Whether you've been trying to conceive for a while or you're just starting the process, chances are, you've heard of the common female hormones such as FSH, estrogen, and progesterone. But hormone interactions are nuanced and complex. It's not as straightforward as "normal estrogen levels equal fertility." In fact, normal rarely means optimal. There are other hormones that make conception possible behind the scenes as well.
In this episode, we explore the complex interplay of several well-known hormones and a few not-so-well-known ones and their critical roles in conception. Here is what to expect:
• An overview of the major fertility hormones
• The importance of hormones acting in conjunction and what happens when they don't
• Hormones in supporting roles that are critical for fertility
• Common misconceptions about how hormones work
Follow me on instagram @dradriennewei
Website: www.adriennewei.com
Episode Transcript
Welcome to the Practically Fertile Podcast.
I'm Adrienne Wee, doctor ofacupuncture and Chinese medicine
, functional medicinepractitioner and functional
nutritionist.
I specialize in using anevidence-based method, blending
principles of East Asianmedicine and modern functional
medicine to help women optimizefertility and get pregnant.
(00:22):
I believe in a world whereevery woman who wants to be a
mother becomes one.
If you're tired of being toldthat you're infertile and you
want to take the right steps toget pregnant naturally and
quickly, this podcast is for you.
Hey, fertile friend, to kickoff this brand new season of our
(00:42):
podcast, let's start from thevery beginning and make sure
that we have a goodunderstanding of how our bodies
work.
We're going to dive into theworld of fertility hormones.
I know, I know you might besaying I already know all about
my hormones.
Yes, you might be familiar withthe major players, but we're
also going to talk about thehormones that are super critical
(01:04):
for fertility, but they'renever talked about and doctors
don't proactively test them.
And we're also going to look atyour fertility from an East
Asian medicine perspective.
East Asian medicine is alsoknown as traditional Chinese
medicine.
It is thousands of years oldand still used today by billions
of people in Asia.
So I will use East Asianmedicine and Chinese medicine
(01:27):
interchangeably, because they'rethe same thing.
Since my method is a blend ofEast meets West, you'll need to
get familiar with both concepts.
Anyway, I think, whether you'vebeen trying to conceive for a
while or you're just starting,or maybe you haven't even
started thinking about havingkids, you might be dealing with
PCOS, endometriosis or yourperiod's doing something wonky.
(01:49):
Before you can fix something,you have to know what you're
dealing with and the why.
So let's get started.
First, let me define what ahormone is.
A hormone is a messenger.
It takes the message to aspecific part of your body and
tells it what to do.
Follicle-stimulating hormone,for example, tells your ovaries
(02:13):
to produce follicles.
Antidiuretic hormone tells yourbody that you're thirsty.
Insulin tells your body to takeup a glucose molecule to use
for energy.
You know that saying don'tshoot the messenger.
Well, same thing for ourhormones.
If your hormones are actingweird and not doing what they're
supposed to do, it's really nottheir fault.
(02:35):
They're not getting the rightmessage.
The second thing I want to sayabout hormones is that no
hormones ever act alone.
There is a certain degree ofinterconnectedness between all
of them.
This is something that's beendrilled in my head by my
functional medicine schoolteacher.
She has said it so many timesthat it's now just automatic for
(02:57):
me.
We tend to think that, oh, myestrogen is high, my
progesterone is low, let mesupplement something.
And not realizing that lowprogesterone could be caused by
egg quality, that could becaused by low estrogen, that
could be caused by hightestosterone.
So you're not really fixing theroot problem by supplementing
(03:18):
progesterone.
It's not going to help you ifyour egg quality was the issue
to begin with.
What about things likemelatonin?
You think that taking melatoninis harmless.
Well, melatonin affects insulin.
It keeps the insulin low whilewe're sleeping.
This means, if you're alreadyhaving blood sugar issues,
taking melatonin can mean thatyou wake up with high blood
(03:41):
sugar in the morning, even ifyou don't have blood sugar
issues.
Over time, that can put you atrisk for becoming insulin
resistant.
Anyway, I hope these twoconcepts make sense.
Chinese medicine doesn't havethe idea of hormones and because
of that, the way that it looksat fertility is very different.
There's less of well, thishormone is high or low, let's
(04:03):
give you a pill.
