Understanding hormonal treatment for infertility

Fear that there may be a significant issue impacting a couple’s ability to become pregnant is common for many who are struggling to conceive.

Fortunately, hormonal treatment can a be simple solution that results in pregnancy, said reproductive endocrinologist and infertility specialist Kavitha Persaud, MD of University Reproductive Associates (URA).

“The correct balance of hormones throughout our bodies is critical for optimal reproductive function,” Dr. Persaud said. “As a result, hormonal imbalances comprise the majority of cases of infertility. These include female causes of infertility such as any disruption in ovulation. Hormonal imbalances in males can lead to decreased sperm production.”

Dr. Persaud said couples should schedule an appointment with a fertility specialist to find out if hormonal treatments can help with conception “sooner rather than later” as “time is never on our side.”

“Age — one of the most common causes of infertility — affects the overall quality of eggs that remain in the female ovaries,” she said. “Additionally, it becomes harder to release a normal egg each month as women age. It’s not impossible, but there can be a drastic change after the age of 35 in the ability to be able to get pregnant.”

Knowledge Is Power

“The initial evaluation for fertility involves testing to determine how well the ovaries are functioning, also known as the overall ovarian reserve status,” Dr. Persaud explained. “We test for follicle stimulating hormone (FSH), and estrogen — in particular estradiol (E2) levels at the beginning of the menstrual cycle, specifically on the third day after menstrual bleeding has started. We also count the number of follicles that are present in both ovaries, seen through an ultrasound. These values, along with anti-mullerian hormone (AMH), help determine how well the ovaries are functioning.”

To determine if a hormonal imbalance is the issue, fertility specialists will use an in-office ultrasound and blood tests. Additionally, hormones tested in males are similar to those tested in females, including FSH, LH and estradiol.

“We additionally test for testosterone levels among others as well,” Dr. Persaud said. “Low testosterone levels can decrease the amount of sperm that are produced every three to four months. Older age, particular after 40 years, affects the quality of sperm. This includes the genetic makeup of sperm, along with the production, movement/motility, and shape/morphology of sperm.”

Obtaining Medical Assistance

If the fertility specialist detects a hormone-related issue, oral and injectable medications can be started immediately. In females, the goal is to induce follicular growth to allow the follicles to release an egg and cause ovulation, Dr. Persaud explained.

“With oral medications, you're taking those pills, typically once a day for about five days, sometimes up to eight days,” she said. “With the injectable medications, you can be taking them anywhere from around seven days until around two to three weeks, depending on how your body reacts.”

To get the brain to release higher concentrations of hormones, and in turn promote the ovaries to allow follicular growth, individuals may be given Clomiphene citrate, or Clomid, an oral medication that tricks the brain into thinking that the body has low levels of estrogen.

“Clomid is used for women who do not normally ovulate on their own, or to increase the chances of pregnancy by allowing more than one follicle to grow each month,” Dr. Persaud explained.

Oral medications including Clomid or injectable treatments, such human chorionic gonadotropin (hCG), are often prescribed to treat male infertility.

“The agents support sperm production and quality. It is important that men with male-factor infertility get evaluated by a reproductive urologist,” Dr. Persaud said.

Couples receiving Clomid should be aware of side effects. While the drug has been associated with multiple births in the past, the risk has been minimized.

"There is an increased risk of multiples (up to 20%) with the use of Clomid,” Dr. Persaud said. “However, now, with our monitoring that we have in the form of ultrasounds and blood tests, we're able to control the doses of the medication to minimize that risk of multiples.”

Progesterone is one of the most important hormones involved in maintaining a successful pregnancy and is given once conception occurs. The hormone is produced and secreted by the ovaries (and pregnancy tissue once pregnant).

If progesterone levels aren’t high enough, synthetic formulations of the hormone, progestins, can be used. Progestins are relatively safe and since they are similar to hormones women make in their own bodies, have minimal side effects.

“The biggest side effects involved with the use of these agents include feelings of bloating, breast tenderness or headaches,” Dr. Persaud said.

Many individuals also fear that they will gain weight while taking hormones. However, Dr. Persaud said patients are taking the medications for such a short period that it is not typically an issue.

Adjusting Through COVID

With offices in Hasbrouck Heights, Hoboken and Wayne, URA also has embraced telehealth since the onset of the pandemic to ensure that patients and providers remain safe.

“It makes it easier for the patient to be able to connect with a physician, and they get some advice from almost any platform,” Dr. Persaud explained. “Some people use their phones while they're at work to be able to have consultation with us. They don't have to take an entire day off of work and block their schedules to make it all the way out to the office. It makes communication a lot more effective and easier on both parties, and that option is still very much available.”

 For more information, visit URA’s website or call (201) 288-6330.

— Liz Alterman

Author

University Reproductive Associates