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Iron is a very important mineral for fertility. Not having enough iron is associated with ovulation problems, miscarriage, low birth weight, and preterm labor. When there isn’t enough flow of oxygen to the ovaries, it can also reduce egg quality. This can make conception more difficult and prevent a fertilized egg from implanting in the womb.

Iron deficiency anemia can be caused by:

Pregnancy can also lead to iron deficiency anemia.

Doctors diagnose iron deficiency anemia based on the results of different blood tests. These tests check the following blood parameters:

It’s super important to increase your iron levels before getting pregnant because pregnant women need even more iron than non-pregnant women to have a healthy flow of oxygen to the growing baby.

Thankfully iron deficiency can be easily treated through supplementation and dietary changes. You can take a supplement as a daily pill, or if necessary through regular injections, depending on your iron levels. Research shows that women who take iron supplements have a 40% lower risk of ovulatory infertility than those who don’t.

Here are the iron-rich foods that you can eat more of to improve your iron levels:

Besides that, it’s helpful to know that vitamin C enhances your body’s absorption of iron.So it’s a good idea to eat these foods too to help raise your iron levels and improve fertility:

Iron tablets may cause constipation, but eating a high-fiber diet, staying hydrated, and exercising regularly can prevent that.
You can read more in-depth about iron and fertility in our blog article.

Up to 50% of women with endometriosis experience difficulty getting pregnant. This condition affects fertility because tissue growth or scarring can damage the ovaries or fallopian tubes, blocking the movement of sperm or eggs. Endometriosis can also harm egg quality and distort pelvic anatomy.

There’s not a clear cause for endometriosis, but experts believe it to be due to one or a combination of the following factors:

Genetics and environmental toxins could also play a role.

Based on your symptoms, LEVY makes a suspected diagnosis for endometriosis. We recommend you visit an OB-GYN for a physical exam to confirm if you have this condition. Endometriosis can be diagnosed through the following methods:

When diagnosed, endometriosis gets classified into four stages (I-IV), ranging from minimal to severe.

Although there’s, unfortunately, no definitive cure for endometriosis just yet, treatments exist that can ease symptoms and improve fertility. Your age, how long you’ve been trying to conceive, and level of pelvic pain are all important factors to consider when deciding on the right path for treatment.

Surgical operations, including surgical ablation and laparoscopy, can destroy or remove endometrial tissue, scarring, and ovarian cysts to reduce pelvic pain and improve the chances of conceiving. Studies have found that surgery helps almost 40% of infertile women with endometriosis get pregnant within 2 years. Assisted reproduction

treatments like intrauterine insemination (IUI) and in vitro fertilization (IVF) may also be recommended to help you conceive.
It’s possible for the endometrial tissue to grow back after surgery and pain to return, so many women need other treatments over the long-term. For instance, birth control

pills can lessen period cramping and pain from endometriosis.
Lifestyle changes like adopting an endometriosis-friendly diet, exercising more, and practicing meditation can also help to manage symptoms and improve quality of life. Add
more foods rich in antioxidants, fiber, iron, and healthy fats to your plate as they may help reduce inflammation and pain from this condition.
The good news is that lots of women with endometriosis are able to have a baby, either naturally or with medical assistance.

Thrombocytopenia itself doesn’t affect your chances of conceiving. However, some of the causes of low platelets can impact fertility, so be sure to get an in-depth checkup to find out what is decreasing your platelet count and begin targeted treatment if necessary.

During pregnancy, having too few platelets can lead to premature labor and a slight risk of increased bleeding during delivery. It can also prevent you from being able to get an epidural or deliver via cesarean section. Antiphospholipid syndrome (APS) is a potential cause of thrombocytopenia and can increase the risk of miscarriage and stillbirth.

A low platelet count has 3 potential causes: either your bone marrow isn’t producing enough of these cells, your spleen stops platelets from circulating through your bloodstream, or your body is destroying platelets.

Thrombocytopenia can be due to the following:

Certain pregnancy complications, including preeclampsia and HELLP syndrome, can also cause thrombocytopenia.

Rarely, severe thrombocytopenia can cause dangerous internal bleeding.

Doctors diagnose thrombocytopenia with a physical exam and various tests. A complete blood count (CBC) checks your levels of different blood cells. During a blood smear, a healthcare provider looks at platelets under a microscope. You may have a blood clot test, which determines how long it takes your blood to clot. Finally, you may get a biopsy of your bone marrow.

People with mild thrombocytopenia (which is the case most of the time) usually don’t need treatment, just observation. Ask your doctor what your low platelet count means for you and how it may affect a future pregnancy. If your thrombocytopenia is due to an underlying medical condition such as an autoimmune disorder, your doctor will create a treatment plan for the root cause.

When needed, doctors commonly prescribe medication (corticosteroids) to increase the platelet count. In rare and severe cases, healthcare providers may recommend a blood transfusion or surgical removal of the spleen to treat thrombocytopenia.

Eating more of the following foods can also help boost your platelet count:

On top of that, make sure you are taking your prenatal vitamins because they contain folic acid and vitamin B12. These are important for both platelet production and the baby’s development.

If you drink a lot of alcohol, know that this can decrease platelet levels and affect fertility. No amount of alcohol is safe for a growing baby, so all women trying to conceive are recommended to stop drinking completely.

It’s common for the platelet count to go down during pregnancy because of normal changes in the body. Treatment for thrombocytopenia during pregnancy is usually not necessary unless the platelet count drops to dangerously low levels. The platelet count usually returns to a healthy level on its own after delivery.

Primary dysmenorrhea is cramping caused by the body’s own production of prostaglandins. These are chemicals produced by your uterine lining which build up over the course of your cycle and make your uterus contract. The pain tends to be the strongest on the first day you start bleeding and goes down as you shed your uterine lining through menstruation. Some cycles may be more or less painful than others.

Secondary dysmenorrhea is when painful periods are due to a reproductive health condition which may also be impacting fertility.

Painful periods can be a symptom of the following conditions:

ain from secondary dysmenorrhea typically begins earlier in the cycle and lasts longer than common cramps.

Primary dysmenorrhea doesn’t affect fertility. Secondary dysmenorrhea, on the other hand, is a symptom of another condition which could be making it more difficult for you to get pregnant.

For instance, endometriosis (the most common cause of secondary dysmenorrhea) can damage and scar the ovaries and fallopian tubes, which blocks the movement of sperm and eggs and can stop a fertilized egg from reaching the uterus. Endometriosis can also reduce the quality of your eggs and alter your pelvic anatomy.

Uterine fibroids and polyps can change the shape of the uterus, block a fertilized egg from implanting, and increase the risk for miscarriage. Polyps may also cause inflammation in the womb which interferes with implantation and normal development of the embryo.

Pelvic inflammatory disease (PID) can lead to permanent scarring on the fallopian tubes, preventing sperm from reaching an egg and a fertilized egg from getting to the uterus. PID can also cause fallopian tubes to become swollen and filled with fluid (called a hydrosalpinx). These increase the probability of an ectopic pregnancy six-fold.

Cervical stenosis can prevent sperm from entering the uterus and complicate fertility treatments including intrauterine insemination (IUI) and in vitro fertilization (IVF).

To find out if you have primary or secondary dysmenorrhea, you should get diagnostic tests and discuss any other symptoms you’re experiencing with your healthcare provider. Tests to look for the cause of dysmenorrhea may include:

If your doctor finds that you have a health condition such as endometriosis or fibroids that are causing you to have severe period pain, you can start on a treatment plan to improve both your symptoms as well as your fertility.
For endometriosis, surgical operations can destroy or remove endometrial tissue, scarring, and ovarian cysts to help with pain and improve the chances of getting pregnant. Evidence shows that surgery helps almost 40% of infertile women with endometriosis get pregnant within 2 years. Read more about endometriosis and treatments in our factsheet and blog article.

Treatment for fibroids can include surgery, medication, non-invasive treatments, and interventional radiology and is decided on a case-by-case basis. Research shows that when submucosal fibroids are surgically removed before getting pregnant, women have higher rates of pregnancy and delivery, particularly when fibroids are the only thing reducing fertility. Read more about the types of fibroids and treatment in our blog article.

Medication and surgery can also be used to treat polyps. Studies find that surgical removal of polyps can significantly improve pregnancy rates in women who conceive naturally as well as those who use IUI to get pregnant.

PID is treated with antibiotics, but that unfortunately can’t reverse scarring to the fallopian tubes. Surgery can help clear blockages in fallopian tubes and improve the chances of conceiving naturally. If the tubes are too damaged, in vitro fertilization (IVF) is a good option to get pregnant. A hydrosalpinx may need to be removed or separated from the womb to raise the probability of IVF success.

Finally, cervical stenosis is treated through dilation (widening) of the cervix. Small, lubricated metal rods get inserted through the cervical opening, progressively increasing in size. A doctor may place a tube in the cervix and leave it in place for several weeks to keep the cervix open.

