How Hormonal Imbalance Can Impact Fertility (And What You Can Do About It)

When you're hoping to conceive, waiting month after month for those two pink lines can be challenging. Struggling with infertility can be extremely stressful, disheartening, and confusing. Further complicating the experience is how difficult it can be to find out what is causing the fertility issues. One of the things that can affect your chances of getting pregnant is hormonal imbalance.

To determine if hormonal imbalance may be impacting your fertility, you can use an at-home hormone imbalance test. Your doctor may also order lab tests to further investigate your hormone levels. From there, a health care provider can determine an appropriate diagnosis and help you decide which treatments may improve your odds of getting pregnant.

Read on to learn about the key hormones that can affect your fertility, how to have your levels tested (including at-home testing options), and how to treat hormonal imbalances to improve your odds of conception.

Key Hormones That Affect Fertility

Youy body has many different hormones, many of which come directly into play when you're trying to conceive. Hormonal imbalance with any of the following hormones could make it difficult to get pregnant.

Follicle-stimulating hormone (FSH)

FSH is one of the most important hormones for fertility. This hormone is made in the pituitary gland and is responsible for maintaining menstrual cycle regularity and producing healthy mature eggs. It also controls sperm production in people with testes.

An imbalance in FSH can lead to fertility, menstrual, and libido problems.

Luteinizing hormone (LH)

LH, or luteinizing hormone, may sound familiar; it's the hormone that's measured in at-home ovulation predictor kits (OPKs). Like FSH, the pituitary gland makes this hormone. LH is the hormone that tells your body to release an egg that's ready to be fertilized. It also causes the testes to produce testosterone, which is needed for sperm production.

An imbalance in LH can lead to infertility, irregular menstruation, and low libido.

Anti-müllerian hormone (AMH)

AMH, also called anti-müllerian hormone, is responsible for maintaining your body's immature eggs. This hormone is made in the testicles and ovaries.

AMH gradually declines with age. However, according to researchers, an imbalance in AMH levels occurs in about 5% of people people with uteruses. Hormone tests that check your ovarian reserve (egg quantity/quality/viability) do so by measuring AMH.

Progesterone

The hormone progesterone is critical in preparing the body for pregnancy and helping a new pregnancy thrive. Specifically, it triggers the uterine lining (endometrium) to thicken to prepare for a fertilized egg. It also keeps the uterine muscles from contracting so the egg is not rejected. This hormone is produced in the ovaries after ovulation.

Plummeting progesterone levels are often a culprit in repeated miscarriages.

Prolactin

If you think that this hormone is the one that handles milk production, you'd be correct! But it's also a key player in ensuring your menstrual cycle stays regular, which is important when trying to conceive. This hormone is made in the pituitary gland.

An imbalance in prolactin, especially excess prolactin, can cause menstrual and fertility problems, low sex drive, and erectile dysfunction.

T3 and T4

The hormones T3 and T4 are made in your thyroid. They work together to regulate your body's energy use. They also play a role in your weight, body temperature, muscle strength, and nervous system.

Research suggests that imbalanced thyroid hormones may significantly influence your ability to get pregnant. That's because thyroid hormone abnormality can impair ovulation.

Causes of Hormonal Imbalance

If you have a hormonal imbalance, it's normal to feel that you're to blame. However, it's important to know that it's not your fault and you're not doing anything wrong.

"For better or worse, there are very few things we can do lifestyle-wise that negatively (or positively) impact hormone production and balance," says Emily Jungheim, MD, chief of reproductive endocrinology and infertility in the department of obstetrics and gynecology at Northwestern University.

Causes of hormonal imbalance can include:

• Age
• Certain medications
• Exposure to certain chemicals
• Food allergies
• Low body fat
• Obesity
• Polycystic ovary syndrome (PCOS)
  
• Stress
• Thyroid disease
• Excess exercise
• Eating disorders
  

Dr. Jungheim says weight-related issues, like obesity and low body fat, can lead to hormonal imbalances. These changes can impact both your menstrual cycle and ovulation.

Medical conditions affecting the thyroid and adrenal glands can also lead to hormonal imbalance. Another is PCOS, a condition characterized by irregular cycles, excess testosterone levels, acne, male-pattern hair growth, and infertility. According to the Centers for Disease Control and Prevention (CDC), PCOS affects between 6% and 12% of people of childbearing age.