It's more about looking at howthe hormone imbalance is
affecting your body in allaspects of life and where that
might be coming from.
But, on the other hand, thething about Chinese medicine is
that it also can't tell youanything about your blood
chemistry, whether you have highFSH, low AMH or high blood
sugar.
So that's one of the reasonswhy I decided to go back to
(04:25):
school for functional medicinetoo, because I recognize that
both systems can fill the gapsfor each other.
All right, so let me come offof my soapbox and let's get on
with what we were going to talkabout on this podcast.
All right, let's think of yourfertility hormones as a big bowl
of soup the hormone soup andthe key ingredients in this
(04:46):
recipe are estrogen,progesterone, luteinizing
hormone and follicle-stimulatinghormone.
These four are the heavylifters in the fertility process
.
Follicle-stimulating hormone FSH.
This is a hormone thatstimulates the ovaries to
produce follicles.
A certain number of follicleswill naturally die off when
(05:09):
they're growing.
That's just the way things are.
So a larger number of folliclesat the beginning of the cycle
will increase the likelihoodthat one follicle will grow to a
good size that's big enough toovulate.
So, especially for IVF, youwant as many follicles as
possible at the beginning, soyou'll have more to choose from
(05:29):
to fertilize with the sperm andmake embryos, and that's what
they're testing for at thebeginning of the IVF cycle the
antral follicle count.
The higher the number of theAFC, the more likely you're
going to produce many folliclesand get higher quality embryos.
The main problem with the FSH isthat when the number is high,
(05:51):
it actually means your ovariesare not responding to the
signals.
You would think that the higherthe better, but this is the
opposite.
That's because our hormoneswork off of what we call a
feedback loop.
They rely on messages from eachother to know how to act.
No hormones ever work alone.
Right?
(06:11):
In this case, the ovaries arenot responding, so the pituitary
gland, where the FSH comes from, keeps sending more, and this
is usually not a good sign.
Even if your AMH is normal orif it's high, it still means
that the ovaries won't be ableto fully utilize the full egg
reserve that's available.
(06:32):
In clinical practice I haven'tseen a case of high FSH and high
AMH, because it's usually thecombo of high FSH and low AMH.
That typically signifiesthere's a problem with the
ovarian reserve.
But theoretically, the scenariothat I described high FSH, high
(06:54):
AMH theoretically it's possible.
Okay, to make the follicles grow, you need estrogen, typically
when a follicle wins the raceand then sucks up all the
estrogen and becomes the one theone that ovulates.
Estrogen also helps withlubrication.
You'll notice more watery andrunning cervical mucus as you
(07:15):
get closer to ovulation.
Sometimes you'll even notice awatery mucus again after you've
ovulated, and that's becauseestrogen surges again in the
luteal face after you ovulate tohelp with aligning and also to
help sustain a pregnancy, alongwith the progesterone.
So you might think thatprogesterone is the only hormone
that's at play after ovulation.
(07:36):
It's not.
It is the dominant hormone,which means that there are more
of them.
But that doesn't mean thatestrogen is not important.
Once your estrogen gets to acertain level usually over 200,
that will correspond to afollicle size of 16 millimeters
to 18 millimeters Then the eggis considered mature.
(07:59):
That is when the luteinizinghormone comes into play.
When you have an estrogenproblem meaning even though your
estrogen levels rise and youovulate, it doesn't mean the egg
is at the best quality.
There are many factors thatinfluence egg quality, I know,
but follicle size is one of them.
(08:20):
Small follicles have beenassociated with lower
progesterone levels in theluteal phase, even though you're
ovulating.
The follicle might need to be alittle bit bigger for that
specific cycle.
Low estrogen could also meanthat you don't see a lot of the
watery stringing mucus and youmight have some vaginal dryness
(08:41):
and make intercourse painful.
But if your estrogen gets to below enough then you won't have
a follicle that grows and youmight skip a cycle more.
So those are all the issuesthat come with low estrogen.
Now the luteinizing hormone thelevels are rising along with
the rising estrogen and itsurges once the egg is mature
(09:05):
and the estrogen signals back tothe pituitary gland and says
hey, we have a winner.
The LH surge is what yourovulation predictor kits are
measuring.
