Written by Stephanie Wood

Many women spend years trying to not get pregnant that when they’re finally ready to start a family, fertility issues may come as a shock. Your ability to conceive could be affected — without you even realizing it — for various reasons. Genetics, nutrition, weight, exercise, stress, medications, and hormone disorders, to name a few, can all factor into fertility.[1]

It may sound strange, but if you’re experiencing fertility issues, being diagnosed with a hormone disorder could give you the insights needed to resolve these issues, as they can often be well managed once detected. “These are some of the easiest infertility diagnoses to treat,” says Jane Frederick, M.D., a reproductive endocrinologist and OB-GYN in Orange County, California. “Older eggs, sperm count issues, or blocked tubes are all more difficult to overcome.”[2]

We’re focusing on two of the most common hormone disorders here, so you can recognize the signs that may point to a need for testing and treatment — the first steps on the road to starting a family.

Related article: 5 Common Fertility Myths, Debunked

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Culprit #1: Your Thyroid Gland

This small gland, said to resemble a butterfly, sits low on the front of your neck and is a major control center for many body functions. It releases a steady flow of thyroid hormones into your bloodstream, and these play a big role in metabolism, growth, body temperature — and ovulation. Though the hormone estrogen tends to get all the attention, two main thyroid hormones, referred to as T3 (triiodothyronine) and T4 (thyroxine), are equally crucial for conception.[3]

Check your T3 and T4 levels from home now

“The thyroid is very important to reproductive health,” says Dr. Frederick. “It needs to act synergistically with other hormones or your monthly cycle is thrown off.”[2]

Here’s how that synergy works: Ovaries have specific thyroid hormone receptors, says Dr. Frederick, so they’re waiting around each cycle to receive signals from T3 and T4 to release an egg. If they get too little or too much of these hormones, the second half of your cycle is disrupted. You may never release that egg, or the egg may not implant properly in your uterus once it’s released and fertilized.[2]

Thyroid disorders are very common. The American Thyroid Association notes that women are five to eight times more likely than men to have a thyroid issue, and one in eight women will develop a thyroid disorder at some point.[4] What’s more, up to 60% of people with thyroid disease are unaware of their condition. Fortunately, these days, if you suspect you have a thyroid problem, you can take a home test to measure those key hormones.

A thyroid gland that’s not producing enough hormones is said to be underactive — a condition called hypothyroidism. Symptoms include:[5]

  • Weight gain
  • Fatigue
  • Increased sensitivity to cold
  • Heavier than normal menstrual periods, or irregular cycle
  • Constipation
  • Dry skin
  • Puffy face
  • Hoarseness
  • Muscle weakness
  • Elevated blood cholesterol level
  • Muscle aches, tenderness, and stiffness
  • Joint pain, stiffness, or swelling

Less common is hyperthyroidism, or overactive thyroid, when the thyroid produces too much hormone. In this case, you might experience:[6]

  • Weight loss
  • Nervousness, restlessness or irritability
  • Sweating or sensitivity to heat
  • Lighter or fewer periods
  • Rapid or irregular heartbeat
  • Increased appetite
  • Tremors
  • Changes in bowel patterns
  • An enlarged thyroid gland
  • Fatigue, muscle weakness

If you’ve been trying to get pregnant for six months or longer, a home thyroid test can be a smart idea. You’ll have results in two to five days and access to a medical team that can help you understand what they mean.

Your next step would be to see your provider for treatment. For an underactive thyroid, that’s fairly straightforward: “All you need is a once-a-day synthetic thyroid hormone replacement medication to restore adequate levels,” says Dr. Frederick.[2]

Treatment for an overactive thyroid is more involved. “We can suppress its ability to produce hormones, and then treat you with the same synthetic hormone replacement medication to bring you back to optimal levels,” says Dr. Frederick.[2, 2a]

Suppressing an overactive thyroid may involve either taking an anti-thyroid medication for 12 to 18 months or doing radioactive iodine (RAI) therapy, a one-time treatment in capsule form.[7] RAI is a safe and reliable therapy that’s been used for decades, but you will need to delay trying to conceive for six to 12 months afterward.[7a] Both treatments stop the thyroid from making new hormones. The least used treatment is surgery to remove part or most of the thyroid gland. [7,8]

Whether your thyroid is overactive or underactive, you’ll need to take a synthetic hormone for life (it’s safe during pregnancy) and be monitored at least annually. Figuring out the optimum prescription and dosage can take time, so you may not ovulate normally again for several months to a year. But here’s some promising research: In one study, three out of four infertile women conceived within six weeks to one year after treatment for underactive thyroid.[9]

Related article: Are You One of 13 Million Americans With an Undiagnosed Thyroid Condition?

