MR. John and Mrs. Jane Doe have heeded every orthodox and scientific advice to address their infertility issue. Jane who is in her mid-thirties had long noticed that her menstrual period was irregular and lately discovered that she had in fact ceased to menstruate. This has become a major concern for her and it seems to have overly affected her mood, sexual desire and her fertility potential.
Review:
The human endocrine system in literal terms is the seat of our social and physiological chemistry. From mood swings to sexual appetite and even anger management all have an underlying chemical hormone responsible. The reproductive system, for example, depends on the actions of various hormones to produce eggs and sperm, maintain a pregnancy and to regulate the physical changes that accompany puberty and menopause.
Continue after the cut...
The centre of control and regulation of fertility hormones (placing the woman as a case study) – lies mainly in the hypothalamus, thyroid and the pituitary glands – all located in the brain. The ovaries also produce many hormones. Chief among them are estrogen, progesterone, and testosterone. Testosterone which, is a male fertility hormone (responsible for the development of the testes and its accessory glands) is also produced in women but at very low levels; however when hormonal imbalance takes its turn – high levels of testosterone in women may trigger the expression of masculine physical attributes such as excess facial and body hair growth amongst others. While the ovarian hormones estrogen and progesterone interact to coordinate a woman’s menstrual cycle during her reproductive years, the brain also produces the fertility hormones – follicle stimulating hormones (FSH) and luteinizing hormone (LH), which in turn – trigger hormone production from the ovaries. When any of the hormones coming from the brain or the ovaries are imbalanced, symptoms may occur. Such imbalances are most common in puberty and menopause, but imbalances can happen even during the childbearing age from the early 20s to early 40s. A significant dip or imbalance in these fertility hormone levels would therefore have phenomenal effects such as anovulation (no ovulation), amenorrhea (absence of menstrual periods) or premature menopause to mention a few. Except a concerted effort is made towards restoring hormonal balance, infertility may persist untowardly.
Whilst there are other factors that cause infertility in men and women, hormonal imbalance as researched, seems to be responsible for about 30 per cent of all cases. A few noticeable signs may however include: Irregular menstrual cycles, mood swings, decreased sex drive, tender breasts, depression, excess facial or body hair growth, fatigue, hair loss, nervousness, urinary incontinence, urinary tract infections, vaginal dryness, weight gain, amongst others.
Other conditions associated with hormonal imbalance may also include:
• Polycystic Ovary Syndrome – PCOS:
A condition whereby numerous cystic follicles develop in the ovary – yielding very immature eggs or even no eggs at all; and as such resulting in abnormally high levels of LH and relatively low levels of FSH.
• Abnormal Cervical Mucus:
Irregularities in the nature of cervical mucus which could be too thick – preventing sperm penetration.
• Premature Menopause /Premature Ovarian Failure:
A condition that occurs when, women under the age 40 lack the hormones required for ovulation and menstruation.
Depending on such simple factors as diet, nutrition, life-style and even stress, hormonal imbalance – which is one of the main causes of female infertility, may continually alter the fertility potential of an aspiring couple relentlessly if unchecked.
Success story
Considering our hypothetical Jane Doe case, with irregular cycles that deteriorated to an eventual cessation of menstruation for many months, in her mid-thirties; hormonal imbalance seems to be consistent with her prevailing physiological disposition. She was subjected to a series of tests by her Reproductive Endocrinologist to find out which hormone was either deficient or markedly elevated in her body. From her history of amenorrhea (non-menses), she was first given a “progesterone withdrawal test” to establish if the lack of menstruation was caused by a uterine abnormality or hormonal imbalance. The artificial hormone – progesterone was given by injection to induce a period – following which her other hormone levels (FSH, LH, Prolactin, etc.) were profiled at various points of the cycle.
Jane was later subjected to transvaginal ultrasound scanning and endometrial biopsy – where tiny bits of her uterine tissues were taken and analysed in order to rule out other underlying factors, which may have been responsible for the infertility issue.
With a lot of psychological support from her husband – a few months after her screenings and medical investigations, her fertility specialist placed her on artificial fertility hormones. She later resumed her normal menstrual cycle and with thorough monitoring and follow-up, Jane Doe eventually got pregnant and naturally was overjoyed!
...To be continued
Sources: Basic Endocrinology. The University of Ottawa information site on endocrine disruption. www.emcom.ca
Dr. Iketubosin is an Obstetrician, Gynaecologist, Fertility Specialist and the medical director of Georges’ Memorial Medical Centre at Lekki, Lagos, Nigeria. Further enquiries on this educational series may be sent to: fertilityreview@georgesmedical.com
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