Hormone-Related Infertility
Hormonal factors account for approximately 25 -- 30% of female infertility. The most common causes are anovulation from PCOS or hypothalamic amenorrhea, thyroid dysfunction, hyperprolactinemia, and luteal phase deficiency. Identifying and correcting a hormonal imbalance is often sufficient to restore natural conception without requiring assisted reproductive technology.
Symptoms
Irregular or absent menstrual cycles, short cycles (less than 25 days) or long cycles (more than 35 days), lack of mid-cycle signs of ovulation (cervical mucus changes, basal body temperature rise), and the absence of premenstrual symptoms that typically indicate progesterone production.
Causes and risk
PCOS is the leading hormonal cause. Hypothalamic amenorrhea from under-eating, over-exercise, or stress suppresses GnRH pulsatility. Elevated prolactin from a pituitary adenoma or medications inhibits ovulation. Thyroid dysfunction -- both hypo and hyper -- disrupts the hypothalamic-pituitary-ovarian axis. Premature ovarian insufficiency causes early follicle depletion.
How it is evaluated
Day 2 -- 5 FSH, LH, and estradiol establish ovarian reserve and pituitary function. AMH correlates with ovarian reserve. Prolactin, TSH, and free T4 round out the endocrine panel. Mid-luteal progesterone (day 21 of a 28-day cycle) confirms ovulation. Pelvic ultrasound and hysterosalpingography assess structural factors.
Treatment
Thyroid normalization and prolactin reduction often restore spontaneous ovulation. Letrozole is first-line for ovulation induction in PCOS. Clomiphene is an alternative. Hypothalamic amenorrhea requires nutritional rehabilitation and stress reduction before medications are added. Progesterone supplementation supports the luteal phase when deficiency is confirmed.