetal crown–rump length (CRL) should be 45 mm and the maximum 84 mm
• At Suburban Diagnostics Radiologist are Fetal Medicine Foundation (FMF) UK certified

Anomaly Scan (18-23 weeks)
•Screen structural and developmental abnormalities
   • Neural Tube Defect (NTD)
   • Fetal aneuploidy



• Infections by TORCH in women are usually asymptomatic and chronic which leads to – Neonatal Death | Intrauterine Growth Retardation | Recurrent Abortion | Intrauterine Death | Preterm Labor | Congenital Malformation
• Based on the findings of the study (TORCH profile in patients with bad obstetric history in 2012) it was concluded
• Previous history of pregnancy loss and TORCH infections during current pregnancy must be considered while managing BOH cases to reduce the adverse fetal outcome
• Tests in TORCH panel: Toxoplasma | Rubella | CMV | HSV


Antenatal Panels

• An essential assessment for every pregnant woman to ensure healthy pregnancy
• Assist you in predicting the chances of Diabetic baby & ABO-Rh incompatibility
•Antenatal Panels available:
• Antenatal Panel 1: CBC, FBS, Blood Group, HIV, HBsAg, VDRL, Urine Routine
• Antenatal Panel 2: Ante Natal Panel 1 + TSH
• Antenatal Panel 3: Ante Natal Panel 2 + BUN + Hb Electrophoresis



• State-of-the-Art machines from
• GE Voluson P8 • Philips HD 15 & HD 11 • Toshiba Nemio-XG
• Clinical findings are discussed with prescribing doctor through telecon
• Sonography is available across all Suburban radiology centres between 9am to 1pm (Mon-Sat) & at select centres in the eveningsPelvic Sonography
• Evaluation of pelvic organs such as Uterus and Ovaries
• Evaluate Adnexa

Pelvic Doppler
• Determine vascularity in conditions such as Ovarian torsion

Follicular study
• Monitor follicular growth and Ovulation



Obstetric Sonography
• Estimation of: Gestational age | Fetal growth | Fetal well being

• Obstetric Doppler
• Study of fetal hemodynamics
• Assess utero-placental and feto-placental sufficiency



Aston, 2 nd Floor, Sundervan Complex, Opp. Union Bank, Above Mercedes Showroom, Andheri West, Mumbai – 400053

Book your appointment to test your puberty or menopause.

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