Infertility: Hormonal Imbalances and Treatment Options

Is it infertility?

Hello, Doctor.
I have high androgen levels and low estrogen levels.
An ultrasound shows that my endometrium is thin and there are small follicles.
I often experience abnormal bleeding, and my basal body temperature does not show significant fluctuations.
My menstrual cycle is very irregular, and I often need medication to induce menstruation; with the use of such medication, I may only have six periods in a year.
I have been married for nearly a year and have not become pregnant.
The doctor suggested that I take ovulation induction medication.
I would like to ask the doctor: I have heard that ovulation induction medication can cause the endometrium to become thinner, and since my endometrium is already thin, is it appropriate for me to take it? It seems that ovulation induction medication needs to be taken during menstruation; if I am using medication to induce menstruation, will it affect the eggs? In this situation, with irregular menstruation and no pregnancy, does this qualify as infertility? Should I see a fertility specialist?

Xiao Jie, 30~39 year old female. Ask Date: 2017/06/19

Dr. Huang Jianzhong reply Obstetrics and Gynecology

I have elevated androgen levels and low estrogen levels.
An ultrasound shows a thin endometrium and small follicles, and I often experience abnormal bleeding.
My basal body temperature does not show significant fluctuations, and my menstrual cycle is very irregular; I often need medication to induce menstruation.
With the use of menstrual induction medication, I may only have six periods in a year.
I have been married for nearly a year without becoming pregnant, and my doctor has suggested that I take ovulation medication.
I would like to ask the doctor:
1.
I have heard that ovulation medication can cause the endometrium to become thinner.
Since my endometrium is already thin, is it still appropriate for me to take it?
Answer: Ovulation medication may cause thinning of the endometrium after 3-4 cycles of use.
2.
It seems that ovulation medication needs to be taken during menstruation.
If I am using menstrual induction medication, will it affect the eggs?
Answer: It will not affect the eggs.
3.
In this situation, with irregular menstruation and no pregnancy, does this count as infertility?
Answer: Yes, it is considered infertility.
4.
Do I need to see a fertility specialist?
Answer: Yes, you should see a fertility specialist.

Reply Date: 2017/06/19

More Info

Infertility can be a complex issue, often rooted in hormonal imbalances and various underlying health conditions. In your case, it appears that you are experiencing elevated androgen levels, low estrogen levels, and a thin endometrial lining, which can significantly impact your menstrual cycle and fertility.

Hormonal Imbalances and Their Impact on Fertility
1. Androgens and Estrogens: Elevated androgen levels can lead to conditions such as Polycystic Ovary Syndrome (PCOS), which is characterized by irregular menstrual cycles, anovulation (lack of ovulation), and often, infertility. Low estrogen levels can contribute to a thin endometrial lining, making it difficult for an embryo to implant successfully.

2. Menstrual Irregularities: Your description of having very irregular periods, requiring medication to induce menstruation, suggests that you may be experiencing anovulation. This condition is often classified as infertility if you have been trying to conceive for a year without success, especially given your age and the hormonal imbalances you mentioned.

3. Thin Endometrial Lining: A thin endometrial lining can be a significant barrier to conception. The endometrium needs to be adequately thick to support implantation of a fertilized egg. If the lining is too thin, it may not be conducive to implantation, leading to difficulties in achieving and maintaining a pregnancy.

Treatment Options
1. Ovulation Induction: Your doctor has suggested using ovulation induction medications. These medications can help stimulate the ovaries to produce eggs and promote ovulation. However, there is a concern regarding the effect of these medications on the endometrial lining. Some studies suggest that certain ovulation induction drugs may lead to a thinner endometrium, which could be problematic in your case.

2. Monitoring and Adjustments: It is crucial to closely monitor your response to any medication. If you start ovulation induction, your healthcare provider may want to perform regular ultrasounds to assess the thickness of your endometrial lining and the development of follicles. If the lining remains thin, your doctor may consider alternative treatments or adjunct therapies to enhance the endometrial thickness.

3. Addressing Hormonal Imbalances: In addition to ovulation induction, it may be beneficial to explore treatments that can help balance your hormones. This could include lifestyle changes, dietary adjustments, or medications that specifically target your hormonal imbalances. For instance, estrogen supplementation may be considered to help thicken the endometrial lining.

4. Fertility Specialist Consultation: Given your history of irregular cycles and challenges with conception, it may be advisable to consult a fertility specialist. They can provide a comprehensive evaluation and tailor a treatment plan that addresses your specific hormonal issues and fertility goals.

Conclusion
In summary, your situation does qualify as infertility due to the irregular menstrual cycles and unsuccessful attempts to conceive over the past year. While ovulation induction medications may be a viable option, it is essential to consider their potential impact on your endometrial lining. Regular monitoring and possibly consulting a fertility specialist can help you navigate your treatment options effectively. It is crucial to have open communication with your healthcare provider about your concerns and treatment preferences to ensure the best possible outcome for your fertility journey.

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