Besides treating the cause of secondary dysmenorrhea, here are several ways to relieve pain from cramps:

Having fewer eggs in your ovaries can make it more difficult to get pregnant, but it’s by no means impossible. It just takes one egg and one sperm to conceive. In fact, women under 35 with DOR who ovulate regularly have around the same chances of getting pregnant per cycle as other women the same age with a normal ovarian reserve. Egg quality is another important factor for fertility, which begins to go down around age 35.

Normal aging causes the egg reserve to go down most of the time. But it may decrease faster for some women due to:

Doctors can diagnose diminished ovarian reserve through blood tests on days 2–5 of the cycle. Low AMH levels are the best indication that the egg supply is reduced, and can be analyzed in combination with FSH and estrogen levels.

While it’s unfortunately not possible to reverse diminished ovarian reserve or get the ovaries to produce more eggs, there are ways to help you achieve your reproductive goals. In vitro fertilization (IVF) is a good option for women with a low egg reserve who are struggling to conceive.

In short, IVF is a medical treatment where you take hormonal medication to make your ovaries mature several eggs in one menstrual cycle, which get extracted and combined with sperm in a petri dish. If a sperm successfully fertilizes an egg, it will be placed into the uterus. You can choose to freeze eggs or embryos for use in a future IVF in case you need to try again or if you wish to have more children.

It’s also important to protect the quality of your eggs to improve your chances of conceiving. You can do this by not smoking, taking vitamins (including folic acid), and leading a healthy lifestyle including proper nutrition and plenty of exercise.

Beyond that, research from 2018 found that women under 35 with DOR who were treated with a supplement called CoQ10 for 60 days before undergoing IVF had higher numbers of retrieved eggs, higher fertilization rates, and higher quality embryos than those who didn’t receive treatment.

If these treatments are unsuccessful, using donor eggs together with IVF is a good option for women with a low egg reserve, especially if the eggs that are left are low quality.

Because of menstrual bleeding, women of reproductive age have a higher risk of iron deficiency. If the deficiency continues for too long, it can develop into iron deficiency anemia.

So, how much iron do you need? According to guidelines from the American College of Obstetricians and Gynecologists, non-pregnant women require 18 mg of iron per day. During pregnancy, the daily need increases to 27 mg.

Iron and fertility are closely linked. A deficiency of this crucial mineral can interfere with ovulation, making it more difficult to conceive. It can also reduce the quality of your eggs (due to decreased oxygen flow to the ovaries) and lead to implantation failure (when a fertilized egg can’t implant in the uterus). During pregnancy, iron deficiency increases the risk of miscarriage, low birth weight, and preterm birth. Babies born to mothers who are deficient in iron may also have poorer neurodevelopment.

Possible causes of iron deficiency include:

It can also make symptoms of hypothyroidism persist despite treatment.

Iron deficiency is diagnosed via blood tests. Ferritin is considered the most sensitive test of the iron stores in the body and is used widely to diagnose iron deficiency. Ferritin is a protein that stores iron, and low levels point to a deficiency.

Transferrin is a protein that transports iron and healthcare providers may measure this as well to diagnose iron deficiency.

Iron deficiency is diagnosed via blood tests. Ferritin is considered the most sensitive test of the iron stores in the body and is used widely to diagnose iron deficiency. Ferritin is a protein that stores iron, and low levels point to a deficiency.

Transferrin is a protein that transports iron and healthcare providers may measure this as well to diagnose iron deficiency.

Iron deficiency is diagnosed via blood tests. Ferritin is considered the most sensitive test of the iron stores in the body and is used widely to diagnose iron deficiency. Ferritin is a protein that stores iron, and low levels point to a deficiency.

Transferrin is a protein that transports iron and healthcare providers may measure this as well to diagnose iron deficiency.

Luckily, you can correct an iron deficiency through simple supplementation to improve health and symptoms and boost fertility. Talk with your doctor about finding a good prenatal vitamin that contains the right amount of iron and folic acid. These 2 nutrients are vital to supporting the healthy growth of a baby in the womb and preventing anemia.

A 2006 study published in the Obstetrics & Gynecology journal found that women who took iron supplements had a significantly (40%) lower risk of ovulatory infertility than women who didn’t take iron supplements.

Additionally, you can increase your iron stores by eating these foods:

Vitamin C increases iron absorption in the body, so be sure to also eat plenty of foods rich in this vitamin, such as:

Check your iron levels again 2-3 months after starting supplementation. If they haven’t improved, you may be referred to a specialist such as a gastroenterologist or a gynecologist to further look into what’s behind your iron deficiency.

A low white blood cell count usually refers to a low level of neutrophils (infection-fighting white blood cells) – this is known as neutropenia. Having too few of these cells makes you more vulnerable to infections. Because neutropenia is the most common form of leukopenia, people usually mean neutropenia when talking about leukopenia.

White blood cells play a role in conception and implantation, as well as the health of the mother and baby during pregnancy and the birthing process. A low amount of neutrophils during pregnancy is associated with premature labor and severe infections, which may lead to miscarriage. Some causes for leukopenia can also reduce fertility and increase the chance of complications during pregnancy.

Many things can reduce your white blood cell count, including:

Chronically low levels of white blood cells may not have a clear cause.

Doctors diagnose leukopenia based on the results of a complete blood count (CBC) test. If you have symptoms of an infection, they may order additional tests such as a urine test or a chest X-ray.

Leukopenia is treatable, and the prognosis is quite good. Once your doctor figures out what’s leading to your low white blood cell count, they will treat the underlying cause. For instance, you may be prescribed antibiotics or antiviral medication to treat leukopenia due to an infection.

Your doctor may also prescribe growth factor drugs, which increase white blood cell production in your bone marrow. Research shows that treatment with growth factor for women with severe chronic neutropenia is associated with a higher percentage of live births, a lower number of miscarriages, and a lower rate of severe complications for the mother and newborn.

If you have an autoimmune disorder, your doctor may have you take corticosteroids. These will prevent your body’s immune system from destroying white blood cells.

If your doctor determines that genetic mutations are responsible for your low white blood cell count, they may recommend undergoing genetic counseling before you get pregnant.

To reduce the risk of pregnancy complications due to infections, make sure you have your essential vaccinations (such as varicella, AKA chickenpox). And here are some general tips to follow to help you prevent illness when you have a low white blood cell count:

Anemia is a widespread condition: according to the World Health Organization, almost 25% of the global population has anemia. Women of reproductive age are more likely to become anemic. Microcytic hypochromic anemia can mean that you have another type of anemia or a medical condition that needs treatment.

This form of anemia is usually due to an iron deficiency, which has been proven to reduce fertility. Too little iron in the body can interfere with ovulation and increase the risk of miscarriage, low birth weight, and preterm labor. Copper deficiency, another potential cause for microcytic hypochromic anemia, is also associated with miscarriage and infertility.

A low flow of oxygen to the ovaries due to reduced hemoglobin in the blood can lower egg quality, which can cause problems with fertilization and implantation and lead to miscarriage. Thalassemia is associated with infertility, higher rates of miscarriage, and premature labor. During pregnancy, severe anemia can increase the chance of developing high blood pressure.

Possible causes for this form of anemia include:

Healthcare providers diagnose microcytic hypochromic anemia with a variety of lab tests. A complete blood count (CBC) provides information about your levels of hemoglobin and other components of your blood. In a blood smear, a provider will examine your blood cells under a microscope. Finally, a reticulocyte count informs if your bone marrow makes enough healthy red blood cells.

You may be referred to a hematologist (a blood disorder specialist) for further testing to determine what is behind your microcytic hypochromic anemia. If you have stomach pain, you may be referred to a gastroenterologist who might do imaging tests to look at your abdomen, such as an ultrasound, CT scan, and an upper GI endoscopy.

Your therapy regimen will depend on what is behind your anemia. If you have an iron deficiency, you may be prescribed iron supplements. Evidence shows that taking iron supplements significantly decreases the risk of ovulatory infertility. Iron supplements aren’t recommended for people receiving blood transfusions.

The following are iron-rich foods that you can incorporate more of into your diet if you have a deficiency:

Vitamin C helps your body absorb iron better. Foods rich in this vitamin include:

Treatment for thalassemia depends on how severe the condition is – people may need blood transfusions to increase the amount of hemoglobin in the body. Regular blood transfusions can cause a build-up of iron. To counteract this, doctors can prescribe chelation therapy, a medicine to remove excess iron (chelation therapy will most likely pause during pregnancy). Studies show that women receiving blood transfusions for thalassemia can conceive naturally or with the help of assisted reproductive technology (ART) and, with the supervision of a multidisciplinary team of doctors, have a safe pregnancy.

Anorexia can make it more difficult to conceive because under-eating and having a low body weight messes with the menstrual cycle. It disrupts your reproductive hormone levels and can cause your cycle to become irregular – periods may stop altogether (a condition called amenorrhea) and you may stop ovulating. Without ovulation, pregnancy isn’t possible. Anorexia can also reduce the quality of your eggs.