Depending on the type thatyou're using, you might notice
that a line is getting darkereach day as you get closer to
ovulation and then it getsreally dark.
(09:25):
That's when, usually when thesurge is happening.
Measuring the LH to predictovulation is probably the bane
of your existence.
If you're trying to getpregnant.
It is notoriously hard to catchat the right time.
That's because when you'repeeing on the stick, the hormone
is already on its way out ofthe body.
You literally have to catch itin the act.
(09:47):
Blood work isn't the mostaccurate, but it's also very
impractical if you're not doingany fertility treatment.
It's also very impractical ifyou're not doing any fertility
treatment.
There are fancier methods oftracking, like the Oura Ring
Mira app and Neato.
I have opinions about them, butthat's for another podcast.
If you're peeing on a stick, myadvice is to pee in the
(10:10):
afternoon.
Most women up to 80% will surgeat night, which means the LH
won't be in your urine untilhours later.
If you're testing first thingin the morning, that can create
frustration because you're not,because you're going to think
that you're not surging when inreality you are.
You just have to wait a fewmore hours.
Problems with the LH meansovulation might not happen.
(10:34):
A lot of PCOS patients canexperience this.
Your LH can be constantly highdue to cysts on the ovaries, and
then your body gets confusedand the LH never surges.
If the LH doesn't surge, thenthere's no ovulation, okay.
Finally, the progesterone,progesterone, will rise after
(10:55):
ovulation.
That's a given fact.
Progesterone does so much more,however, than what we think it
does.
We know that progesteroneprepares the uterus and thickens
the lining, but it's alsopreventing uterine contractions
to prevent premature birth.
It also acts as animmunosuppressant, which means
(11:17):
it prevents the mother's immunesystem from rejecting the baby.
So that's pretty cool, right.
It is, however, verycontroversial what the
progesterone level needs to beat after ovulation, and even the
OBs don't really agree on this.
I've seen some OBs who don'tcare about their progesterone
level under 10, even when thewoman's pregnant.
(11:37):
That happened to one of mypatients Her progesterone level
was 8, and her OB did notsupplement.
I've also known OBs who freakout if the levels are not over
15.
Some OBs don't worry too muchbecause progesterone, like all
other hormones, the secretion ofthe progesterone is not
(11:58):
consistent.
It's not constant.
It means it's released inspurts.
So that means that there mightbe a chance that you're testing
your progesterone at a time whenthere isn't a lot of it being
released.
It being released.
There's also inconsistentresearch data about whether or
(12:20):
not low progesterone truly cancause problems like spotting,
miscarriage, shortened lutealphase.
So in this case, you reallyneed to work with your OB on
this and see what they recommend.
All right, so now that we'vecovered the main ingredients of
the soup, let's look at thesupporting ingredients.
If you were making soup in reallife, this would be things like
(12:41):
onion, garlic, potatoes.
So these supporting hormonesthey don't get talked about much
, but without them, the hormonesthat we just talked about
wouldn't work, or wouldn't workproperly.
So remember, no hormones everwork alone.
Let's get started with ahormone called
gonadotropin-releasing hormone,gnrh.
(13:01):
This is the fire that cooks thesoup.
Without it, the soup can't cook.
Gnrh comes from thehypothalamus, which is located
in the brain.
Naysayers about stress affectingfertility listen up.
There is something called theHPTGA axis.
The five organs involved arehypothalamus, pituitary, thyroid
(13:25):
.
G stands for gonads, which arethe sex organs, and A stands for
adrenal gland.
This is how the hormones areall interconnected.
You can't think that a problemwith one area isn't going to
affect the other.
It's like an elevator Ifsomething isn't quite right, the
elevator isn't going to affectthe other.
It's like an elevator Ifsomething isn't quite right, the
elevator isn't going to goanywhere.
(13:46):
An easy way to understand thisis the adrenal glands will
produce cortisol, which is thestress hormone that many are
familiar with.
But the stress hormone comesbased on the signals from the
hypothalamus, from your brain.
Your brain processes theinformation that you're
receiving like triggers and thendetermines whether or not it's
(14:08):
a threat or it's a non-threat.
If your brain perceives thatthere is a tremendous amount of
threat that you're facing, theadrenals will hyperproduce
cortisol to keep you alive,fight, flight or freeze.