Symptoms of Hormonal Imbalance

If you've been trying to conceive for more than a few months and you're otherwise healthy, it may be time to consider your hormone levels. Symptoms of hormonal imbalance vary, depending on which hormones are involved.

Symptoms of reproductive hormone imbalance

According to the Endocrine Society, some symptoms that may indicate a reproductive hormone imbalance include:

• Abnormal uterine bleeding
• Acne
• Appetite changes
• Depression or anxiety
• Early menopause
• Excess body and facial hair
• Fatigue
• Fibrocystic breasts
• Hot flashes
• Infertility
• Insomnia
• Low libido
• Menstrual cycles that are irregular, excessive, or absent
• Mood swings
• Premenstrual syndrome (PMS)
• Recurrent miscarriages
• Uterine fibroids
• Vaginal dryness
• Weakness
• Weight changes
  

Symptoms of thyroid hormone imbalance

According to the Office on Women's Health, symptoms associated with thyroid hormone imbalance include:

• Appetite changes
  
• Constipation or diarrhea
• Depression, anxiety, and irritability
• Dry, thinning hair
• Eye changes (puffiness, bulging, redness)
• Fatigue or trouble sleeping
• Feeling cold or hot when others are not
• Hoarse voice
• Joint or muscle pain
• Menstrual changes
• Muscle weakness
• Pale, dry skin
• Puffy face
• Slow or rapid heart rate
• Sweating more or less than usual
• Trembling
• Weight changes
  

When to Test for Hormonal Imbalance

Fertility isn't one-size-fits-all, and there are many factors that influence a person's ability to conceive. Each person is different, making it tough to determine exactly when it's time to take action. However, in general, Dr. Jungheim suggests getting your hormones checked in the following cases:

• You haven't conceived after six to 12 months of trying (six months if you're over 35)
• Your cycles are irregular and unpredictable
• You have symptoms of PCOS or a thyroid condition

Another scenario where hormone testing makes sense? If you're planning to have your eggs frozen for later use. "An AMH level can be helpful in understanding how many oocytes one might expect to get during a banking cycle or during IVF," says Dr. Jungheim.

How to Test for Hormonal Imbalance

Testing hormone levels is often the first step in determining whether you're dealing with an easily solvable hormone imbalance or something more serious. It used to be that to get tested for hormonal imbalance, you would first have to experience months of trying and not getting pregnant, then schedule a visit to a reproductive endocrinologist. Now, at-home hormonal imbalance tests like those offered by companies like Proov, Everlywell, and Modern Fertility allow you to test yourself and present your findings to a health care provider.

Hormones can be measured in blood, hair, urine, or saliva. A blood test is the traditional method for testing hormonal imbalances and is likely the route a medical provider will recommend. However, saliva hormone testing is becoming a widely accepted way of testing as it provides a better average over time by collecting several different spit samples in a single day. Each at-home hormone test option functions a little differently, and there are benefits and drawbacks to each method.

If you decide to try an at-home test, discussing your findings with a health care provider is a good idea, especially if anything unusual pops up. Not only will they want to add your results to your medical history, but they may want to perform their own tests to confirm or investigate the test findings.

"There are a number of at-home hormone tests. Some are reliable, and some are not, but all should be confirmed and interpreted with a medical provider if someone is concerned about an underlying medical condition or if someone is struggling with fertility," says Dr. Jungheim.

Treating Hormonal Imbalance to Get Pregnant

How hormonal imbalance is treated will depend on the underlying cause of the imbalance.

PCOS is one of the most common causes of hormonal imbalance that interferes with getting pregnant. According to the Office on Women's Health, treatment to increase fertility with PCOS includes:

• Weight loss to regulate your menstrual cycles
• Medication to help you ovulate, like Clomid (clomiphene)
• In vitro fertilization (IVF)
• Surgery to restore ovulation

If your hormonal imbalance is due to thyroid disease, on the other hand, the most likely course of action is thyroid medication to correct the problem. Which type of medication will be best for you will depend on whether you have an overactive thyroid (hyperthyroidism) or an underactive thyroid (hypothyroidism).

With hyperthyroidism, an antithyroid drug helps the thyroid make less thyroid hormone. For hypothyroidism, hormone therapy helps supply the body with sufficient thyroid hormone.