During pregnancy, eating too little can affect the baby’s development in the womb because there isn’t enough transfer of nutrients through the placenta. Because of that, anorexia can increase the risk of preterm birth and having a baby with low birth weight. This eating disorder is also linked to iron deficiency and folic acid deficiency, as well as zinc and vitamin A deficiencies, which can play a role in pregnancy complications.

Eating disorders occur as a way to deal with difficult emotions. Many factors can trigger the onset of anorexia – it’s often a combination of factors that play a role. Some people are predisposed to developing an eating disorder due to genetics, hormones, and personality traits. Your environment, peer pressure, family situation, and a culture that emphasizes thinness may also be responsible.

Healthcare providers diagnose anorexia according to the following criteria outlined by the American Psychiatric Association:

Your doctor may do a variety of other tests to diagnose this eating disorder and rule out medical reasons for weight loss. These may include:

The good news is that research shows that anorexia doesn’t have a permanent impact on fertility. So by recovering from anorexia, incorporating healthy eating habits, and reaching a healthy BMI, your periods will return to normal and you will greatly improve your chances of conceiving and reduce the risk for anorexia-related pregnancy complications.

To treat anorexia, it’s important to find out what’s causing it. Speaking to a therapist can be very helpful to find new ways to cope with underlying emotional issues that have changed your relationship with food. You can also meet with a LEVY nutritional counselor who can offer guidance on healthy eating and come up with a personalized meal plan to help you reach your goals.

Recovering from an eating disorder isn’t easy. But with the right support system to back you up, you can have a healthy relationship with eating again and greatly improve your chances of a successful pregnancy.

A low supply of oxygen to the ovaries decreases the quality of your eggs. This can lead to problems with fertilization and implantation. It can also cause miscarriage.

Macrocytic hyperchromic anemia can be caused by:

With this form of anemia, you may also experience changes to your mood and memory or feel tingling in your arms and legs.

Doctors diagnose macrocytic hyperchromic anemia through a variety of lab tests. A complete blood count (CBC) shows your red blood cell count and function. Additional tests include a peripheral blood smear, which healthcare providers use to analyze blood cells under a microscope, and the reticulocyte count, which shows if your bone marrow makes enough healthy red blood cells.

Your doctor may order additional tests to find the cause of your anemia, like tests for thyroid hormones, vitamin B12 levels, and signs of liver problems.

Most cases of macrocytic hyperchromic anemia are due to high alcohol consumption. If this is the case for you, know that no amount of alcohol is safe for a growing baby. So it’s recommended that all women trying to conceive cut out alcohol entirely. Once you do that, your anemia will resolve itself quite quickly.

If your anemia is due to a deficiency of vitamin B12 or folic acid (or a problem preventing your body from effectively absorbing these nutrients), your doctor will likely prescribe supplements. Having a healthy level of these nutrients is vital for fertility and a successful pregnancy.

Foods high in vitamin B12 include meat, dairy, eggs, and fish, as well as cereals and nondairy milk fortified with vitamin B12. Folate-rich foods include leafy greens, broccoli, brussels sprouts, citrus fruits, lentils, nuts, seeds, and asparagus.

In case your anemia is because of an underlying health condition, your doctor will treat the root cause. For example, hypothyroidism is treated with medication that replaces the missing thyroid hormones – and it greatly improves fertility!

Research on how subclinical hypothyroidism influences female fertility is mixed. Some studies link elevated TSH to ovulation problems, unexplained infertility and diminished ovarian reserve (when most of the eggs in the ovaries have been used up). However, data is still limited. Additionally, this condition isn’t more common among women struggling to conceive than in the general population.

Thus, the American Society for Reproductive Medicine (ASRM) and American Thyroid Association (ATA) state that there isn’t enough evidence to say that subclinical hypothyroidism reduces fertility.

During pregnancy, subclinical hypothyroidism is rather common. It affects up to 28% of people. Several studies find that TSH levels above 4 mU/L are associated with negative pregnancy outcomes, including miscarriage, premature placental abruption, and newborn death, and may impair neurological development in children.

Subclinical hypothyroidism can be due to:

This condition is associated with other health effects, including problems with metabolism and the heart

Subclinical hypothyroidism is diagnosed based on blood tests for thyroid hormones. If your lab results show that you have elevated TSH but normal levels of T4, it signals subclinical hypothyroidism.

Medical experts disagree on whether or not subclinical hypothyroidism should be treated because the evidence is mixed on how helpful it actually is. Healthcare providers usually recommend waiting to see if TSH levels will decrease on their own, which happens about 60% of the time.

But treatment with thyroid hormone replacement medication (levothyroxine) is recommended in the following cases:

Furthermore, evidence finds that women with TSH levels above 4.0 mU/L who get treatment with levothyroxine have higher rates of pregnancy and lower rates of miscarriage. And guidelines by the American Thyroid Association (ATA) state that women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) should be treated with levothyroxine to decrease TSH to under 2.5 mU/L. The ATA adds that thyroid medication may help prevent subclinical hypothyroidism from turning into full-blown hypothyroidism.

The bottom line is that deciding to treat subclinical hypothyroidism is individual, so work together with your healthcare provider to choose the course of action that’s right for you and your body.

You can also do some things to boost your thyroid health: Make sure to get enough vitamin D, iron, and zinc and eat iodine-rich foods like seafood.

The thyroid hormones affect several other important reproductive hormones, including FSH, LH, estrogen, androgens, progesterone, and prolactin. Hypothyroidism causes anovulation (meaning that no egg gets released by the ovaries). It can also interfere with the luteal phase, which makes it more difficult for an egg to implant in the womb – this can cause IVF to fail. For women who are able to conceive, untreated hypothyroidism can lead to miscarriage, high blood pressure, gestational diabetes, placental abruption (when the placenta detaches from the inner wall of the uterus), premature birth, stillbirth, and low birth weight.

Healthcare providers diagnose hypothyroidism based on a blood test. Slightly elevated TSH levels with normal levels of thyroid hormones T3 and T4 indicate subclinical hypothyroidism. High levels of TSH and low levels of T3 and T4 indicate clinical hypothyroidism.

The most common cause of hypothyroidism is a hereditary autoimmune disorder called Hashimoto’s thyroiditis, which causes the immune system to damage the thyroid gland.

Other causes of hypothyroidism include:

Additionally, hypothyroidism is associated with elevated levels of the hormone prolactin, a condition called hyperprolactinemia, which also reduces fertility. Around 46% of women struggling to get pregnant who have hypothyroidism have hyperprolactinemia as well.

Thankfully, hypothyroidism is something that can be easily managed with medication that increases your thyroid hormone levels. A commonly prescribed medication is L-thyroxine. This normalizes the menstrual cycle along with prolactin levels and boosts fertility.

As soon as your thyroid hormones are back in balance, you should be able to get pregnant and have a healthy pregnancy. A study found that over 76% of women with hypothyroidism who couldn’t conceive were able to get pregnant between 6 weeks to 1 year after starting medication.

Certain dietary changes can also help keep your thyroid healthy. Check vitamin D, iron, and zinc levels, and talk to your doctor about supplementation if necessary, as these are all important for the thyroid. In addition, increasing your intake of iodine-rich foods such as seafood can help with hypothyroidism.

Once you get pregnant, be sure to tell your OB-GYN that you have an underactive thyroid. Your medication dosage will likely need to be adjusted and you’ll need to be more closely monitored during your pregnancy.

The thyroid hormones influence a number of important reproductive hormones, including FSH, LH, estrogen, androgens, progesterone, and prolactin. Having an excess of thyroid hormones can make conception more of a challenge because it disrupts the cycle, suppresses ovulation, and causes irregular or missed periods. Hyperthyroidism can also lead to complications during pregnancy, including high blood pressure late in pregnancy, premature delivery, low birth weight, or miscarriage.

To be diagnosed with hyperthyroidism, you need to have low levels of TSH and high levels of thyroid hormones (T3 or T4). Subclinical hyperthyroidism is characterized by normal levels of thyroid hormones and low TSH.

Hyperthyroidism can be due to the following things:

The good news is that it’s easy to manage thyroid problems with medication. Drugs include antithyroid drugs methimazole or propylthiouracil, which stop your thyroid from over-producing hormones. Radioactive iodine shrinks the thyroid. Less commonly, the thyroid may be surgically removed.

Once the thyroid hormones are back in balance, fertility should return and you should be able to have a healthy pregnancy. It’s important to note that methimazole and radioactive iodine aren’t safe for the baby during pregnancy, so you’ll need to switch to a different treatment before you get pregnant if either of those were part of your therapy plan.

Besides medication, there are a few things you can do to help with hyperthyroidism. For one, ensuring you have enough vitamin D helps keep your thyroid healthy and may decrease thyroid antibodies. Iron and zinc are other minerals linked to thyroid health.

