Hormonal Therapy & Expectations

For both partners, infertility is a complex and situational crisis that is generically psychologically threatening, emotionally stressful, financially challenging, and physically painful most of the time due to diagnostic-curative operations undergone. 

Infertility triggers a range of physical, psychological, social, emotional, and financial effects. Although it is not a life-threatening problem, infertility is yet experienced as a stressful life event for couples or individuals due to the exalted value attributed to having a child by individuals themselves or society in general. Infertile couples are not facing a medical condition alone but coping with a number of emotional states as well. Emotions, thoughts, and beliefs of infertile couples frequently change as one consequence of infertility diagnosis. Exposed to a tremendous social pressure, infertile couples may resort to hiding the problem due to the extreme privacy of the matter. Infertility also affects marriage life adversely.

Hormones therapy such as the recombinant follicle stimulating hormone (rFSH) has been in use in the management of infertility for the past decade. 

What is infertility?

Infertility is a difficulty in conceiving a pregnancy. This general term does not identify the cause of the problem or whether it will be permanent.

Often, physicians and researchers consider a couple to have infertility if they have not conceived, despite regular intercourse without using birth control, for at least a year. 15 to 20 percent of couples will not conceive despite a year of trying. However, this does not mean that they will not conceive later on, even without treatment. Some investigators consider two years without conception to be a better indicator of a couple’s need for assistance.

More than 90 percent of couples will have achieved a pregnancy within two years.

When an individual has no chance to conceive without treatment (for example, a woman does not ovulate or has two blocked fallopian tubes), it is sometimes called sterility.

Is infertility a male or female problem?

In the past, infertility was commonly considered to be solely a female problem. It is now recognized that a couple’s infertility is just as likely to stem from problems in the male partner. After couples with infertility undergo testing, about 40 percent of the cases are found to stem from female factors and another 40 percent from male factors.

In 10 percent of couples, infertility factors are found in both the man and woman. In the remaining 10 percent, the infertility remains unexplained after testing.

Because either or both may be involved, it is important to test both the man and woman before starting treatment. No matter what the cause, most treatments require the active participation of both partners.

Understanding the role of hormones in fertility

Hormones plays an integral role in regulating numerous essential biological processes; Such as temperature regulation, digestion and growth.

For women, the reproductive cycle is regulated by:

  • Estrogen : this hormone plays a vital role in the menstrual cycle and ovulation.
  • Progesterone : This hormone is also crucial in helping the body regulate the menstrual cycle, and it is essential for a healthy conception and pregnancy.
  • Luteinizing hormone (LH) : This hormone is responsible for triggering ovulation.
  • Follicle Stimulating Hormone (FSH) : This hormone regulates several reproductive processes in conjunction with LH.
  • Cortisol : This hormone aids metabolism and suppresses the immune system in response to stress.
  • Testosterone : This hormones supports a health sex drive.

When is hormone treatment useful?

Hormone treatment is particularly suitable for women with impaired egg maturation and/or impaired or no ovulation at all. In most cases, the cause is a disturbance of the balance between the male hormone (androgen) and female hormone (oestrogen) (hyperandrogenism). In affected women, the egg follicles mature only to a small size (about 6-8 mm) and ovulation does not occur. 

In some women, increased numbers of egg follicles are found on the ovaries in an ultrasound scan, meaning the monthly maturation of a single follicle may be delayed or prevented. This disorder is referred to as polycystic ovary syndrome (PCOS). In these cases too, hormone therapy can be used to achieve maturation and subsequent ovulation.

In much rarer cases, there is a reduced concentration of follicle stimulating hormone (FSH) and/or luteinising hormone (LH). FSH promotes the growth of egg follicles in which the eggs mature. There is one egg in each follicle. LH is primarily responsible for ovulation, i.e. releasing the egg from the follicle into the ovarian tube. 

There are also other hormonal causes of impaired follicle maturation. For example, an increased concentration of the hormone prolactin can also inhibit fertility. Prolactin promotes the growth of the mammary glands during pregnancy and suppresses ovulation. An increased prolactin concentration before pregnancy can be treated with prolactin-inhibiting medications.

It is also important not to overlook the thyroid hormones. Normal thyroid levels play an important role in the chances of pregnancy. Hypothyroidism can be treated by a regular administration of thyroid hormone preparations. 

Potential Side effects of hormonal therapy in treating infertility

Like all fertility treatments, hormonal therapy does carry risks. However, it is important to understand that the type of therapy the individual undergoes, how it is received and when it begins all play an important role in the effectiveness and safety of a hormone replacement therapy used as fertility treatment.

Hormones can create a number of side effects, some of which are actually positive, like a reduced risk of certain cancers. However, adding hormones can sometimes increase premenstrual symptoms like bloating, mood swings, cravings, and irritability. Any severe symptoms should be evaluated and treated. Estrogen can also lead to blood clots, so this should be monitored for the duration of hormone therapy.

Hormone therapy can be a life-changing treatment for infertility. For women who struggle with irregular periods or the inability to conceive, it may well be a critical component of their treatment.

Can hormonal therapy guarantee to treat infertility?

Every couple is unique, and there are serious limitations to predict how you will respond to treatment. You will likely be given an estimate of the chances you will achieve a successful pregnancy (either with or without treatment). It should be based on your diagnosis or test results, as well as the previous experience of that treatment or others in using the techniques. 

Infertility treatment depends on:

  • What’s causing the infertility
  • How long you’ve been infertile
  • Your age and your partner’s age
  • Personal preferences

Some causes of infertility can’t be corrected.

In cases where spontaneous pregnancy doesn’t happen, couples can often still achieve a pregnancy through use of assisted reproductive technology. Infertility treatment may involve significant financial, physical, psychological and time commitments.

Next read: Hormone Therapy For Infertility

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