As the pelvic health realm expands and becomes better well-rounded, fertility has become a hot topic of discussion. When it comes to fertility issues, an underlying cause that can wreak havoc on someone trying to conceive are our hormones.
As a pelvic health physical therapist and women's health advocate, I want to discuss the specific hormones that I have my clients test, and that I test myself for my own fertility, to help us get a better understanding of our body’s current state.
Infertility Defined
Before diving into the specific hormones that I recommend testing, I want to first help define the issue of infertility. To be considered infertile, there are different criteria based on a person’s age and those criteria are as follows:
Someone under 35 years of age who has tried to conceive for 12 months without success
Someone 35-39 years of age who has tried to conceive for 6 months without success
Someone 40 years of age or older who has tried to conceive for 3 months without success
The reason that the length of time varies by age is that as we get older, a female’s ability to conceive becomes less likely. Because we know this, we encourage women 35 years of age or older to seek help sooner than someone under the age of 35.
Contrary to common belief, fertility issues are widespread between male and female, rather than typically a female dysfunction. About one-third of infertility is due to the male, one-third the female, and the remaining one-third is both the female and male together.
With all of that to say, the female reproductive system and hormones are more complex than a male’s, making fertility dysfunction more challenging. Because of my background working with females in pelvic health physical therapy, and my experience testing my own hormones, for the sake of this blog post we are going to focus specifically on female fertility.
The Role of Female Anatomy & Physiology
When it comes to infertility, there can be many culprits at play. One such is the female anatomy. This includes the reproductive organs like the ovaries, uterus, fallopian tubes, etc. Main anatomical factors that can impact fertility and a female’s hormones can include:
The position of an organ in the body
The mobility of an organ
Any anatomical anomalies
To touch on one specific aspect, the mobility of a reproductive organ is critical. If that organ lacks mobility, typically that can result in a lack of blood flow and poor nutrients leading to improper function or hormone imbalance.
One method of treatment that has been shown effective in improving organ mobility is called Mercier Therapy. You can learn more about this non-invasive, natural treatment offered here at Inspire Physical Therapy in the blog post here.
On the other hand, there is a physiological component of each organ specific to its function. Surgical procedures, hormone imbalances, and other factors can impact the specific function of reproductive organs, thus impacting fertility.
Hormones I Recommend Testing
As I mentioned before, as well as the main topic of discussion, when a client comes to me in the clinic struggling with infertility, I recommend a baseline hormone panel to help us get a better understanding of how their body is functioning and where our efforts should be focused.
With all that to say, the following are the list of hormones I recommend testing as well as an in depth discussion of each hormone itself:
Anti-Mullerian Hormone
Follicle Stimulating Hormone
Luteinizing Hormone
Estrogen or Estriol
Testosterone
Progesterone
Dehydroepiandrosterone
Thyroid Hormones
Cortisol Levels
Vitamin D Levels
Anti-Mullerian Hormone (AMH)
This hormone helps to determine the specific number of follicles remaining in a female's ovaries. Females are born with the specific number of eggs they are going to have available to them for their entire life. As a female reaches reproductive age, there are a certain amount of follicles remaining in the ovaries, called a reserve.
As far as testing goes, AMH can be tested for accuracy at any point in a female's menstrual cycle.
Follicle Stimulating Hormone (FSH)
This hormone can clue us into the current state of the eggs in reserve inside of the ovaries. High FSH levels can indicate that eggs are not maturing to the point that they are ready for reproduction. FSH is what signals the ovaries that the follicles need to begin growing and maturing for reproduction. Once the eggs begin maturing, as a result, FSH levels will start to decrease.
For testing purposes, FSH is best tested around 2-4 days of a female menstrual cycle, with day 3 being optimal. This is because FSH and another hormone estrogen, work on a feedback loop of each other. On day 3 of the menstrual cycle, estrogen is at a low point, allowing a baseline picture of FSH without estrogen influencing the accuracy of the test.
