Hormone Therapy for Infertility in Men and Women
Doctors have numerous types of hormone therapy for infertility in both men and women. As with other methods of hormone replacement, fertility treatments are customized to the individual. What works for one person may not be suitable for another.
The definition of hormone therapy for infertility is the use of specific hormones to induce spermatogenesis or ovulation, resulting in conception.
The androgen sex hormones – progesterone, testosterone, and estrogen play pivotal roles in fertility. Progesterone may help some women avoid miscarriage. The polypeptide protein somatotropin (growth hormone) is also crucial to both men and women.
In this review, we look at the following:
- How hormones influence fertility in men and women
- Which hormones promote fertility
- Side effects of hormone therapy for infertility
- Benefits of hormone therapy for fertility
- How to begin and use hormone therapy
The use of hormone therapy for infertility helps many couples conceive.
How Do Hormones Influence Male and Female Fertility?
How hormones influence fertility has a lot to do with the specific hormones. Each of these vital chemical messengers plays a unique role in the process. The prescribed hormone therapy for infertility focuses on the area or areas of need.
For example, a man may produce enough testosterone, but the problem could be with any point of the sperm cell maturation cycle. Women are born with all their eggs, but if the follicles are not sensitized to accept the hormone stimulation, the oocytes may not reach the necessary maturity to undergo fertilization.
In many cases, fertility treatments are a bit of a trial and error action. For women who need to undergo In vitro fertilization (IVF), poor ovarian stimulation response can make it impossible to succeed. A variety of hormones can help improve the response to ovarian stimulation. The doctor may have to try multiple treatments before determining the right one.
Which Hormones Promote Fertility in Men and Women?
As we look at the use of hormone therapy for infertility, one treatment might be a bit of a surprise. Although testosterone is the male sex hormone, its use for improving fertility is only for women. Exogenous testosterone does not enter the testes.
Therefore, it cannot stimulate spermatogenesis. Only testicular-produced testosterone can accomplish that goal. Instead, exogenous testosterone can actually lower a man’s sperm count, having the opposite reaction than the desired outcome.
Here are the leading hormone therapies used for infertility:
- Hormone therapy for male infertility
- Clomiphene Citrate: CC binds to estrogen receptors in the hypothalamus and pituitary gland to inhibit the effects of estrogen on the production of gonadotropin. The result is an increase in luteinizing hormone (LH) production, which, in turn, increases testosterone production to support spermatogenesis.
- Follicle-Stimulating Hormone: FSH works on the Sertoli cells in the testes that produce sperm. Patients with hypogonadotropic hypogonadism may receive FSH to improve the fertilization of their partner. HCG is often used with FSH to increase testosterone production along with the FSH stimulation of sperm cells.
- Human Chorionic Gonadotropin: HCG acts in the same manner as LH on the Leydig cells to stimulate testosterone production. It bypasses the pituitary gland, so it does not interfere with FSH levels. Many males will also need to use FSH along with HCG for optimum results. HCG can also be used in men who are receiving testosterone therapy for Low T levels to help increase natural testosterone production.
- Human Menopausal Gonadotropin: HMG treatment helps to stimulate spermatogenesis, and, along with HCG, which improves testosterone levels, can increase fertility odds.
- Aromatase Inhibitors: AIs such as anastrozole and letrozole block the action of aromatase in the conversion of testosterone into estradiol. By helping maintain more testosterone in the bloodstream, AIs increase the ability of testosterone to assist in sperm cell maturation.
- Human Growth Hormone: HGH comes primarily from the pituitary gland but is also expressed in small amounts in the testes where it helps stimulate testosterone production and spermatogenesis. Growth hormone also stimulates the production of insulin growth factor 1 (IGF-1), which assists with sperm production. HGH promotes the early development of spermatogonia, improving sperm maturation, and motility.
