Table 2: Utility of various hormonal tests for primary infertility in the patient with ovulatory dysfunction.

UTILITY	TEST	INDICATION
HIGH Utility	b-hCG	To rule out pregnancy
	Early follicular FSH and Estradiol	To rule out primary ovarian insufficiency
	PRL and TSH	To rule out hyperprolactinemia and thyroid dysfunction
	17-OH Progesterone drawn in the morning during the follicular phase	To rule out non-classic congenital adrenal hyperplasia in high risk populations (Ashkenazi Jewish, Mediterranean, Middle eastern and Indian)
	Mid-luteal Progesterone	To confirm ovulation if the menstrual history is unclear. Can be deferred if the patient has grossly abnormal cycle lengths
LOW Utility	Free/Bioavailable Testosterone, DHEA-S	To identify biochemical hyperandrogenism. However, androgen testing is neither sensitive nor specific for the diagnosis of disorders of androgen excess such as PCOS and NCAH
	Early follicular serum LH with FSH	To calculate the LH/FSH ratio as a marker of PCOS. This test is especially unreliable in obese patients with suspected PCOS.
	Growth Hormone, 24 hour urinary or serum Cortisol	Only recommended when other clinical features are suggestive of pathology
	Anti-mullerian Hormone	Not yet a validated test for the diagnosis of PCOS