If this cycle gets to a pointwhere your brain determines that
you're in imminent danger, thehypothalamus will prioritize
(14:30):
survival instead of sending theGnRH Because having a period is
not going to help you survive.
I know you might feeldifferently, but having a period
, having high fertility andhaving a baby your brain thinks
that it's not high priority whenit comes to survival.
Hypothalamic amenorrhea getsthe name from this phenomenon.
(14:51):
The body is under so muchstress the period stops
altogether.
The next step is testosterone.
Not all bad for women, becauseit is actually very much
involved in helping the folliclegrowth in the early stages.
It acts as a precursor forestrogen.
It's having too muchtestosterone that's the problem,
(15:13):
and if you have too muchtestosterone in the body it
actually doesn't help, becausethen it actually stops the
follicles from growing in thelater stages of development and
then you might not ovulate.
This is very common for PCOS,but you don't have to have PCOS
to be affected by hightestosterone.
I recently tested the patientwho doesn't have PCOS symptoms
(15:36):
but she has high testosterone.
I really believe that thatcould be affecting the egg
quality and causing hermiscarriage.
The levels weren't too high,but they were high enough to
have an impact, and her doctornever tested testosterone
because she never showed anyPCOS symptoms.
Okay, next up is insulin, one ofthe most important hormones for
(15:58):
fertility and often overlookedbecause we associate insulin
with conditions like diabetes.
Insulin is so important formany other processes in the body
because it acts like a nutrienttraffic director.
It tells your body whether touse the glucose or to store fat,
and how insulin impactsfertility is this.
(16:21):
It's very much involved in thefollicle recruitment and
development stages.
Think about it An egg is a cell, and every cell in the body
will need glucose for energy inorder for it to grow.
Insulin helps to take theglucose to the ovaries to help
with that.
In fact, studies have shownthat larger follicles usually
(16:43):
have more glucose in thefollicular fluid, and we know
that larger follicles typicallyis associated with higher
progesterone levels.
Insulin also prevents thefollicles from premature death,
increasing the chance that morefollicles can survive in the
selection pool.
So the estrogen has a chance tochoose a really good one.
(17:06):
Another important function ofinsulin is to stimulate the
production of testosterone, andwe just talked about how
testosterone acts as a precursorfor estrogen in the early
stages of follicle development.
This means any imbalance ininsulin can affect the
production of testosterone.
When you have too much insulin,you can end up with too much
(17:28):
testosterone.
Now, to be clear, your adrenalglands also produce male
hormones, which the name isandrogens.
Testosterone is part of theandrogens, so your adrenal
glands also produce these metalhormones.
So it's not just insulin, buthaving high insulin can
definitely add to the mix.
(17:50):
Okay, finally, we have thethyroid hormone, which pretty
much regulates everything in thebody.
I want to do an entire episodeon thyroid hormones, so I'm not
going to get into too muchdetail about it right now.
But we really need to test notjust the TSH, the thyroid
stimulating hormone, but we needto see how the TSH is being
(18:12):
converted and used by the body.
Sluggish thyroid means sluggishanything.
This is another easy way toremember how the thyroid really
impacts the body.
So, to wrap up, on the surfaceit seems really straightforward
and most of you already knowabout the FSH, estrogen, lh and
(18:32):
progesterone.
What I hope you would walk awaywith from this episode is not
like all of a sudden, you'llbecome an endocrinologist, but
that you walk away from theunderstanding that there's a
degree of interconnectednessbetween all the hormones and all
the systems in the body thateither make things run smoothly
(18:54):
or cause problems.
It's time to really look beyondjust what's showing up on your
blood work.
That's one snapshot in time,not the complete picture, and
when you understand that, thenyou'll actually feel better and
less frustrated, because if youcan find the root cause, you can
find the answers as to why youare struggling to get pregnant,
(19:14):
and then you can come up with aplan to overcome these obstacles
.
All right, fertile friend,these obstacles.
All right, fertile friend.
If you found this episodehelpful, please subscribe and
share it with someone who mightbenefit.
Until next time, take care ofyourself and your amazing body.
You're one fertile cycle awayfrom getting pregnant, thank you
.
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