Can hormones cause infertility
Fertility

Can hormones cause infertility?

Consultant dietitian Sarah Keogh explains why hormones are key to a woman’s reproductive health.

Women tend to be very aware of their hormones. We are used to our monthly cycles and the changes they can bring both physically as well as the effects on mood (not to mention the sugar cravings!).

Hormones have control over fertility and our monthly cycles, but they can have a wider effect on the whole of our health – and pregnancy is one area they can really influence.

An estimated one in six couples in Ireland is affected by infertility and it can be heartbreaking to experience. There are so many potential causes of infertility and with some couples, no cause is ever found.

So, can hormones cause infertility?

Imbalances in hormones can affect conception and the progression of a pregnancy. An underactive thyroid has an effect across the board on metabolism and can make it harder to become pregnant.

In recent years, scientists are paying more attention to the link between hormones and fertility and looking at conditions like under-active thyroid and Poly Cystic Ovary Syndrome (PCOS).

Underactive thyroid

Your thyroid produces a hormone called thyroxine, which in turn controls metabolism. Low levels of thyroxine literally slow down the body, so you can feel extremely tired, have dry skin, find your hair is thinning or falling out as well become constipated and gain weight.

People often assume that weight is the only symptom of an underactive thyroid, but it is possible to be slim and still be lacking thyroxine, so don’t rule it out.

One effect of having an underactive thyroid is that it can interfere with the release of an egg from the ovary, making it harder to become pregnant. An underactive thyroid, if it is undiagnosed, can also lead to an increased chance of having a miscarriage.

A number of causes

Underactive thyroid can have a number of causes. In Ireland, the most common cause is a type called Hashimoto’s Thyroiditis. This type of underactive thyroid is caused when the body makes antibodies that attach to the thyroid gland and reduce the amount of thyroid hormone that it can make.

Another cause is low levels of iodine. The thyroid gland needs lots of iodine to work, so it is worth topping up with iodine-rich foods like fish and milk. The soil in Ireland is naturally quite low in iodine, so if you normally don’t eat fish or dairy, you may need to start taking an iodine or kelp supplement. As with any condition, never selfdiagnose!

An underactive thyroid may also be linked to problems with your pituitary gland, which is essentially the control centre for all of the hormones in your body. A simple blood test can rule out (or in) an underactive thyroid and it is generally easily treated by taking thyroxine as a tablet. It also helps if you add 200 micrograms of selenium, as this helps your thyroid hormone to work a little better.

It is important for your GP to know your thyroid is underactive once you become pregnant, as you will need to have the levels of your thyroid hormone carefully controlled for the nine months.

Can hormones cause infertility

PCOS (Polycystic ovary syndrome)

Polycystic ovary syndrome affects about 10% of women and is a leading cause of infertility. Several hormones are affected in PCOS and women with this condition typically have higher level of male hormones (called androgens) and there can also be issues with insulin levels.

The exact cause of PCOS is unknown, but it can run in families so it might be genetic. Women with PCOS can have very irregular periods or long cycles (more than 35 days between periods). They can also have facial hair and more hair than normal on their legs and chest. Acne can be a problem and women often struggle with weight.

Women with PCOS can find it harder to become pregnant, as the increased levels of male hormones means that fewer eggs are released from their ovaries. They are also more likely to have miscarriages.

Treating PCOS

In recent years, there has been more focus on managing insulin levels. Women with PCOS seem to be more ‘insulin resistant’ than other people and this can lead to higher levels of insulin in their blood.

Why does this matter?

Higher levels of insulin can be a trigger for the body to make more male hormones, which go on to affect fertility. Higher levels of insulin can also lead to weight gain. Insulin has the effect of ‘switching off’ fat burning, and encouraging the body to store fat. This means that women with PCOS put on more weight and find it much, much harder to lose it compared to everyone else.

Some diabetes medicines that reduce insulin resistance have been used to help women with PCOS, but they have had only limited benefits so far.

One important treatment for PCOS is weight loss and a low-glycaemic index diet. A major cause of insulin resistance is weight gain, so it can become a vicious cycle for women with this condition: the insulin makes them put on weight, which makes them more insulin resistant, so they put on more weight and become even more insulin resistant and so on.

A very low glycaemic index diet is a great way to start reducing insulin resistance and weight. Exercise is also very helpful as it has a huge effect on getting insulin levels down.

What are low-glycaemic index foods?

High-fibre foods take longer to digest and therefore produce a slower rise in blood sugar. The following foods help to keep you fuller for longer. Wholegrain bread, pasta, rice and crackers, new potatoes, basmati rice, unsalted nuts and seeds.

Women with PCOS benefit hugely by working with a dietitian – both for advice on a very low GI diet and support with what can be quite a long process. If you think you may have PCOS, an underactive thyroid, or you are experiencing infertility, do talk to your GP for advice and further testing.

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Ask Tracey

Midwife Tracey Donegan answers your questions about pregnancy and birth

Q When should I have my first pregnancy scan? And how many scans should I get throughout my pregnancy?

A
Your first scan is known as your dating scan and is routine in all hospitals. Most mums will have this scan at their booking visit, which can be anywhere between 12-18 weeks. The earlier the scan the more accurate it will be. If you have experienced recurrent miscarriages some hospitals will scan you earlier. Contact your antenatal clinic for more information. In Ireland, most women will have two scans in a healthy pregnancy – a dating scan and an anomaly scan at around 20 weeks. However, some units provide a dating scan only. Private scans are also available in most cities and many parents use these services for additional reassurance and to find out the sex of their baby.

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Q My son is 18 months old and has just started saying his first words. It is an extremely exciting time in our house and my husband and I are eager to encourage his speaking as much possible. What advice would you give us on how we can foster this without bombarding and confusing him?

AThere is nothing better than hearing your baby begin to talk. All the hard work you have put in over the last two years is coming back tenfold.
Toddlers will vary significantly with ability and speed of which they talk however a guide would be about 50 words by 2 years of age. The most important thing to watch for is that your baby/toddler is cooing and babbling and begins to string sounds together like “Mama/Dada” They should have a wide range of speech sounds and like to imitate you and things they hear.
There are many ways that you can promote Speech and Language development at home:
1. Slowing down your own speech and taking time over conversations with your little one. Every day is a new experience when you are 18 months, nappy changes, bath time, baking a cake brings endless opportunity for you to interact and offer new words for them to hear and repeat. Make eye contact, smile and use exaggerated tones to keep things interesting and fun for your tot.
2. Review the toys that you have on offer to your tot and ensure that they give plenty of open ended play opportunities. Role play is a wonderful way to allow children to take the lead. Kitchens with lots of plates, cups and pots. Fill the pots with dry pasta and allow your child to cook and serve you. Playdoh, painting, gardening and sandpits are also great for allowing your child to take the lead and babble about what they are doing. Read plenty of books together and point and allow them time to answer any questions that you ask.
3. Limit screen time. Overuse of televisions and iPads do not give your child opportunity to interact in a two way manner.
4. Ask your child lots of open ended questions “What’s that?” “Where are we?” Point at things they know the answer to for boosting confidence (Car/ Car, etc.) When they don’t know the answer, explain it to them. Limit baby talk and speak clearly with good pronunciation, remember you are the teacher and they will copy you.
If you are concerned about your child’s speech and language development, be sure to speak with your GP or developmental Health Nurse. They are very skilled at understanding the difference between speech delays and spotting something that may require professional attention.
Enjoy watching their little brains absorb the world around them and listen to what they have to say. It won’t be too long before they won’t stop talking to you, asking “Why Mummy/ Daddy?” every 5 minutes….