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Hormone therapy

For couples who are unable to have children, hormone treatment can increase the chances of pregnancy.

In many cases, an inability to have children can be attributed to hormonal imbalances. Although hormonal causes can be present in both men and women, hormone treatment is usually performed for women.

Hormone treatment in women aims to promote egg maturation and trigger ovulation. This increases the likelihood of successful fertilisation. The success rates for each treatment cycle can vary greatly depending on the age of the women and the extent of the underlying hormone disorder, ranging between 10 and 20%. In most cases, it therefore makes sense to perform treatment over several months (cycles).

When is hormone treatment useful?

Hormone treatment is particularly suitable for women with impaired egg maturation and/or impaired or no ovulation at all. In most cases, the cause is a disturbance of the balance between the male hormone (androgen) and female hormone (oestrogen) (hyperandrogenism). In affected women, the egg follicles mature only to a small size (about 6-8 mm) and ovulation does not occur.

In some women, increased numbers of egg follicles are found on the ovaries in an ultrasound scan, meaning the monthly maturation of a single follicle may be delayed or prevented. This disorder is referred to as polycystic ovary syndrome (PCOS). In these cases too, hormone therapy can be used to achieve maturation and subsequent ovulation.

In much rarer cases, there is a reduced concentration of follicle stimulating hormone (FSH) and/or luteinising hormone (LH). FSH promotes the growth of egg follicles in which the eggs mature. There is one egg in each follicle. LH is primarily responsible for ovulation, i.e. releasing the egg from the follicle into the ovarian tube.

There are also other hormonal causes of impaired follicle maturation. For example, an increased concentration of the hormone prolactin can also inhibit fertility. Prolactin promotes the growth of the mammary glands during pregnancy and suppresses ovulation. An increased prolactin concentration before pregnancy can be treated with prolactin-inhibiting medications.

It is also important not to overlook the thyroid hormones. Normal thyroid levels play an important role in the chances of pregnancy. Hypothyroidism can be treated by a regular administration of thyroid hormone preparations.

How does hormone treatment work?

1. Cycle diagnostics

Before starting hormone treatment, a detailed diagnosis is performed during the menstrual cycle. During this diagnosis, the doctor checks whether there is a hormone imbalance, and, if so, which hormone levels are too high or too low. In addition, the doctor uses ultrasound to monitor the follicular growth in the ovaries and to check whether and when ovulation occurs. This information is important to determine whether hormone treatment is necessary and which hormone preparations are most suitable for the treatment.

2. Commencing therapy

The treatment usually starts on the third to fifth day after the onset of menstruation. The medication can be administered either orally as tablets (clomifene) or as injections under the skin. The injections usually contain only FSH, but occasionally a combination of FSH and LH as well, and are usually injected once a day using a pen. After being given brief instructions, the women can perform the injection themselves. For certain very rare hormone disorders, treatment with a hormone pump provides the best prospects for success.

3. Ovulation and fertilisation

From around the eighth day of the menstrual cycle, the doctor checks the progress of follicular development using an ultrasound and blood tests. In some patients, ovulation occurs spontaneously once the largest follicle has reached a size of about 18-20 mm. In other cases, ovulation has to be triggered by administering another hormone, human chorionic gonadotropin (hCG). The doctor will then recommend certain days on which to have sexual intercourse in order to have the best prospects of fertilisation. If, however, the motility or number of sperm is significantly reduced, treatment with artificial insemination will be necessary.

Side effects and risks

Interfering with the hormone balance can entail side effects and risks, which the attending physician will explain individually before the treatment. In addition, during the treatment period, the doctor will regularly monitor egg maturation and hormone levels in order to avoid overdosing and to minimise the risks.

Possible side effects of the treatment include:

Hot flushes
Headaches
Depressive moods
Hyperstimulation: If the treatment results in the formation of too many egg follicles, the doctor will advise against sexual intercourse, since too many mature eggs increases the risk of a multiple pregnancy (twins, triplets, etc.), which is associated with health hazards. The dose of the hormone preparation can then be reduced for the next treatment cycle.