Culprit #2: Polycystic Ovarian Syndrome (PCOS)

This hormonal disorder affects 1 in 10 women of childbearing age in the U.S. and is characterized by larger-than-normal ovaries, often with cysts.[10] Women with PCOS have higher-than-normal levels of male hormones known as androgens (principally androstenedione), which can affect their monthly cycle so they may not ovulate regularly.[10]

Even when they do ovulate, they could be at greater risk of miscarriage. “The eggs are developing normally, but they never get the signal from the brain to release, so it’s all about getting these women to ovulate,” says Dr. Frederick.[2]

“Although PCOS can be diagnosed as early as adolescence, many women don’t even know about it until they try to have a baby,” says Dr. Frederick. Once you know what to look for, however, the symptoms can become obvious. They include:[11]

  • Irregular periods, which may be frequent and heavy, or infrequent and light
  • Excess hair growth on the face, neck, or forearms
  • Male-pattern hair loss at the temples
  • Adult acne
  • Weight gain or difficulty losing weight
  • Darkening of the skin along neck creases, in the groin, and beneath breasts
  • Skin tags in the armpits or neck area

If you’ve noticed one or more of these symptoms and have been trying to conceive for at least six months, consider getting screened for PCOS. A home progesterone test can help you find out if you’re ovulating. You’ll have results in two to five days, and if those results indicate an issue, visit your provider to discuss this and carry out any additional testing for PCOS, as well as possible treatments.

The first line of treatment is clomiphene, [12; 13] an oral medication. It stimulates ovulation by making your body think your estrogen levels are lower than they are, spurring your pituitary gland to produce more follicle-stimulating hormone (FSH) and luteinizing hormone (LH).[12] Dr. Frederick says about 10% of women under age 40 with PCOS will get pregnant [per cycle] on this medication. “If that doesn’t work after about three menstrual cycles, we can move on to other fertility treatments,” she says.[2]

Other options include letrozole, a breast cancer drug prescribed off-label to curb estrogen production; gonadotropins, which are injectable fertility drugs; intrauterine insemination; or in vitro fertilization. “We always start with the lower-tech options and then move on,” Dr. Frederick says.[2]

The bottom line: PCOS and thyroid disorders are highly treatable and don’t have to stand in the way of pregnancy. The first step to conceiving, however, is figuring out what is causing your fertility issues and how to manage this. “Once we know why you’re not getting pregnant, we have lots of options to help it along,” says Dr. Frederick. “Most PCOS patients can and do successfully get pregnant.”

Related article: 5 Signs You Might Have PCOS

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NIH National Institute of Child Health and Human Development
1: https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/causes/lifestyle
2: Dr. Frederick: https://www.havingbabies.com/physicians/jane-l-frederick/
2a: NCBI National Center for Biotechnology Information
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657979/#:~:text=Hormone therapy with thyroxine is,to 1 year of therapy
NCBI National Center for Biotechnology Information
3: https://www.ncbi.nlm.nih.gov/books/NBK279388/
3a: https://www.endocrineweb.com/thyroid-disorders-fertility
4: https://www.thyroid.org/media-main/press-room/
NIH National Institue of Diabetes and Digestive and Kidney Disease
5: https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism;
NIH National Institue of Diabetes and Digestive and Kidney Disease
6- https://www.niddk.nih.gov/health-information/endocrine-diseases/hyperthyroidism
7: https://www.thyroid.org/hyperthyroidism/
University of California Endocrine Surgery
7a: https://endocrinesurgery.ucsf.edu/conditions--procedures/hyperthyroidism.aspx
Cleveland Clinic
NCBI National Center for Biotechnology Information
9:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657979/#:~:text=Hormone therapy with thyroxine is,to 1 year of therapy
US Department of Health and Human Services Womenshealth.gov
11: U.S. Department of Health and Human Services, Office on Women’s Health. Polycystic Ovary Syndrome. Online: WomensHealth.gov
NIH National Institute of Child Health and Human Development
12: https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/treatments/infertility
13: Clomid brand discontinued: https://www.drugs.com/clomid.html
NCBI National Center for Biotechnology Information
14: letrozole (Femara): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221580/
15: https://www.thyroid.org/media-main/press-room/
NCBI National Center for Biotechnology Information
16: clomiphene: https://www.ncbi.nlm.nih.gov/books/NBK559292/
17: metformin recall: https://www.singlecare.com/blog/news/metformin-recall-fda/