Hormone Imbalances and Infertility

Expect a series of blood tests if you're having trouble conceiving. Once you've identified if you have a hormone imbalance, treatment options can be discussed.
Expect a series of blood tests if you're having trouble conceiving. Once you've identified if you have a hormone imbalance, treatment options can be discussed.
©iStockphoto.com/Thinkstock

You really only need three things to become pregnant the old-fashioned way. You need an egg. A woman needs to ovulate and have regular menstrual periods to become pregnant. You need sperm. A man needs to produce healthy sperm. And you need to have sex.

While baby-making seems pretty easy, the reality of getting pregnant can be a bit tricky. You need to have sex regularly, and that sex needs to be well timed (increase the romance a few days before ovulation for the best chances). Sometimes it's more than bad timing, though. More than 6 million American women are considered infertile, which means they have had unprotected sex regularly for six months to a year (depending on age) and haven't become pregnant or haven't been able to carry a pregnancy to term [source: Centers for Disease Control and Prevention].

See, in addition to well-timed sex, your body also needs to have all its processes well timed. And for many women, that timing is off. One of the most common reasons why this well-coordinated arrangement may get thrown off-balance? Hormones.

Hormones run the ovulation process, which works like this:

At the beginning of a woman's menstrual cycle, the brain signals the pituitary gland that it's time to prep some eggs. The pituitary gland produces a hormone called the follicle-stimulating hormone (FSH), which in turn signals the ovaries to begin maturing eggs for this cycle. As these follicles mature, the level of estrogen in the body rises, signaling the pituitary gland that an egg is ready. This first half of the menstrual cycle is called the follicular phase.

When high estrogen levels signal an egg is ready, the pituitary gland then produces a luteinizing hormone (LH), triggering the ovary to release the mature egg -- ovulation usually occurs about 24 to 48 hours after this LH surge [source: American Pregnancy Association]. The day ovulation happens is the first day of the second half of the cycle, the luteal phase.

During the luteal phase of the menstrual cycle the ovaries (specifically the corpus luteum, which is the follicle that produced the mature egg) begin to increase the levels of progesterone in the body. Progesterone is a hormone that prepares the lining of the uterus for pregnancy. If the egg is fertilized and implants, the body continues to produce progesterone -- and if not, then progesterone levels fall, and that month's menstrual period begins.

If the timing is off in any part of the process, ovulation may be disrupted, causing fertility problems. Let's look into how these hormones can negatively impact fertility, as well as some ways to tell if your own hormones are out of line.

How Hormone Imbalances Affect Fertility

Ovulation problems are probably more common than you'd guess: As many as 25 percent of women with fertility problems suffer from ovulation problems, although many may not know it until they seek treatment for infertility [source: MayoClinic].

There are a few clues your body may be giving you, if you know what to look for. First, your periods. Are they regular? Irregular or absent periods, as well as periods that are increasingly lighter or heavier than normal, are a red flag that FSH and LH levels may be off. Hormonal imbalances may also cause some women to gain weight, grow hair in unwanted places (including the upper lip, chin, abdomen and chest), lose hair on the scalp and develop acne.

Sometimes, it's simply your daily life that throws hormones out of whack. Stress, weight loss or gain and even a new intense workout are all enough to cause temporary problems with ovulation, but sometimes hormone imbalances occur because your body's systems are malfunctioning.

Polycystic ovarian syndrome (PCOS), for example, is an endocrine disorder that affects as many as 10 percent of women [source: Washington Center for Reproductive Medicine]. PCOS is a disruption in communication between the brain, the pituitary gland and the ovaries, but we don't currently know the cause. PCOS is characterized by irregular or lack of ovulation, irregular or lack of menstrual periods, elevated levels of androgens (hyperandrogensim) including testosterone, androstenedione and dehydroepiandrosterone sulfate (DHEA-S), abnormal levels of LH, FSH and estrogen and small cysts covering enlarged ovaries (polycystic ovaries). It also is associated with obesity and difficulty losing weight, insulin resistance, cardiovascular disease, hair and skin changes, endometrial cancer, sleep apnea and depression. PCOS is also one of the most common causes of infertility among women of reproductive age, and may also increase a woman's miscarriage rate by 45 percent or more [source: INCIID, Inc.].

PCOS is a heavy-hitter, but it's not the only hormonal disorder that might disrupt fertility. A condition known as premature ovarian failure (POF) -- not to be confused with menopause, despite similar symptoms -- is an ovulation disorder affecting, typically, women under the age of 40. Women with POF have ovaries that have stopped working, causing irregular periods (or none at all).

Women with POF may have no follicles remaining in their ovaries, or the follicles they do have are not functioning as they should. Because of this, they tend to always be in the follicular phase of their cycle -- the pituitary gland keeps pumping out FSH to mature an egg, but it falls on deaf ears, or in this case ovaries. Women with this disorder also typically have low estrogen levels because no follicle becomes mature enough to trigger estrogen levels to rise in preparation for ovulation.

Thyroid disease may also cause hormonal imbalances that affect fertility. Thyroid hormones play important roles in many of our body's systems -- hyperthyroidism is the condition where the thyroid gland produces too many hormones and when too few hormones are produced it's called hypothyroidism. Either scenario may disrupt a woman's menstrual cycle. And hypothyroidism may be associated with a condition known as luteal phase dysfunction (LPD), or luteal phase defect. LPD is a problem with the uterine lining (the endometrium), caused when the ovaries don't produce enough progesterone after ovulation or when the uterine lining just doesn't properly thicken in response to progesterone.

Fertility Treatments for Hormonal Imbalances

Often, women experiencing fertility problems are asked to track their temperature each day to determine if and when ovulation takes place.
Often, women experiencing fertility problems are asked to track their temperature each day to determine if and when ovulation takes place.
©iStockphoto.com/Thinstock

For women trying to get pregnant, a hormone imbalance is not necessarily an insurmountable barrier, but one that more likely than not will need to be managed by a reproductive specialist.

To make an accurate diagnosis of the cause behind your infertility, your health care provider will likely do a series of diagnostic tests. When a hormonal imbalance is suspected, expect tests to check your thyroid function, estradiol (estrogen) levels, progesterone levels, prolactin levels, and tests to determine your ovarian reserve, as well as a urine sample to test the level of LH. You may also be asked to track your basal body temperature on a daily basis to pinpoint when (or if) ovulation occurs -- a woman's body temperature rises slightly when she ovulates.

Women who do not wish to become pregnant may find oral contraceptives relieve the symptoms associated with hormone imbalances.

Women with ovulation problems who do wish to become pregnant are most often prescribed fertility-enhancing drugs, including clompiphene citrate (Clomid) or gonadotropins (such as Follistim) to stimulate the pituitary gland and induce ovulation. Women with high levels of prolactin may find bromocriptine (Parlodel) restores their ovulation.

Women with PCOS who may also have insulin resistance may find that insulin-sensitizing medications such as glucophage (metformin) help not only to improve insulin resistance and glucose tolerance, but also helps to lower androgen levels and restore ovulation. In addition to prescription drugs, women may find their hormones are better balanced when they maintain a healthy weight -- women who are overweight or obese may re-establish healthy menstrual cycles by losing as little as 10 pounds (4.3 kilograms) [source: WebMD].

While some women may have luck restoring their fertility with hormone-stimulating drugs, other women may need to try reproductive therapies in addition to hormone treatments. Assisted reproductive techniques (ART) include treatments such as in vitro fertilization (with or without an egg donor) and intracytoplasmic sperm injection (ICSI), all of which have different success rates based on a woman's age and her fertility complications.

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More Great Links

Sources

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