In addition, note that the mineral iodine helps your body produce more thyroid hormones, so it’s helpful to have a diet low in iodine when your thyroid is overactive. Opt for non-iodized salt and reduce your intake of seafood (as it’s the food with the highest amount of iodine). Cruciferous vegetables, including broccoli, Brussels sprouts, cauliflower, and kale may help with hyperthyroidism too.

Once you get pregnant, it’s important to let your OB-GYN know that you have hyperthyroidism. Your medication dosage will likely need to be adjusted and you’ll need to be more closely monitored during your pregnancy.

When you have too many androgen hormones, it can mess with your menstrual cycle. The cycle (number of days from the start of a period to the start of the next period) may become shorter or longer. Hyperandrogenemia also impacts ovulation, causing infrequent or missed ovulation. Without ovulation, it’s not possible to conceive.

Severe hyperandrogenemia may be due to:

While hyperandrogenemia usually happens in association with polycystic ovary syndrome (PCOS), severe hyperandrogenemia is rarely due to PCOS.

Having excess androgen hormones is closely linked to weight gain.

Severe hyperandrogenemia is diagnosed based on a blood test that measures your levels of androgen hormones and your symptoms.

The ACTH test is another blood test used to diagnose adrenal gland disorders. It measures the level of adrenocorticotropic hormone (ACTH) in the blood (a hormone produced by the pituitary gland which regulates cortisol) and can help to find the cause of hormonal imbalances.

When androgen levels are severely elevated, doctors may also order imaging tests to make a diagnosis, which can include:

These tests look for tumors which could be responsible for high levels of androgens in the blood.

If the cause for severe hyperandrogenemia can’t be found, you may be referred to a radiologist for an advanced blood test. During the test, blood is drawn from the arm and the adrenal and ovarian veins simultaneously to find the source of excess androgens.

There are several ways to treat severe hyperandrogenemia to improve your symptoms and chances of conceiving. For instance, anti-androgens are a type of medication that bind to androgen receptors to block the effects of androgens on the body. These can be used in combination with oral contraceptive pills to suppress the production of androgen hormones by the ovaries, improve symptoms, and regulate the cycle within a few months.

If severe hyperandrogenemia is due to insulin resistance, metformin is an effective medication that can improve the body’s response to insulin and reduce androgen levels. Additionally, a low dose of glucocorticoids (such as cortisone) can decrease the adrenal glands’ production of androgens, normalize the menstrual cycle, and help with fertility.

There are also different medications you can take which trigger ovulation, such as clomiphene or letrozole. These increase your body’s production of reproductive hormones FSH and LH and have high success in helping women get pregnant.

Lifestyle changes are another key aspect of severe hyperandrogenemia treatment. Healthy nutrition can help to bring your hormones back in balance and normalize your cycle. Weight loss has been shown to decrease androgens and reduce hair growth in obese women (BMI > 30).

A common effect of bulimia is weight gain, because the average bulimic takes in thousands of calories which get absorbed before purging. As a result, many bulimics are overweight, which disrupts cycle hormones LH and FSH and interferes with ovulation. Even in bulimic women who have a normal body weight, amenorrhea (missed periods) is common, affecting up to 40% of people.

Bulimia is also associated with other hormonal imbalances including low estrogen, excess androgens (hyperandrogenemia), and polycystic ovary syndrome, all of which reduce fertility. Beyond that, nutritional deficiencies due to bulimia can affect egg quality and make it more difficult to conceive.

Having bulimia during pregnancy is linked to miscarriage, preterm delivery, and postpartum depression.

Bulimia and other eating disorders occur as a way to cope with painful emotions. Bulimia specifically is closely linked with past trauma, and research finds that around 1/3rd of people with bulimia have a lifetime history of post-traumatic stress disorder (PTSD).

Stressful life changes like going through a breakup or changing jobs, in addition to genetics, hormones, and social pressure from your environment can all play a role in the development of bulimia.

Oftentimes, someone becomes bulimic after going through a period of dieting, and up to 30% of people with bulimia have a prior history of anorexia.

Research shows that treating bulimia and related nutritional deficiencies can make the menstrual cycle return to normal, thereby greatly improving fertility.

In order to recover from your eating disorder and develop a healthy relationship with food, it’s vital to first find out what triggered the onset of bulimia and treat the underlying psychological cause. To do this, it’s best to seek help from a mental health professional who specializes in eating disorders.

At LEVY Health, we offer personalized nutritional counseling. Our coaches will support you with knowledge on healthy eating habits and create meal plans to ensure you’re getting all of the nutrients you need to support overall health and fertility.

Pregnancy takes a toll on a woman’s body and so it’s more important than ever to nourish your body with nutritious foods. Weight gain during pregnancy may trigger a relapse of eating disorders, so stay aware of the signs of bulimia and seek treatment if necessary to help you have a successful pregnancy.

There currently isn’t enough data to determine how hypervitaminosis D may impact fertility. Studies on animals find that it can harm the maturation of the egg after fertilization and it is associated with higher rates of newborn death, but these results have not yet been replicated in human studies.

However, hypercalcemia is known to have harmful impacts on pregnancy and newborns. For instance, too much calcium can restrict the baby’s growth in the womb and lead to miscarriage. It can also lead to pregnancy complications including severe hypertension (high blood pressure), preeclampsia, pancreatitis (inflammation of the pancreas), and kidney stones. Babies born to hypercalcemic mothers have higher rates of newborn death, severe hypocalcemia (abnormally low amount of calcium in the blood), and mild hypercalcemia.

Vitamin D toxicity usually happens when someone takes very high doses of vitamin D supplements (over 10,000 IU per day) over a long period of time – it doesn’t normally come from too much sun exposure or a vitamin D-rich diet. Guidelines from the World Health Organization state that adults up to 50 years old should take 200 IU of vitamin D per day.

An oversupply of vitamin D can also be due to a malfunction in how the body metabolizes vitamin D or a health condition that makes the body produce an excess of an active form of vitamin D (such as Williams-Beuren syndrome).

If it goes on for a while, it may cause kidney stones and bone pain.

Hypervitaminosis D is diagnosed based on the results of various tests. Your healthcare provider may order the following tests:

To get your vitamin D back to a healthy level and raise your chances of a successful pregnancy, you should stop taking vitamin D supplements and reduce your calcium intake. Your doctor may also prescribe intravenous fluids and medications including corticosteroids or bisphosphonates to restore balance to your vitamin levels, correct dehydration, and improve kidney function. Therapy with glucocorticoids decreases calcium levels in the blood.

Be sure to have your vitamin D and calcium levels checked before you get pregnant to avoid harmful effects on your baby.

Anemia is a health condition that happens when you have a lower-than-normal amount of healthy red blood cells in your body. Red blood cells are responsible for transporting oxygen from your lungs all around your body and removing carbon dioxide as waste.

When not enough oxygen can reach the ovaries, it can harm egg quality. Poor egg quality can make it more difficult for sperm to fertilize an egg. If a lower-quality egg does get fertilized, it may not be able to implant properly or develop normally, resulting in miscarriage.

Many health conditions that cause normocytic normochromic anemia and bodily inflammation can also cause problems with fertility. Finally, inflammation can interfere with the menstrual cycle and implantation.

Most cases of normocytic normochromic anemia are due to an inflammatory health condition, such as:

But it can also be due to:

Some people are born with normocytic normochromic anemia. Congenital (present at birth) normocytic anemia can affect people with sickle cell disease.

Anemia is diagnosed with a variety of blood tests. The complete blood count (CBC) shows your hemoglobin levels and red blood cell count. To find the cause of normocytic normochromic anemia, a healthcare provider will do a peripheral blood smear. They may order other lab tests to find the health condition affecting your red blood cells.

With a reticulocyte count, your provider can tell if your bone marrow is making enough healthy red blood cells. You may be referred to a hematologist (a specialist in blood disorders) and an internal medicine doctor for consultation and treatment.

Many health conditions can lead to normocytic normochromic anemia, and treatment will vary depending on what’s behind it. Therapy directed at that condition should reduce symptoms of anemia and prevent related health complications.

Treatments may include anti-inflammatory medications for people with autoimmune disorders like rheumatoid arthritis, weight loss for people with obesity, or antibiotics for people with a bacterial infection.

People with severe cases of anemia may need injections of a medication (erythropoietin) that makes the bone marrow produce more red blood cells. Less commonly, blood transfusions may be necessary.

Iron supplements are used to treat other forms of anemia, including iron deficiency anemia and microcytic anemia, but they may be dangerous if you have this form of anemia and normal iron levels. Be sure to talk to your doctor before taking any supplements to ensure it’s right for your body, and ask what you can do to help prevent anemia in the future.

Primary adrenal insufficiency is a rare condition that occurs when the adrenal glands have been damaged and can’t produce enough hormones. Addison’s disease is the most common cause of primary adrenal insufficiency. Secondary adrenal insufficiency is when the pituitary gland doesn’t produce enough of the hormone ACTH (adrenocorticotropin).