- Hormone therapy for female infertility
- Testosterone Therapy: TT given to women with a poor ovarian response in the IVF cycle has a significant impact on fertility by increasing oocyte numbers and pregnancy success.
- Human Growth Hormone: Aside from pituitary gland production, the ovaries also produce growth hormone. HGH therapy helps monofollicular growth and promotes gametogenesis while sensitizing the ovaries to gonadotropin stimulation. Women with poor IVF stimulation response who receive HGH have more fertile oocytes. HGH may also be combined with HCG and HMG for improved ovulation and follicle growth.
- Clomiphene Citrate: Oral CC stimulates FSH and LH release from the pituitary gland to stimulate ovarian follicle growth and ovulation.
- Follicle Stimulating Hormone: FSH helps stimulate oocyte maturation and ovulation release.
- Human Chorionic Gonadotropin: HCG helps increase egg maturate and stimulate release at ovulation.
- Human Menopausal Gonadotropin: HMG stimulates the ovaries to produce multiple eggs. It may be used with HGH.
- Progesterone: Helps prepare the endometrium for fertilization and supports the fetus during pregnancy.
- Cabergoline or Bromocriptine: Dopamine agonists help improve ovulation when excess prolactin is present.
- Metformin: Used in women with PCOS or insulin resistance to help improve ovulation.
- GnRH Antagonists: These medications increase GnRH release to prevent premature ovulation.
- GnRH Agonists: these analogs available as a nasal spray or injectable help the body produce higher quality eggs. They also prevent a surge of hormones mid-cycle that can cancel the cycle.
Side Effects of Hormone Therapy for Fertility
Doctors typically use the lowest dosage possible when treating infertility with hormone medications. Hormone therapy for infertility side effects are possible in some cases.
Risks for hormone therapy for male infertility include:
- Clomiphene Citrate: excessive sweating, facial flushing, weight gain, tender or enlarged breasts, acne, cataracts, hypertension, dizziness, hair loss, gastrointestinal distress
- AIs: side effects are rare, and most often include low libido, mild headaches, and possibly decreased bone density
- HGH: side effects can occur if growth hormone levels get too high, and include carpal tunnel syndrome, insulin sensitivity, edema, acromegaly, and joint, muscle, and nerve pain
Risks for hormone therapy for infertility in females include:
- Certain medications increase the risk of multiples. Oral formulations carry a less than 10 percent chance of twins. Injectables increase the risk up to 30 percent, including triplets or more. Premature labor, developmental problems later in life, and low birth weight are possible when carrying multiple fetuses.
- Injectable drugs that induce ovulation can cause ovarian hyperstimulation syndrome – OHSS – which can lead to painful, swollen ovaries, abdominal pain, nausea, bloating, diarrhea, and vomiting.
- Fertility drug use in women for longer than 12 months may increase ovarian tumor incidence later in life.
Benefits of Hormone Therapy for Fertility
The use of hormone replacement therapy for male infertility can help increase spermatogenesis. Increased sperm cell count and better motility offer an improved chance of conception.
With hormone replacement therapy for infertility in women, the treatment is also targeted to specific needs. HRT allows doctors to use a variety of treatment options to help improve follicle sensitivity and ovulation.
How to Begin and Use Hormone Therapy for Fertility
A hormone or infertility specialist will run diagnostic tests to determine the cause of infertility. Some men and women may require the use of multiple types of hormone therapy for infertility. Duration of treatment varies depending on the method – and how soon success is attained.
As with starting, getting off of hormone therapy for infertility also requires doctor supervision. Do not begin or stop the use of any hormone treatment without doctor authorization.
Men who are currently using testosterone replacement for the treatment of Low T often ask about stopping hormone therapy for infertility improvement. It may take between six and twelve months after ending testosterone therapy for sperm counts to improve. HCG or clomid may help shorten than period.
For additional information, please contact National HRT for a free, confidential phone consultation.
National HRT Staff
Please note that the information provided in this article is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.