What is hormone?
Hormone is a chemical that is made by specialist cells, usually within an endocrine gland & is released in bloodstream to send message to another part of body.
Hormones are generally referred to as chemical messengers & their main role is internal communication between different cells located in distant part of the body.
Hormones are used for two types of communications:
- Communication between endocrine gland & target organ.
- Communication between two endocrine glands in which one gland releases hormone which stimulate another gland to change the hormonal levels secreted by that gland.
Hormones affect many physiological activities including growth, metabolism, appetite, puberty & most important, infertility, which rest of the article is all about.
How does hormonal imbalance affect fertility?
Almost 1 in 8 couple in reproductive age is experiencing difficulty in conceiving. Hormonal imbalance is the most prevalent reason, attributing to more than 60% of the cases of infertility.
Hormonal imbalance as the name suggest is a condition where the level of one or more hormone in body, goes too high or too low. The imbalance of certain hormones can cause infertility in both male & female.
It affects function of ovaries & implantation in women & testicular function in male giving problems in conception.
Hormones responsible for fertility needs to be balanced for ovulation process & endometrial development in women & sexual drive & healthy sperm production in men.
Lifestyle changes & increasing stress levels are the main culprits causing hormonal imbalance, leading to infertility.
Which hormones impact fertility?
Everyone taking treatment of infertility should know how hormones impact fertility & what steps you should do to correct this imbalance.
Many hormones come into play when we mention hormone related infertility. Hence it is very challenging to identify which one(s) have gone out of balance. Hence clinicians use patient’s history and investigations to zero down on hormones causing problem.
It is critical to correct the level of below hormones before beginning any infertility treatment:
· Thyroid
Mainly plays a role in metabolism & digestion, it also impacts reproduction by affecting functioning of other endocrine glands.
· Prolactin
Mainly this hormone is responsible for breast milk production, it gives cycle irregularities & anovulation which in turn affects ovulation.
· AMH
Produced by ovarian follicles which contains immature eggs. it is a best predictor to know if ovaries have capacity to produce good eggs. Ideal range is 1.0 to 4.0 ng/ml. A level lower than this means quality of eggs is not good enough for fertilization. On the other hand values of AMH higher than 4 indicate PCOD.
· Follicle Stimulating Hormone (FSH)
This hormone is directly linked with fertility. It is one of the key hormones for regulating menstrual cycle & induce production of eggs.
· Luteinizing Hormone (LH)
This hormone signals the body to release mature egg. A lower level of LH leads to Hypogonadotropic hypogonadism (HH) i.e. no egg or immature eggs, where higher levels lead to menopause.
Usually FSH and LH work in tandem, where by if one goes up or down the other follows.
· Progesterone
This hormone is essential in maintenance of pregnancy. It helps in thickening the endometrial layer which in turn helps supporting the implantation & growth of embryo.
· Oestrogen
This female hormone is important in supporting ovulation & implantation. Egg matures and become capable of implantation because of oestrogen only.
What are the signs of Hormonal imbalance?
History & good general examination always gives clues to reach the diagnosis of hormonal imbalance.
Most common signs in women are:
· Menstrual cycle irregularities
· Spotting or irregular bleeding
· Acne & facial hair
· Unexplained weight gain or loss
· Baldness like male
· Extreme mood changes
Hormonal imbalance in men is less likely to contribute to infertility, but here are a few:
· Erectile Dysfunction
· Low sperm count
· Reduced hair growth
· Overdevelopment of breast known as gynaecomastia
· Baldness
How hormonal imbalance affects infertility
Female hormones
· Thyroid dysfunction giving irregular ovulation & irregular menstrual cycles
· Polycystic ovarian syndrome due to high level of male hormone androgen
· Abnormal prolactin levels giving cycle abnormalities, ovulation & implantation problems
· AMH levels which are predictors of very low or high values oocyte count are associated with either poor responders or PCOD.
· Oestrogen levels either very high or low acts as diagnosis of either hyper ovulation or poor response.
· Progesterone levels are important for prediction of implantation.
· Follicular stimulating hormone (FSH) – it is a predictor of ovarian function & functioning of end organs like ovaries & testes.
· Androgen levels imbalance gives PCOS due to conversion in estrogen & side effects like excessively thick endometrium.
· Inhibin B level is also a good predictor of number of eggs production by ovaries.
· Luteinizing hormone is raised in PCOD which is a predictor of severity of PCOD.
Male hormones
· Testosterone is the main hormone in male which affects fertility due to decreased levels.
· Follicular stimulating hormone is a good predictor of testicular function -High values indicates low function
· Thyroid hormones imbalance also affects fertility due to effect on body metabolism & other endocrinal glands
· Prolactin level is a predictor of stress in male -High vales are associated with decreased fertility due to sexual dysfunction
All the above hormones need to be checked during infertility treatment according to signs & symptoms of infertility couple
Treatment plans for hormonal imbalance
Female
· Restore Thyroid function in Thyroid hormone problem.
· Normalise Prolactin levels for imbalanced prolactin level.
· Induce ovulation by hormonal injection for superovulation according to AMH levels.
· Supplements of progesterone hormones in luteal phase deficiency.
· Treatment for High Androgen levels in PCOS.
· Laparoscopic PCOD drilling for reducing androgen.
Male
· Restore testosterone levels
· Correction of Thyroid levels
· Control prolactin levels
· High Follicular stimulating hormone in male can get sperms by TESE/TESA, Micro-TESA technique
Conclusion
Hormonal imbalance is a common problem associated with other causes of infertility, interfering with success & outcome of conception. In 60% of the infertility cases, hormonal imbalance is also present as one of the factors.
That is why, infertility couple need to undergo all required hormonal blood tests before starting the treatment.
Tests usually include
Female:
T3 /T4 TSH /PROLACTIN /FSH /LH /OESTROGEN /PROGESTERONE /AMH
Male:
T3 T4 TSH /PROLACTIN /TESTOSTERONE /FSH
Other Hormonal tests are advised by clinician if required.