Adrenal insufficiency can disrupt the menstrual cycle, and many women with this condition have irregular periods. Addison’s disease is associated with autoimmune thyroid disease and primary ovarian insufficiency (when the egg reserve is depleted before the age of 40), which are known to reduce fertility.

In women with congenital adrenal hyperplasia and non-classical congenital adrenal hyperplasia, elevated progesterone during the follicular phase can alter the cervical mucus. This makes it more difficult for sperm to swim to an egg and interferes with the thickening of the uterine lining to prepare the womb for implantation.

During pregnancy, women with adrenal insufficiency are more likely to have a miscarriage, preterm birth, or need a C-section. But close management by an endocrinologist and OB-GYN can help you have a pregnancy without complications.

Primary adrenal insufficiency is usually due to an autoimmune disorder in which the immune system mistakenly attacks the healthy adrenal glands. It may also be caused by:

Secondary adrenal insufficiency is caused by a lack of the hormone ACTH. This can be because of:

When the body is under stress from illness, infection, surgery, or an accident, these symptoms can become much worse all of a sudden and lead to an emergency condition called adrenal crisis. If you experience stomach issues like severe nausea and vomiting, diarrhea, or faint, please seek urgent medical care.

Adrenal insufficiency is diagnosed with blood and urine tests that measure the levels of adrenal hormones and ACTH. The ACTH stimulation test involves measuring the blood cortisol levels before and after an injection of ACTH. You may also have imaging tests (X-rays, ultrasound, MRI, or CT scan).

With medication that replaces the missing adrenal hormones, you can live a long and healthy life and improve your fertility. Glucocorticoids are a type of medication that replace cortisol, and mineralocorticoids replace aldosterone. Some women may need androgen replacement therapy as well. These medications work to put the hormone levels back into balance and offer relief from symptoms.

You may also be recommended to make some nutritional changes like increasing your intake of vitamin D (read here why this vitamin matters for fertility).

Your pituitary gland is a pea-sized gland at the base of your brain, around eye level. Although it’s very small, it plays an essential role in your endocrine system and affects almost every part of your body.

Elevated prolactin is a very common hormonal imbalance, affecting around 1 in 3 women with irregular periods but normal ovaries.

High levels of prolactin reduce ovarian function, leading to something called normogonadotropic hyperprolactinemic ovarian insufficiency. Ovarian insufficiency means that the ovaries aren’t working as they should, causing problems with egg maturation and ovulation.

This happens because elevated prolactin levels prevent the pituitary gland from releasing follicle-stimulating hormone, which is the one responsible for maturing your eggs each cycle. It can also interfere with the production of other important reproductive hormones, including estrogen and progesterone. As a result, women with excess prolactin don’t ovulate regularly and may experience luteal phase deficiency. In luteal phase deficiency, the uterine lining doesn’t thicken as it should, making it difficult for a fertilized egg to implant in the womb. Because of this, getting pregnant becomes quite challenging.

Common causes of hyperprolactinemia include:

Medical experts are unsure what causes a prolactinoma to form. A rare genetic disorder called multiple endocrine neoplasia, type 1, can increase the risk of getting a prolactinoma.

Doctors diagnose hyperprolactinemia based on a person’s symptoms, medical history, and a test that measures the level of prolactin in the blood. Because some factors, including stress, sleep deprivation, exercise, and medication, can affect the prolactin measurement, it may be tested again to confirm the high level and diagnose hyperprolactinemia.

When the blood tests show highly elevated prolactin, doctors may order an MRI scan of the brain to check for prolactinoma. You may be also referred to an eye doctor (ophthalmologist) if you’re experiencing vision problems. Finally, you may be referred to a specialist in hormonal disorders (endocrinologist) for further testing and treatment.

The good news is that hyperprolactinemia is just a temporary cause of infertility. In most cases, hyperprolactinemia responds quite well to treatment.

Depending on what’s causing your body to make extra prolactin, treatment can include:

Once treatment helps get prolactin back to a normal level, the ovaries will work normally again and periods and ovulation will return, along with fertility.

Hyperandrogenemia is the most common hormonal imbalance in women struggling to conceive, so you’re not alone! If you have severe hyperandrogenemia, it means that your levels of androgen hormones are very high.

Having excess androgens in the body can impact ovulation. Some women with this condition may have a shorter menstrual cycle or a luteal phase defect. Others will have a longer cycle, infrequent ovulation, or may not ovulate at all. Without ovulation, it’s not possible to conceive because there is no egg waiting to be fertilized by sperm.

Hyperandrogenemia is often associated with polycystic ovary syndrome (PCOS). But PCOS is rarely the cause of severe hyperandrogenemia. Other possible reasons for elevated androgen hormone levels in the body include:

Insulin resistance may also play a key role in the development of hyperandrogenemia.

There’s a close connection between hyperandrogenemia and weight gain.

Doctors diagnose hyperandrogenemia based on your symptoms and blood tests that measure levels of androgen hormones. You may also have a vaginal ultrasound to check for cysts on the ovaries, a symptom of PCOS, or ovarian tumors.

The ACTH test is another blood test used to diagnose adrenal gland disorders. It measures the level of adrenocorticotropic hormone (ACTH) in the blood (a hormone produced by the pituitary gland which regulates cortisol) and can help to find the cause of hormonal imbalances.

When androgen levels are severely elevated, doctors may order additional imaging tests to make a diagnosis, including an MRI scan or CT scan of the abdomen.

If the cause for your high androgen levels can’t be found using these tests, you may be referred to a radiologist for an advanced blood test. During the test, blood is drawn from the arm and the adrenal and ovarian veins simultaneously to find the source of excess androgens.

The treatment of hyperandrogenemia depends on what’s causing it. If it’s because of PCOS, doctors usually prescribe a combination estrogen-progestin birth control pill to restore balance to sex hormone levels, regulate the period, and help with symptoms. Usually, symptoms improve pretty quickly – within 3-4 months of starting the pill. Get another blood test after taking the pill for a few months to see if your reproductive hormones are back in balance. If so, you can stop taking the pill and start trying to conceive again. But keep in mind that the cycle can become irregular again and symptoms can return after stopping the pill.

Other treatment options include various medications and hormones that trigger ovulation. These include clomiphene or letrozole, which make the body produce the hormones FSH and LH. This often helps women conceive.

If severe hyperandrogenemia is due to insulin resistance, metformin is an effective medication that can improve the body’s response to insulin and reduce androgen levels. Additionally, a low dose of glucocorticoids (such as cortisone) can decrease the adrenal glands’ production of androgens, normalize the menstrual cycle, and help with fertility.

Certain lifestyle changes can also help. For women who are obese (BMI > 30) and have hyperandrogenemia, weight loss has been proven to decrease levels of androgens and reduce excess hair growth. A well-balanced diet can help regulate your hormone levels and menstrual cycle and improve your fertility.

During pregnancy, rubella infection can cause severe damage to the baby, especially during the first 3 months. Congenital rubella syndrome (CRS) occurs when a pregnant mother passes rubella onto the baby. This can cause various birth defects including heart issues, vision and hearing problems, intellectual disability, low birth weight, and problems with the bone marrow, liver, and spleen.

Rubella infection during pregnancy also increases the risk of miscarriage, stillbirth, and preterm birth.

Rubella is a highly contagious virus that spreads through the air when someone who is infected coughs or sneezes. It can also spread by sharing food or drinks. During pregnancy, rubella can pass from a mom to her baby.

The most common physical signs of rubella include mild, flu-like symptoms and a pinkish rash that starts on the face and then spreads around the body.

Up to 50% of people infected with rubella display no symptoms at all but are still contagious.

Since the rubella rash looks very similar to other viral rashes, the only way to know for certain if you have rubella is through a blood test or a virus culture. These lab tests make it possible to detect rubella antibodies and show if you are currently infected or have had rubella in the past.

If you’re not immune to rubella, it’s very important to get the measles, mumps, and rubella (MMR) vaccine. After getting vaccinated, it’s recommended to wait a month before trying to conceive. Having rubella immunity will stop you from infecting your baby during pregnancy and prevent serious complications associated with the virus.

It’s not safe to get this vaccination during pregnancy. So if you get pregnant and don’t have the vaccination, stay away from anyone who is infected.

If you get pregnant without immunity to rubella and catch the virus, let your doctor know right away. Your baby will need to be closely monitored after birth to catch any health issues early. Doctors recommend bed rest, drinking enough fluids, and acetaminophen (paracetamol) to reduce fever and relieve symptoms of rubella. In case of a severe infection, treatment can involve a blood transfusion or steroid medication to reduce inflammation.

About 50% of women with Graves’ disease have difficulties getting pregnant. Having an excess of thyroid hormone can cause irregular periods – and women with irregular periods may not ovulate monthly.
During pregnancy, untreated Graves’ disease can lead to low birth weight, miscarriage, stillbirth, birth defects, preeclampsia, premature labor, heart failure, and passing hyperthyroidism onto the baby.