Luteinizing Hormone (LH)
Luteinizing hormone is another hormone that works directly in a feedback loop with estrogen. During a normal menstrual cycle, LH stimulates estrogen production. At the midpoint of the menstrual cycle, LH works to stimulate ovulation. Once ovulation is complete, LH promotes the corpus luteum to continue producing estrogen, also known as the luteal phase.
Estrogen
Estrogen is a hormone that most females are familiar with. This hormone is secreted by the follicles in the ovaries during the follicular phase of the menstrual cycle. Once ovulation is complete, estrogen is released by the corpus luteum, as mentioned before this is called the luteal phase.
Estrogen plays a role in the thickness of a female’s cervical mucus, allowing sperm safe passage into the cervix for fertilization of an egg. It also helps to prepare the endometrium once the egg has been fertilized and provides it a safe environment for implantation.
In regards to testing, estrogen is best tested after ovulation is complete around the 19th day of a female menstrual cycle.
Testosterone
Next up is testosterone. Although this is a hormone we more commonly think of when it comes to males, this hormone is still a factor in a female’s reproductive system.
If testosterone levels in a female are too high, it can impact endometrial development. On the other hand, if levels are too low, estrogen is not going to be produced in sufficient amounts.
Progesterone
Progesterone is a hormone I refer to as the “calming hormone.” This hormone plays a critical role in helping us become pregnant, as well as staying pregnant. It is produced by the corpus luteum after ovulation occurs and helps to produce the blood networking system required for the process of conception. Once an egg is fertilized and implanted, progesterone helps to form blood vessels and grow the placenta to ensure the implanted embryo is able to thrive. It also helps to increase nitric oxide in the body to increase blood flow to the uterus and prevent contractility from occurring until the time is right.
Progesterone also reduces the chances of the body invoking an immune response in result of an implanted egg. It helps the body to accept the implanted egg rather than see it as a foreign invader, allowing the healthy embryo to continue growing.
Dehydroepiandrosterone (DHEA) and Thyroid Hormones
These next hormones I want to give just a quick run down. DHEA is a hormone that helps maintain the quality of eggs within the ovarian reserve. This helps to ensure the eggs produced have the chance of thriving as a healthy baby.
In that same token, the thyroid plays a key role in many hormone functions, not just reproduction. Specific thyroid hormones that are helpful to test are Thyroid Stimulating Hormone (TSH), Thyroid Peroxidase (TPO), Triiodothyronine (T3), and Thyroxine (T4). It is important to note that T3 has been found in cervical mucus, possibly suggesting that its levels within the body are impactful to cervical mucus production and quality.
Vitamin D
The final hormone that I recommend testing is Vitamin D. Although this is not a hormone that we tend to think of having an impact on reproduction, it can be critical in female fertility. There has been research conducted specifically on individuals suffering from medical conditions such as Polycystic Ovary Syndrome (PCOS) who were given Vitamin D as their only form of fertility treatment. The results of this intervention lead to individuals with PCOS gaining the ability to become pregnant after struggling with infertility.
It is common for the average individual to be Vitamin D deficient. The amount of time that we spend outside is minimal, and our time in Mother Nature has dwindled with the hustle and bustle of modern society. For that reason, Vitamin D deficiencies have become more common due to a reduction in sun exposure. Not to mention that there have been Vitamin D deficiencies tied back to immune system dysfunction.
Wouldn't it be amazing if one of the treatment options for infertility was sunlight?
Conclusion
At the end of the day, prioritizing your hormone balance is critical to optimal fertility and one of the key fertility tips that I discuss with all of my clients struggling to conceive. Fertility in itself is quite individualized, but testing fertility hormones like the ones we’ve discussed is something I believe allows a person to establish a baseline to help decide where their efforts can be best directed. Keep in mind that it takes time to help hormones come into balance. You can learn more about the timeline to balanced hormones in the blog post here.
It is my goal that this information speaks to someone struggling to conceive right now and give them a starting point on their journey to pregnancy. And if you’d like another resource on how to naturally support your hormones, read the blog post here on the benefits of castor oil on hormone balance.
If you or someone you know is struggling with infertility and would like help, please feel free to contact us at 502-939-8564 or request a free consultation here.
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