I wanted to address one of the most common questions I get about infertility: dealing with hormones. Specifically which hormones should clients be concerned about? Which should they be tracking? Which hormones have the most impact on infertility?
About Infertility
Before we dive into that, let's define infertility. Infertility is defined as anyone who has been unable to become pregnant after trying for 12 months with unprotected intercourse. That changes as a client ages. By the time you reach 35 we shorten that to 6 months. At 40 or older we shorten it to 3 months. The reason for that is as we get older, the chances decrease of being able to get pregnant each month. We don't want women when they reach 35 - 40 years old spending a lot of their energy and time trying to do this on their own and dealing with these issues on their own so we encourage them to start seeking help a little bit quicker just because of the nature of the time that we're dealing with.
When it comes to infertility, the research shows that about 1/3 of the issues of infertility are male, 1/3 are female, and then the other 1/3 is BOTH male and female together. So it's not just a female issue. I want to be sure to say that first, but since the female hormone world is a little more complex compared to males hormones, I want to address the female issues today.
Anatomical
Infertility can be anatomical (the organs themselves: ovaries, uterus, fallopian tubes). This can include the organ's position, kinks or twisting in the tubes, the placement of the uterus itself, sometimes the organs get stuck and there isn't a lot of mobility in the abdominal cavity. If there isn't a lot of mobility in the organs then that's going to lead to another issue related to poor blood flow and poor nutrients.
Physiological
The other thing to think about is physiological: ovulation, structural changes (such as surgical procedures that can change the physiology of the organs), and hormonal issues.
The Key Players
The hormones I consider of utmost importance when working with a mom who is struggling with infertility are:
AMH
FSH
LH
Estrogen or Estriol
Testosterone
Progesterone
DHEA
Thyroid hormones
Cortisol levels
Vitamin D
AMH
AMH helps determine the number of follicles left in the ovaries. We know that girls are born with all of their eggs so when you reach reproductive age there are certain amount of follicles left in the ovaries and that's what we call the reserve. The AMH can be tested at any time during the cycle.
FSH
FSH stands for follicle stimulating hormone. FSH tells us what's going on with the egg reserve or what's going on inside your ovaries. Too much FSH might indicate that the eggs are not maturing or getting stuck in this immature state. FSH tells the ovaries that the follicles needs to start growing or maturing. If the eggs start to grow or mature, then what we're going to see FSH levels start to drop.
It's best to test this between days 2- 4 of your cycle (optimal day being day 3). The reason we do this is because Estrogen and FSH work on a feedback loop. If we get it on that day 3 timeline, Estrogen will be low and that gives us a baseline picture of where FSH is at without the influence of Estrogen trying to pump it up.
LH
LH stands for leutinzing hormone. This also works on the feedback loop with Estrogen. During the cycle, LH stimulates Estrogen production and they work on this feedback loop. Mid-cycle you get this LH surge that stimulates ovulation. Then, after you ovulate, LH helps that corpus luteum (luteal phase) to keep producing the Estrogen.
Estrogen
Estrogen is typically tested after ovulation (around day 19). This is secreted by the follicles in the ovaries during the follicular phase. Then, after ovulation, it is secreted by the corpus luteum in the luteal phase. Estrogen is important because it creates the cervical mucus that allows the sperm safe passage into the cervix and help fertilize the egg. It also prepares the endometrium once the egg is fertilize by providing a safe place to implant.
Testosterone
If testosterone is too high it's going to interfere with that endometrial development. If too low, we are not going to have sufficient Estrogen.
Progesterone
Progesterone is a very important hormone. I refer to it as the "calming hormone". If Estrogen is responsible for getting us pregnant, then you may look at Progesterone as being responsible for keeping us pregnant. It is produced by the corpus luteum after ovulation, and it helps to form that ever important blood network. Once the egg is fertilized and implanted, then you need blood vessels to grow and that placenta to form, and Progesterone is very important for that.
It will also help to lower that immune system response. We know that sometimes when miscarriages happen it's because your body sees your implantation of the egg as an invader. We need that progesterone to lower that immune response so your body can accept this new life that's forming.
Progesterone helps improve nitric oxide so you have that nice, rich blood flow into the uterus. It helps calm and decrease that contractility of the uterus so that it remains calm throughout this process. Typically Progesterone is tested after ovulation when it peaks.
DHEA
DHEA helps to improve the quality of the ovarian reserve. We want good quality eggs released by the ovaries and in turn will produce healthy babies
Thyroid Hormones
We want to look at thyroid hormones such as TSH, TPO, T3, T4. We want to know all of these numbers. T3 has been found in the cervical mucus.
Vitamin D
There's a lot of research that still needs to be done on how this impacts fertility but I know there are some eye opening research studies on PCOS clients specifically. There were some of those clients where the only intervention was Vitamin D and there was a large percentage of those clients became pregnant. We know that's an important part of our body.
We also know that typically people are deficient in Vitamin D. We don't get outside like our ancestors did (not out in the sunshine getting the Vitamin D like we should). A lot of us are not grounded or in contact with Mother Nature like our ancestors were either so there are some deficiencies there and that ties back to the immune system.
Obviously balancing and supporting your fertility hormones is way more complicated than just these hormones I'm mentioning here. It's very individualized. It varies from client to client. There's client history to consider and so many things that need to be considered with where to start and support your body. However, in my practice, these are the tests that I initially start. Then from there we create the best plan of action based on each client's history and where they are in the present moment. Hormone testing is the perfect way to start. It's not everything, but it's a great start.
I hope this information helps and sparks your interest on where you may be with your fertility journey or someone you love. If you have any questions please feel free to reach out and contact us at 502-939-8564 or request a consultation here. Let us help change your fertility journey.