Doctors aren’t sure what causes the immune system to attack the thyroid, but there are certain factors that can increase the risk of developing Graves’ disease, such as:

⅓ of people with Graves’ disease also experience eye problems including inflammation, swelling, and bulging of the eyes. If you are having any eye symptoms, be sure to consult with an ophthalmologist in addition to an endocrinologist.

Rarely, people with Graves’ disease get a skin condition which causes lumpy, red, and thicker skin at the front of the shins (called pretibial myxedema or Graves’ dermopathy).

Treatment for Graves’ disease is very successful and the prognosis is quite good for people with this condition. Once your hormone levels are back to normal, your menstrual cycle will become regular again, fertility will improve, and you shouldn’t experience problems during pregnancy.

Autoimmune thyroid disease is treated with medications that stop your thyroid hormones from getting too high. For Graves’ disease, doctors usually prescribe beta-blocker drugs to control the heart rate, and antithyroid medications, which prevent the overproduction of thyroid hormones

If, after 6 months of taking medications, your thyroid levels are still too elevated, your doctor may recommend treatment with radioactive iodine or surgery to remove all or most of the thyroid. These can eventually lead to hypothyroidism (underactive thyroid), which will need to be treated with daily medication

You’ll work closely together with your endocrinologist to monitor your thyroid hormone levels and make any necessary adjustments to your treatment plan during pregnancy. For instance, methimazole, an antithyroid medicine, and radioiodine therapy can’t be used during pregnancy as they can harm the baby. Propylthiouracil is an antithyroid medication that is safe to take throughout pregnancy. Your body goes through many hormonal changes during pregnancy, which can also make your thyroid hormone levels go up.
To boost thyroid health, you can also take vitamin D, iron, and zinc supplements. Ask your doctor for advice on the right supplement and dose. Finally, a diet low in iodine (seafood has the highest iodine content) and high in cruciferous vegetables (broccoli, Brussels sprouts, cauliflower, and kale) can help with hyperthyroidism

The thyroid is a small organ in the front of your neck that produces essential hormones which influence many bodily functions, including metabolism and fertility. Hashimoto’s thyroiditis is the leading cause of hypothyroidism, a condition where the thyroid doesn’t make enough hormones.

Not everyone with Hashimoto’s has hypothyroidism, but the condition usually results in a decline of thyroid hormones because it destroys the thyroid gland, leading to hypothyroidism at some point.

Hashimoto’s thyroiditis can make getting pregnant more challenging and raise the risk of pregnancy complications. This is because it can lead to decreased thyroid hormone production, which significantly influences your reproductive hormones.

Hypothyroidism can suppress ovulation – and without ovulation, there’s no egg ready to be fertilized by sperm, making conception impossible. It can also interfere with implantation of a fertilized egg into the uterus, which is a possible reason for in vitro fertilization to be unsuccessful. During pregnancy, not having enough thyroid hormones can cause miscarriage, high blood pressure, gestational diabetes, placental abruption, premature birth, stillbirth, and low birth weight.

Experts are unsure what causes someone’s immune system to destroy healthy thyroid cells. It could be triggered by one or more of the following factors:

Hashimoto’s disease is much more common in women and middle-aged people.

Hashimoto’s thyroiditis causes inflammation of the thyroid gland. A common first symptom of Hashimoto’s is a goiter, or enlarged thyroid. This can cause a feeling of fullness and swelling in the neck and throat.

Doctors diagnose Hashimoto’s thyroiditis by asking about your medical history and symptoms, performing a physical exam to check for a goiter and signs of hypothyroidism, and doing a few blood tests.

Lab tests include measuring your levels of thyroid-stimulating hormone (TSH), thyroxine 4 (T4), and antithyroid antibodies. You may also have an ultrasound of your thyroid gland.

Treatment for Hashimotos’ thyroiditis isn’t always necessary, if it’s not causing your thyroid to underproduce hormones. Your doctor may recommend simple observation to see how it develops.

If autoimmune thyroid disease is causing hypothyroidism, you will be prescribed treatment with a medication called levothyroxine (or L-thyroxine). This replaces the missing thyroid hormones and makes your thyroid function normally again.

Once your thyroid hormones are at a healthy level, you should be able to conceive and have a healthy pregnancy. A study found that over 76% of infertile women with hypothyroidism got pregnant within 6 weeks to 1 year after starting treatment with levothyroxine.

To boost the health of your thyroid and immune system and improve fertility, be sure to lead a healthy lifestyle by eating a balanced diet and getting regular exercise. Vitamin D, iron, and zinc supplements can boost thyroid health and fertility too, so talk to your doctor about starting supplementation.

As soon as you get pregnant, inform your OB-GYN about your autoimmune thyroid condition. You’ll need to be more closely monitored during pregnancy and may need to alter your treatment plan.

There are several types of diabetes; the most common are type 1, type 2, and gestational diabetes. Diabetes influences health in many ways and can reduce fertility when not carefully managed

Diabetes can mess with the menstrual cycle and make it more difficult to conceive. It can cause oligomenorrhea (when there are 35 days or more between periods) and amenorrhea (absent periods for 6 months or more). Evidence shows that diabetes is linked to higher rates of primary ovarian insufficiency (when the egg reserve gets depleted before the age of 40 and menopause begins). In addition, diabetes is associated with obesity, being underweight, polycystic ovary syndrome (PCOS), endometrial cancer, diabetic complications, and autoimmune disorders, all of which can reduce fertility.

During pregnancy, uncontrolled diabetes can raise the risk of miscarriage, birth defects, stillbirth, and premature birth. It can also increase the chance that your baby is born with breathing problems or low blood sugar levels. But with proper management and a healthy lifestyle, many women with diabetes can conceive and have a successful pregnancy.

Type 1 diabetes occurs when the body’s immune system mistakenly destroys pancreas cells producing insulin. Because of this, the body can’t make insulin.

Type 2 diabetes happens when the body doesn’t produce enough insulin or use it well. Many factors can increase the risk of developing type 2 diabetes, including:

Gestational diabetes refers to diabetes that appears during pregnancy and usually goes away after giving birth. Women who had gestational diabetes in the past have a higher chance of getting type 2 diabetes later in life.

Doctors use a variety of tests to diagnose type 1 and type 2 diabetes and prediabetes

If your doctor believes you to have type 1 diabetes, they may perform a urine test to look for ketones and check your immune system for autoantibodies.

Experts find that diabetes treatment to control blood sugar levels can regulate the menstrual cycle and significantly improve fertility. With proper management, you can have almost equal chances of getting pregnant as women who don’t have diabetes.

Diabetes is treated with insulin, diabetes medications, or both, depending on the type of diabetes you have. Metformin is the most commonly prescribed medicine to treat type 2 diabetes. Careful monitoring of your blood sugar levels, healthy eating, and frequent exercise are key to diabetes treatment.

You can work with a LEVY nutritionist to create a personalized meal plan to help you reach your health and reproductive goals. Eat plenty of nutritious foods rich in fiber and low in fat and calories, like fresh fruits and vegetables, lean proteins, and whole grains for a balanced diet.

Regular physical activity is vital for everyone, especially for people with type 2 diabetes. That’s because exercise lowers blood sugar levels and makes insulin more effective. A good rule of thumb is to get 30 minutes of movement on most days of the week. If you have type 1 diabetes, talk to your doctor about a safe exercise routine to manage blood sugar levels.

During pregnancy, you may need to work with your diabetes specialist to change your treatment plan and ensure that you meet your blood sugar goals because hormonal changes may change your glucose levels. You may need to alter your meal plan, exercise routine, or medication regimen. Additionally, not smoking and taking prenatal vitamins with folic acid can help keep you and your baby healthy.
By fully committing to your care plan and leading a healthy lifestyle, you can reduce your risk for diabetes-related severe health problems and significantly improve your chances of a successful pregnancy.

High prolactin can stop ovulation by preventing the release of gonadotropin hormones, including FSH (follicle stimulating hormone), the hormone in charge of maturing your eggs each menstrual cycle. Hyperprolactinemia can decrease levels of important sex hormones, including estrogen and testosterone. It can also affect progesterone and the luteal phase of your cycle.

Medical experts are unsure what causes a prolactinoma to form. A rare genetic disorder called multiple endocrine neoplasia, type 1, can increase the risk of getting a prolactinoma.

Hyperprolactinemia can be due to the following:

Hyperprolactinemia is diagnosed through a blood test that shows elevated prolactin levels. When prolactinoma is suspected, you will be referred to have an MRI scan of your brain. You should also see an eye doctor (ophthalmologist) to test if a prolactinoma is causing any vision problems. Finally, you may be referred to a specialist in hormonal disorders (endocrinologist) for further testing and treatment.

Hyperprolactinemia and prolactinoma are usually treated with medication (dopamine agonists) which reduce the prolactin levels in the body and increase fertility. These drugs shrink a prolactinoma, get rid of symptoms, and restore the normal functioning of the ovaries.

Rarely, if medication isn’t successful, surgery or radiation therapy may be necessary to remove the prolactinoma.

