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Hormone treatment: What is a hormone therapy?

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).

How does hormone treatment work?

The hormonal stimulation of ovulation takes place in several stages:


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.

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If you would like to know more about hormone treatment, have a question or would like to make an appointment at your local fertility centre, please contact us. We will get in touch with you as soon as possible.

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What are possible 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.

When is a hormone therapy advisable?

Hormone treatment is particularly suitable for women with impaired egg maturation and/or absent or impaired ovulation.

In most cases, the cause is an imbalance between the male (androgens) and female (oestrogens) hormones (hyperandrogenaemia).

In affected women, the follicles only mature to a small size (around six to eight millimetres) and ovulation does not occur.

In some women, an increased number of follicles can be found on the ovaries on ultrasound, which means that the monthly maturation of a single follicle may be delayed or prevented.

This disorder is called ‘PCO’ – polycystic ovary. In these cases, hormone therapy can also be used to achieve maturation and subsequent ovulation.

Reduced concentrations of follicle-stimulating hormone (FSH) and/or luteinising hormone (LH) are found much more rarely. FSH promotes the growth of follicles in which the egg cells mature.

There is one egg cell in each follicle. LH is primarily responsible for ovulation, i.e. the release of the egg from the follicle into the fallopian tube.

There are also other hormonal causes of a follicle maturation disorder. 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 medication.

Thyroid hormones should also not be neglected. Normal thyroid levels play an important role in the chances of pregnancy.

Hypothyroidism can be treated by regularly taking thyroid hormone supplements.

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