How female hormone imbalances are evaluated and treated before IVF

How female hormone imbalances are evaluated and treated before IVF
If you‘re trying to get pregnant and considering IVF treatment, it’s time to look a little closer at the role hormones play in conceiving and what happens when there’s a hormone imbalance in women. Here we’ll cover how hormones impact fertility and what tests can be done to evaluate for potential hormone imbalances.
Written by Orchid Team 
Medically reviewed by Cristina Vidal, RN
  • Cristina Vidal, RN, is the IVF-Donor-Surrogate nurse coordinator at Stanford Reproductive Endocrinology and Infertility with over 20 years of experience in the fertility and reproductive clinic.

How do hormones impact fertility?

Hormones are your body’s messengers. Tiny amounts can create huge changes as they travel to your body’s tissues and organs. They affect many processes in our body including growth, mood, metabolism, sexual function, and, of course, reproduction.

Infertility affects 1 in 8 couples trying for a baby and in many cases, hormonal imbalances will play a part in difficulty conceiving.

Whilst you may be familiar with some of the hormones, the fact is many come into play when it comes to reproduction, and a few may surprise you. Here are the most significant ones your physician may focus on when investigating infertility:


Follicle-Stimulating Hormone (FSH) is responsible for regulating the menstrual cycle and inducing the production of eggs in the ovaries.

Its measurable levels have a direct effect on fertility. High FSH levels are found in women who have a loss of ovarian function as their bodies try to compensate for the reduced function.


Luteinizing Hormone tells your body to release an egg. If you use an ovulation predictor kit, this is the hormone it measures. LH surges right before ovulation.


Anti-Müllerian Hormone is made by ovarian follicles and supports immature eggs. Doctors can measure this hormone to estimate how many eggs you have remaining.


Estrogen is a sex hormone responsible for female characteristics and reproduction. Levels change throughout the menstrual cycle; highest in the middle of your cycle and lowest during your period.


This hormone is essential for maintaining pregnancy as it thickens the lining of the uterus to support an embryo. Women with low levels of progesterone can have recurrent miscarriages.


When it comes to fertility, low levels of thyroid can interfere with the release of an egg from your ovary.


Prolactin is critical for producing breast milk but you also need it to get pregnant. If your levels are out of kilter it can make your cycle irregular which can make it difficult to conceive.

What happens when female hormones are imbalanced?

Of course, we can’t see all our hormones at work and it’s worth remembering there may be no signs at all that your hormones are out of balance. However, there can be physical signs that you should talk to your doctor about.

Common signs and symptoms
  • An irregular menstrual cycle
  • Spotting or irregular bleeding
  • New or worsening acne
  • Facial hair
  • Male-pattern body hair and male-pattern hair loss
  • Unexplained weight gain
  • Extreme mood changes
  • Menopause symptoms like hot flashes
  • Painful/heavy periods
  • Headaches

What conditions can cause hormonal imbalances?

  • Polycystic Ovarian Syndrome (PCOS) - this syndrome affects how your ovaries work
  • Primary Ovarian Insufficiency (POI) - this is where ovaries stop working properly before the age menopause might be expected
  • Thyroid Dysfunction - if your thyroid isn’t working properly, if can be difficult to conceive
  • Menopause - this is part of the aging process as fertility declines
  • Hyperprolactinemia - higher levels of prolactin need to be normalized for successful conception

How does a hormonal imbalance affect fertility?

With so many hormones involved in the reproductive process, it’s no wonder that an imbalance can lead to fertility issues. So let’s take a look at some of the issues hormonal imbalances can cause.

Ovulatory Dysfunction

To get pregnant you need to ovulate but thyroid irregularities and PCOS can stop your body from releasing an egg.

Short Luteal Phases

The luteal phase is the period of time between ovulation and the start of your period. Generally, this is 13-14 days, but if it’s shorter it might not be enough time for the embryo to implant.

Progesterone controls this phase by keeping the lining thick and strong so low levels might prevent pregnancy or increase the chance of an early miscarriage.


Okay, so not really a medical condition but age plays a part in hormone imbalance nevertheless. The fact is hormone levels change as we get older.

As we age, ovarian function decreases which means FSH levels increase and AMH levels decrease making it harder to conceive and carry a baby.

It’s really worth tracking your cycle through an app, an ovulation kit, or an old-fashioned calendar. The information will help your doctor spot irregularities that might be affecting your fertility.

How is fertility tested at fertility clinics?

There is no test that can predict your ability to get pregnant. In fact, fertility tests can only indicate how easy or difficult it might be to conceive.

However, testing for certain markers such as AMH and AFC will help physicians formulate a plan to improve your chances to get pregnant.

Test 1: AMH

As we discussed earlier, your Anti-Müllerian Hormone levels help determine how many eggs you have remaining.

It exists solely in a woman’s ovaries and is used as a marker of oocyte quality and ovarian reserve. This blood test can be done on any day of your cycle and the higher your AMH levels, the better your egg count is. This test works on women who are ovulating as well as women experiencing infertility.

It’s worth noting that in some cases very high levels of AMH can indicate PCOS which can cause irregular periods.

Your AMH results will give your physician one piece of the puzzle.

Test 2: AFC

This test is conducted via transvaginal ultrasound during the early follicular phase for both ovaries. It allows your physician to count the antral follicles and gives them an idea of how many eggs are available for development. It also helps them determine what your body’s potential response would be to gonadotropin fertility medicines.

The higher the number of antral follicles you have on your ovaries, the greater your egg count will be. A low antral follicle count means there might be a poor response to fertility drugs.

Why are these two tests combined?

Physicians test for both AMH and AFC to get a better and more accurate idea of the possible ovarian response for individual patients.

They use the information to develop a treatment plan, the protocol for medications dosage and if there is a need for a donor egg.

The results of these tests are added to wider information such as age, causes of infertility, medical history and response to prior treatment to give a better picture of your fertility.

What can be done to fix hormonal imbalance?

You’re probably wondering how to treat hormonal imbalance to get pregnant.

Although there are no guarantees, once your physician has completed their tests and investigations they may suggest a number of actions, depending on the results. Here are some approaches to treat hormonal imbalance to help you get pregnant:

  • Normalize prolactin levels
  • Induce ovulation
  • Weight loss
  • Trigger ovulation
  • Restore thyroid function
  • Progesterone supplements
  • Estradiol supplements

Key Takeaways

As you can see there is much to be investigated before starting IVF and several options for balancing hormones for fertility to give you the best chances of success.

  • Many hormones play a role in reproduction from menstrual cycles to ovulation to growing an embryo
  • If your hormones are out of balance any one of the processes involved in conception and pregnancy can be unsuccessful
  • Through identifying hormone imbalances, your physician can devise a plan to help fix and increase your chances of having a baby
Fertility treatment and reproductive medicine have come a long way since IVF was first introduced over 40 years ago. Today, advanced embryo testing is now available to couples who want their child to have the best shot of a healthy life. Explore how Orchid helps you conceive with confidence.
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