If your high prolactin levels are due to another medication you’re currently taking, your doctor will recommend lowering your dose or changing your prescription. In case it’s because of hypothyroidism, you will receive treatment with medication that increases your levels of thyroid hormones.

As soon as your prolactin levels are in a healthy range, your menstrual cycle should return to normal, and fertility will be restored.

Hypergonadotropic hypogonadism can disrupt your menstrual cycle by interfering with egg maturation and ovulation and causing periods to stop (a condition called amenorrhea). Amenorrhea can either be primary (never getting a period) or secondary (periods stop for at least 3-6 months).

Women under 32 with primary ovarian insufficiency generally have the same chances of getting pregnant per cycle as other women their age with a normal egg reserve, but a smaller time frame to build their family. Once the egg reserve is used up and menopause begins, it’s no longer possible to get pregnant.

Here’s what can cause hypergonadotropic hypogonadism:

Healthcare providers use several tests to diagnose hypergonadotropic hypogonadism. After assessing your symptoms and medical history, diagnostic tests may include:

If your tests show low estrogen levels, you may be recommended to get a bone density scan (called a DEXA scan) to check your bone metabolism.

Women with hypergonadotropic hypogonadism and suspected POI are recommended to visit a fertility clinic as soon as possible for treatment to have the best chances of getting pregnant. Hormone replacement therapy with estradiol and progesterone can restore balance to your reproductive hormones.
IVF is also a good option to help women with a depleted egg reserve conceive. You can take hormonal medication which stimulates the ovaries to mature and release eggs during ovulation. During IVF, several mature eggs are retrieved from the ovaries, placed in a petri dish together with sperm, and a fertilized egg gets implanted into the uterus. You can choose to freeze eggs or embryos for use in a later IVF cycle, in case you need to try again or want to have another baby later on. If there aren’t enough eggs left in the ovaries, you can also consider using donor eggs for IVF.

Hypogonadotropic hypogonadism prevents eggs from maturing in the ovaries. This leads to irregular or absent periods due to irregular ovulation. Without ovulation, there’s no egg available to be fertilized by sperm, and it’s not possible to get pregnant.

This condition can be due to the following:

Kallmann syndrome is a type of hypogonadotropic hypogonadism that is genetically inherited.

Tests to diagnose hypogonadotropic hypogonadism include blood tests that measure your levels of FSH, LH, thyroid stimulating hormone (TSH), prolactin, testosterone, and estradiol, as well as a test to check how LH responds to GnRH.

If testing shows that you have a low estradiol level, it’s recommended to get a bone density scan (called a DEXA scan) to check your bone metabolism.

If your doctor suspects you have a tumor on the pituitary gland, they will recommend you have an MRI scan of the brain. You may also have genetic testing and a blood test of your iron level.

To get the ovaries working normally and restore fertility, you can get injections of GnRH and hCG or take clomiphene. These medications help you ovulate again so that you can conceive. Research shows that this is successful at inducing ovulation in people with hypogonadotropic hypogonadism up to 80% of the time.

If the ovaries respond poorly to the medication, fertility treatment with assisted reproductive technology (ART) is an option to increase the chances of getting pregnant.

Beyond that, lifestyle modification measures such as stress reduction and weight gain if you are underweight can restore balance to your reproductive hormones and regulate the menstrual cycle.

PCOS causes an imbalance of the reproductive hormones FSH (follicle stimulating hormone) and LH (luteinizing hormone), which prevents eggs from maturing and getting released from the ovaries through ovulation. Instead they get stuck to the ovaries.

PCOS usually also causes the body to produce too many androgen hormones, which is another condition called hyperandrogenemia. Having an excess of these male sex hormones can make women experience hair loss or excess hair growth, a deeper voice, and increased muscle mass.

PCOS can interfere with the menstrual cycle and ovulation. If there’s no egg available to be fertilized by sperm, it’s not possible to get pregnant. PCOS is the leading cause of anovulatory infertility. However, it’s important to note that this condition is very diverse and impacts women differently, so not everyone with PCOS experiences difficulty conceiving.

Doctors are unsure why someone develops PCOS, but believe it could be caused by a mix of genetics, inflammation in the body, and environmental factors. It may also happen as a consequence of insulin resistance, which can develop as a result of eating an unhealthy, unbalanced diet and not being physically active.

PCOS can vary a lot from woman to woman and there are different levels of severity. Some may have no physical symptoms and don’t realize that they have PCOS, while others have them all.

About half of women with PCOS are overweight and have insulin resistance, which is a precursor to type 2 diabetes. Obesity may act as a trigger for PCOS in some. But there are also plenty of women who are slim or almost underweight with PCOS.

In order to be diagnosed with PCOS, you must have 2 of the following 3 criteria:

While there’s currently no official cure for PCOS, many treatments are available to alleviate symptoms and help women conceive.

Women with PCOS are often prescribed the birth control pill to stabilize the menstrual cycle and reduce symptoms including hair loss, acne, etc. After stopping the pill, the cycle usually becomes irregular again and symptoms can return.

Research has found that for women who are overweight, losing 5 to 10% of their body weight helps regulate the cycle and lessen some PCOS symptoms. But if you’re not overweight, weight loss unfortunately won’t help manage symptoms.

Adopting a PCOS diet and minimizing processed sugars and saturated fats can reduce inflammation while improving symptoms and fertility. Check out our article on foods to help with PCOS to learn more. With expert nutritional coaching, many women are able to successfully conceive.

If you have insulin resistance, therapy with an insulin sensitizer called metformin can improve the body’s metabolization of sugar as well as cycle problems and other PCOS symptoms. Supplements such as myo-inositol can also help with insulin resistance and cycle irregularities.

Beyond that, there are medicinal plants scientifically proven to boost fertility. One well-known example is Agnus castus, AKA monk’s pepper. This plant directly impacts the pituitary gland, normalizing hormone production and stabilizing the cycle.

If necessary, medication is available to stimulate the ovaries to ovulate, such as letrozole and clomiphene. One study found that 80% of women with PCOS who took clomiphene ovulated successfully, and half got pregnant naturally within six cycles. If that’s unsuccessful, treatment with a low-dose of FSH is another option to make the ovaries release a mature egg with ovulation.

In cases where the ovaries don’t respond to hormonal medication, a minimally invasive surgical procedure called ovarian drilling can help lower testosterone. This can normalize the menstrual cycle and help the ovaries release an egg each month. Research shows that 70% of women who didn’t respond to hormonal medication were able to get pregnant within 6 months of the surgery. Because of the treatment’s success and reduced risk of multiple pregnancies (which can happen with medication to stimulate the ovaries), it may become the first choice for treatment in the future.
Finally, assisted reproduction treatments (IVF or ICSI) can help you conceive if other treatments don’t work.

Insulin resistance can affect female fertility in many ways. It can reduce ovarian function, slow egg maturation, and cause infrequent ovulation due to imbalances of testosterone and estrogen. High blood sugar and insulin resistance can also lead to birth defects.

Several factors may trigger insulin resistance or increase the risk of developing it, such as:

To diagnose insulin resistance, healthcare providers take several factors into consideration. They will check your medical and family history, do a physical exam, and run some tests. One of these tests isthe fasting blood glucose test, which measures your blood sugar level after not eating or drinking anything for 8-10 hours. The A1c test is another diagnostic test that measures your average level of blood glucose across the previous 3 months.

The good news is that you can greatly improve insulin sensitivity and fertility while preventing prediabetes and type 2 diabetes by making some key lifestyle changes. Research shows that when overweight people lose 10% of body weight through regular exercise and eating a healthy diet, insulin sensitivity can improve by over 70%.

When it comes to nutrition, aim to incorporate more plant-based foods into your meals, as these can improve insulin sensitivity, and less meat, which increases insulin resistance and raises the risk of gestational diabetes. For more nutritional advice, check out our articles on fertility foods for women and dietary tips for PCOS, and book a consultation with a LEVY nutritionist. You may also want to check your blood sugar after eating to learn how specific foods affect your glucose levels.

A doctor may also prescribe metformin, a diabetes medication, to improve insulin sensitivity and prevent diabetes. Metformin can help women with PCOS and insulin resistance ovulate and reduce the risk of miscarriage.

When sex is painful, it may make you want to avoid it around ovulation. It may also lead to problems with a male partner’s sexual performance as he doesn’t want to hurt you. Infections and gynecological conditions including pelvic inflammatory disease, endometriosis, and scarring on the reproductive organs, as well as diabetes and thyroid problems, can also lead to painful sex while reducing fertility.

Many things can cause pain during sex. Superficial dyspareunia is pain in the vulva, the area around the vaginal opening, the skin inside your vagina, or in the area between your vagina and anus. It can be due to:

Deep dyspareunia is pain in the pelvic area, uterus, bladder, lower back, or the front of the thighs. It has the following causes:

Chronic conditions including diabetes, thyroid disease, and arthritis as well as cancer treatments can also lead to pain during sex.

