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The Link Between Hormones and Infertility - What Your Doctor May Be Missing
For women, monthly ups and downs in a hormone level are normal. Each month their body prepares for ovulation and releases an egg. A woman’s body releases just a few hundred eggs during their lifetime. Every month, there are just a few days when women can conceive a child.
Although these monthly ups and downs in hormone levels are normal, however, it means that these changes are more likely to be affected by any small lifestyle changes, diseases, and more. Hence, all women would experience some issues related to their periods in their lifetime.
Fortunately, for most women, these issues are temporary, and improving lifestyle and treating underlying diseases can help normalize periods and improve fertility.
Infertility in both men and women is almost equally common. Studies suggest that about 12.5% of women have difficulty conceiving a child1.
One of the infertility issues is that it may occur due to many reasons. Thus, doctors find it extremely challenging to identify the cause. Hence, women should also be aware of the factors that can influence their fertility to take measures and share information with treating doctors.
Endocrine organs are interdependent. Dysfunction of one of the glands may affect the working of other glands. For example, the thyroid hormone plays a vital role in maintaining metabolic rate. Low thyroid hormones slow down the body, prevent egg release, and thus impair fertility.
Thyroid problems are pretty common, and an estimated 12% of the population will experience thyroid disease during their lifetime2.
Though not rare, thyroid diseases are not very common in women of reproductive age. That is why doctors may fail to realize that hypothyroidism could be the cause of infertility.
Studies show that about 2-4% of women of childbearing age have hypothyroidism. It means that almost one-third of all women diagnosed with infertility may have low thyroid hormones. Low thyroid hormone levels mean anovulatory cycles and infertility3.
Fortunately, it is among the endocrinal disorders that are readily diagnosed and effectively treated. Thus, some blood tests like TSH (thyroid-stimulating hormone), T3, T4, and TSI (thyroid-stimulating immunoglobulin and other tests like anti-thyroid antibody test may help pinpoint the problem. These tests help identify thyroid problems and even help understand their cause.
Low estrogen/progesterone levels can contribute
These hormones work together to regulate female ovulation and prepare the uterus for pregnancy. Thus, disruption in any of these hormone levels makes pregnancy difficult, if not impossible.
Estrogen plays a vital role in the release of an egg from the ovaries, while progesterone plays a vital role in preparing the inner lining of the uterus for the attachment of fertilized egg.
Not only that, these hormones have many other functions like promoting bone health, influencing cognition and mood, and much more.
Since these hormones play a pivotal role in female reproductive health, checking their levels is one of the first things most doctors would consider4.
Diabetes can influence male and female infertility levels, though in different ways. What is worrisome is that prevalence of diabetes is increasing. More than 10% of women in most countries live with diabetes and a similar number with infertility. There is a significant association between both of these conditions.
Mild diabetes may not produce any signs and symptoms. Thus, it is no surprise that many women with the condition are not even aware that they have diabetes. It is not rare for diabetes to be diagnosed just by chance when being tested for other health conditions.
Diabetes is a frequent cause of light periods and even causes amenorrhea. Menstrual irregularities mean related to diabetes often lead to infertility. If doctors identify diabetes in women living with infertility, they will also order many other diagnostic tests to understand the working of the hypothalamic-pituitary-ovarian axis5.
Doctors may not be able to cure diabetes, but it is a readily manageable condition. Thus, once the doctors have identified diabetes as a cause of infertility, they can treat it effectively.
Diabetes and hypertension are all on the rise, and so is chronic kidney disease (CKD) prevalence. There is a strong association between lower fertility and CKD. It is a common cause of anovulation and irregular cycles6.
Kidney diseases cause infertility and considerably increase the risk of adverse pregnancy outcomes. It means a higher risk of pre-eclampsia, poor fetal growth, preterm delivery, and more7.
Thus, all women living with infertility or planning to get pregnant should know about their renal health. Doctors can check renal function in many ways, like calculating glomerular filtration rate (GFR) with the help of blood tests or checking urine for albumins.
Numerous lifestyle factors may cause female infertility, and identifying them might be a challenge. It is because many lifestyle interventions that are otherwise regarded as healthy, and thus women may not share info about these matters with doctors. For example, sudden dietary changes and starting exercise may influence female fertility in the least expected ways.
Studies show that many issues like excessive exercise, and eating disorders, lead to ovulation problems, pituitary gland dysfunction, and low hormone levels, thus causing infertility.
These days, substance abuse and alcohol abuse are also common factors causing hormonal disruptions and thus infertility in many women.
One of the factors that may suggest that your lifestyle is causing issues is low sex drive or some lifestyle interventions introduced lately.
Even very low-fat levels in the body may disrupt hormone levels, something many women try to achieve these days.
Most chronic disorders like diabetes, hypertension, kidney disease, thyroid problem, and other endocrinal issues and sudden lifestyle changes may affect hormone levels and cause infertility. Thus, women should share greater information about their health with treating doctors. Additionally, in many cases, women may not be aware of these issues, hence a need for much broader health checkups to identify the cause of infertility in women.
- Datta J, Palmer MJ, Tanton C, et al. Prevalence of infertility and help seeking among 15 000 women and men. Human Reproduction. 2016;31(9):2108-2118. doi:10.1093/humrep/dew123
- General Information/Press Room. American Thyroid Association. Accessed April 18, 2022. https://www.thyroid.org/media-main/press-room/
- Verma I, Sood R, Juneja S, Kaur S. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med Res. 2012;2(1):17-19. doi:10.4103/2229-516X.96795
- DeMayo FJ, Zhao B, Takamoto N, Tsai SY. Mechanisms of action of estrogen and progesterone. Ann N Y Acad Sci. 2002;955:48-59; discussion 86-88, 396-406. doi:10.1111/j.1749-6632.2002.tb02765.x
- Livshits A, Seidman DS. Fertility issues in women with diabetes. Womens Health (Lond). 2009;5(6):701-707. doi:10.2217/whe.09.47
- Holley JL, Schmidt RJ. Changes in fertility and hormone replacement therapy in kidney disease. Adv Chronic Kidney Dis. 2013;20(3):240-245. doi:10.1053/j.ackd.2013.01.003
- Wiles KS, Nelson-Piercy C, Bramham K. Reproductive health and pregnancy in women with chronic kidney disease. Nat Rev Nephrol. 2018;14(3):165-184. doi:10.1038/nrneph.2017.187