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Hormone treatment
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Hormone treatment

If the hormone test performed at the beginning (if necessary after further evaluation) revealed a significant hormone disorder, this can be treated specifically. Of course, various hormone disorders can also occur simultaneously, so that several medications may occasionally have to be taken in parallel.

Some comments about the most important hormone disorders here:

  • Hypothyroidism
  • Hyperprolactinemia
  • PCO syndrome
  • Yellow body weakness
  • Thyroid disease

Hypothyroidism (underactive thyroid gland)

Hypothyroidism (hypothyroidism) is found in, for example, 10-20 % of the women seeking to become pregnant (or even in men!). Quite often, one finds a so-called „latent thyroid insufficiency“, which does not cause any physical symptoms but can already severely disrupt follicle maturation (ovulation) and contribute to so-called corpus luteum insufficiency (corpus luteum insufficiency).

Therapy: Even with the administration of thyroid hormone at the lowest dose, your menstrual cycle problem can be resolved; ovulation on the 13th/14th day of the cycle resumes.

Hyperprolactinemia (Prolactin excess)

When the pituitary gland produces too much prolactin (PRL), it is usually due to an (often stress-induced) overproduction (hyperprolactinemia). Less commonly, there are so-called thyroid adenomas, in which the PRL levels are usually extremely high. These are benign growths that can even damage the optic nerve depending on size. Usually, such hyperprolactinemia is treated very effectively with prolactin-lowering drugs. Cycles and ovulation are resumed regularly.

In the case of very high prolactin levels, a pituitary tumor (hypothalamic gland tumor), which is usually a benign adenoma, must be ruled out by CT (computed tomography) or MRI (magnetic resonance imaging).

Therapy: Prolactin levels decreased

Hyperandrogenemia (excess of male hormones)

The overproduction of male hormones, hyperandrogenemia, can also have a significant effect on the sensitive hormonal system of the female cycle. If it is of adrenal origin (adrenal cortex), it can be treated with cortisone. A very common cause of hyperandrogenemia, but also of hyperandrogenism (increased peripheral effects of normal androgen levels, increased hair growth in female non-normal areas, acne), is an increased body weight. In adipose tissue, estrogen is produced from androgens (male hormone), which hinders the cyclical processes. Therefore, it is extremely recommended to reduce body weight (diet, exercise). The often co-occurring PCO syndrome (Polycystic ovary) increases the symptoms

Therapy: Either by targeted androgen reduction through the administration of cortisone or by stimulation with clomiphene tablets, ovulation (ovulation) can often be achieved; however, hormone injection therapy may be followed.

PCO syndrome (Poly-Cystic-Ovarian Syndrome)

PCO syndrome is a condition characterized by cyclical disorders, absent menstrual periods, hyperandrogenemia (excess of male hormones), and hyperandrogenism (signs of androgen elevation without an increase in androgen levels in the blood). The „classic PCO ovaries“ in ultrasound images are no longer a mandatory component of the diagnosis of PCO syndrome today.

If a PCO syndrome is present and glucose tolerance is impaired (also insulin resistance), this leads to the pancreas pumping high amounts of insulin into the bloodstream, which has adverse effects in various places (brain, ovaries, liver).

Therapy: By administering a so-called „insulin sensitizer“ (metformin) over several months, the cycle can be corrected. Often women with PCO syndrome are somewhat heavier, which helps maintain the cycle disorder. Estrogen is produced in adipose tissue from androgens (male hormones), which, together with high insulin, hinders the cyclical processes. Therefore, it is highly recommended to reduce body weight in addition to taking metformin (diet, exercise).

Corpus luteum insufficiency (yellow body weakness)

After ovulation, the follicle (egg sac) becomes the yellow body by vascular dilation and fat accumulation.

Various hormonal disorders are often associated with a so-called corpus luteum insufficiency (CLI), i.e., a deficiency of the corpus luteum, so this should also be treated in addition. Here, not only ovarian hormones are used, but rather the root cause of the problem must be addressed. If the quality of the first half of the cycle is impaired, this also has an impact on the time after ovulation, i.e., the corpus luteum phase.

Therapy: Here, clomifene is initially used to stimulate the ovaries; if this does not work, FSH (follicle-stimulating hormone) can be administered.

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Monitoring / VZO (intercourse to the optimum)

Depending on the couple's wishes, the present findings and other basic requirements (age, duration of the unmet desire for a child, etc.) may indicate that it is advisable to first monitor the course of the natural cycle through more intensive examinations (hormone levels; ultrasound). As a result, you can be informed about the optimal time for conception (the best time to achieve pregnancy).

Hormone treatment

If the hormone test performed at the beginning (if necessary after further evaluation) revealed a significant hormone disorder, this can be treated specifically. Of course, various hormone disorders can also occur simultaneously, so that several medications may occasionally have to be taken in parallel.

Anaesthesia

General anesthesia puts you into a sleep-like state; that is, it shuts down your consciousness and, above all, your sense of pain.

IUI

Insemination is one of the relatively simple procedures and is performed in cases of relatively mild male fertility problems or disorders in the cervical canal, e.g., disorders of mucus production or after a conectomy (incision of the external opening of the vagina). The treatment can be performed with or without hormone treatment depending on any pre-existing oocyte maturation disorder. The purpose of this treatment is to bring the prepared sperm in high concentration close to the egg cell in order to promote the occurrence of fertilization.

IVF

IVF (Reagent glass insemination) is typically used when the woman has bilateral fallopian tube blockage. But the man’s reduced sperm quality, the woman’s age, the couple’s distress, and the failure of other treatments can also lead to the decision to IVF seek this treatment.

ICSI

In cases of severely impaired sperm quality, or when only sperm can be obtained via testicular tissue sampling, an additional test is ICSI required.

Cryoconservation

Thus, if IVF or IVF + ICSI „excessive“ (partially fertilized) eggs have been frozen, they can be used in the so-called „cryocycle“.

ADI

If no sperm are present at all, the use of donor sperm can also be considered. Other reasons may also seem reasonable.

Blastocyst culture

In blastocyst culture, the embryos are further cultured until the 5th day.

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