Superficial dyspareunia is an instant pain at the vaginal opening that usually stops after sex.

Deep dyspareunia is a sharp or dull pain deep in the pelvis that starts during sex and may continue for several minutes or even hours after you stop having sex.

In order to find what’s causing you to experience pain during sex, you should have an open and in-depth conversation with your healthcare provider about where exactly you feel the pain, how it feels, when it started, and if you feel it in all positions. Be sure to mention any prior surgeries you’ve had in the pelvic area.

Then you can get a pelvic exam where your OB-GYN will check to see if you have any skin irritation, infection, or structural problems. You may also have an ultrasound of your pelvic area so that your doctor can take a look at your reproductive organs

There are many ways to treat dyspareunia so that you can enjoy sex again. First it’s important to figure out what is causing the pain so you can start targeted treatment. This could involve medication, a minimally invasive procedure (such as laparoscopy), or a surgical operation.

There are also medications to increase vaginal lubrication (Ospemifene) and relieve pain during sex (Intrarosa).

You may also want to explore mind-body therapeutic techniques to lessen pain and any negative emotions that have built up around sex due to dyspareunia. If it has put a strain on your relationship, you may consider doing psychological counseling or sex therapy.

In addition, Kegel exercises strengthen and relax the pelvic floor muscles, improve circulation to the area, and decrease pain during sex and pelvic exams.

Getting into a relaxed state, like by taking a warm bath and using aromatherapy beforehand, can be helpful for reducing pain and anxiety surrounding sex too.

Amenorrhea is the medical term for when a woman doesn’t get her monthly period. There are times in life when this is supposed to happen, like when you’re pregnant, breastfeeding, or after menopause. But amenorrhea can also be caused by hormonal issues, structural problems with the reproductive organs, lifestyle factors or genetic disorders. The term comes from the Greek words “a”, “men”, and “rhoia” meaning “no monthly flow”. It is not a disease and it does not mean that you are infertile. 3-4% of women have amenorrhea.

There are two different types of amenorrhea :

When you don’t get a period by the time you reach 15, this is called primary amenorrhea . Less than 0.1% of women have this type of amenorrhea.

When you don’t get a period for 6 months or 3 cycles and you previously had a regular period before, this is called secondary amenorrhea . About 4% of women have this type of amenorrhea.

Amenorrhea can be temporary or permanent. A woman normally menstruates every 23 to 35 days. In general, if your period is irregular or if there are more than 35 days between periods, your doctor will check you for amenorrhea.

There are many causes of amenorrhea. Let’s go through each of them:

Hormonal issues can also lead to amenorrhea. Sometimes, there is a problem with your hypothalamic pituitary-gonadal axis. This is the dialogue between two parts of your brain, the hypothalamus and pituitary gland (which produces hormones) and your ovaries. Other hormonal causes include:

Doctors use different tests to check for amenorrhea and find out what’s causing it. First you will get a pelvic exam to check for any structural issues with your reproductive organs. After getting a pregnancy test to rule that out as the possible cause, you’ll get a variety of blood tests to check your hormone levels:

After getting the results of your blood tests back and depending on any other symptoms you have, your doctor might recommend further imaging tests such as ultrasound or magnetic resonance imaging (MRI) to get to the bottom of your missed periods.

As there are so many potential causes of amenorrhea, the treatment will depend on why it’s happening. Some treatments aim to re-start your period through birth control pills or other types of hormonal therapies. For instance, hormonal treatments are used to help with fertility issues. But medications used for some ovulatory disorders (like clomiphene) may not work because of the problems with the dialogue between the hypothalamus and pituitary gland. To make you ovulate, gonadotropin releasing hormone (GnRH) or a combination of luteinizing hormone (LH) and follicle stimulating hormone (FSH) can be injected. If your period doesn’t start again after these hormonal treatments, your doctor may discuss options for assisted reproduction treatments, such as intrauterine insemination (IUI) and in vitro fertilization (IVF). Unfortunately, if primary ovarian failure is the cause of your amenorrhea, there’s no treatment that can increase your egg reserve.<br />Because lifestyle can be a factor, strive to maintain a healthy weight, and avoid extremes of being over or underweight and exercising too much. Be sure that you’re getting enough rest to manage stress levels too. Try some relaxation techniques like meditation, yoga, and taking warm baths. If you need, don’t hesitate to reach out to family, friends, or a mental health professional to help you learn new strategies to reduce stress.

If you’ve missed several periods in a row, check in with your doctor to find out what may be causing it. Depending on why you have amenorrhea, treatments can help your periods come back so you can get pregnant.

In IVF, medications such as human chorionic gonadotropin (hCG) are used to help your ovaries mature multiple eggs at once. In some women, this stimulation can be excessive, causing the ovaries to swell and leak fluid into the abdomen and, in rare cases, into the chest.

This fluid shift is caused by increased vascular permeability, meaning that blood vessels become unusually leaky. The result is fluid moving out of the blood vessels and accumulating in body cavities. This can lead to bloating, abdominal pain, nausea, and in more severe cases, dehydration, difficulty breathing, and blood clots.

OHSS is classified into three types:

• Mild: Abdominal discomfort, bloating, and slight weight gain.
• Moderate: Increased abdominal swelling, nausea/vomiting, diarrhea/constipation
• Severe: Rapid weight gain, severe pain, shortness of breath, decreased urination, and blood clots.

• Age under 30
• Polycystic Ovary Syndrome (PCOS) – due to higher sensitivity to stimulation
• High Antral Follicle Count (AFC) – meaning more potential follicles to stimulate
• High levels of Anti-Müllerian Hormone (AMH) – indicating a high ovarian reserve
• Previous episode of OHSS
• Use of hCG to trigger ovulation or support the luteal phase
• High number of follicles and/or high estradiol levels at time of trigger
• High number of oocytes retrieved

Women who become pregnant in the same cycle may also experience worsening OHSS symptoms, as pregnancy increases natural hCG production, which can prolong or intensify the condition.

The Anti-Müllerian Hormone is a hormone produced by small ovarian follicles and is often measured to assess ovarian reserve. High AMH levels generally mean a higher number of follicles and a greater response to stimulation. Research shows that AMH is one of the best indicators for predicting the risk of ovarian hyperstimulation syndrome. In fact, AMH may be even more accurate than other common markers like estrogen levels or ultrasound findings.

Different labs use different types of assays, so the “cutoff” value, i.e. the point at which risk increases, can vary. Depending on the assay, an AMH greater than 3.4 ng/mL or 5 ng/mL puts you at increased risk of OHSS. Please make sure your physician is familiar with the AMH assay used and its respective cutoff value. Typically, clinics also have in-house cutoff values for concern for OHSS that are based on their patient cohort.

At LEVY Health, we interpret your AMH according to your age and the assay used, so you’ll have the most accurate assessment of your OHSS risk.

Doctors can use your AMH level to create a personalized medication plan for IVF. This helps lower the chance of OHSS. In studies where AMH was used to guide treatment, the number of women who developed OHSS dropped significantly—for example, from 19.8% to 11.2%, or even as low as 1%.

Early recognition of symptoms is crucial. If you experience any of the following, especially in the days after egg retrieval or embryo transfer, contact your fertility clinic or doctor immediately:

• Rapid weight gain (more than 5 pounds/2.3 kg in the 1st few days following retrieval)
• Severe or worsening abdominal pain and bloating
• Nausea or vomiting that prevents you from eating or drinking
• Decreased urine output or dark urine
• Shortness of breath or chest pain
• Leg swelling or sudden tenderness (possible sign of blood clot)

Mild to moderate OHSS is often managed at home with rest, adequate fluid intake, and careful monitoring. Your doctor may recommend rest, monitoring your fluid intake and urine output, avoiding vigorous exercise/activity, and weighing yourself daily.

Severe OHSS may require hospitalization for IV fluids, monitoring of kidney function and electrolytes, drainage of excess fluid, or anticoagulants to prevent blood clots.

If you are not a good candidate for becoming pregnant based on your risk for OHSS, your physician may recommend a frozen transfer in a later cycle (so not a fresh transfer days after the retrieval). This is to ensure that you can recover from OHSS before you become pregnant given the high risk of severe OHSS in setting of both OHSS and pregnancy. However, if you do happen to develop severe OHSS while you are pregnant, your doctors will recommend hospitalization for close monitoring as mentioned above.

Yes. Doctors take several steps to reduce the risk:

• Adjusting medication doses based on your individual hormone levels and follicle response
• Using a “GnRH agonist trigger” instead of hCG for ovulation if you’re high-risk
• Considering a “freeze-all” approach, where embryos are frozen and transfer is delayed to avoid OHSS worsening from pregnancy
• Monitoring estradiol levels and follicle count closely during stimulation

When choosing your fertility clinic, please inquire how often complications such as OHSS occur in this clinic and if there is an altered medication regime in place if you have a high AMH or PCOS. Ideally, fewer than 5% of cycles are affected by OHSS. Ask for instructions in case you experience symptoms, and who should call.