Knowledge Centre

Luteinising hormone is an important cycling hormone, involved in the regulation of the menstrual cycle and ovulation. But what happens when our levels get a little off balance? In this article, we’ll explain exactly what luteinising hormone is, how it works, and take a deep dive into its importance for female fertility. We’ll also take a look at LH levels and why they’re important, as well as how to recognise the symptoms of low or high LH. Quick facts: What is Luteinising Hormone (LH)?  Luteinising hormone (LH) plays a huge role when it comes to fertility and ovulation, despite it being one of the lesser-known cycling hormones. Luteinising hormone (LH) is what’s known as a gonadotropin hormone. There are only two types of this hormone, LH and its partner in crime, follicle-stimulating hormone (FSH). Gonadotropins are hormones that are released from the pituitary gland in the brain, into the bloodstream where they are transported to the gonads—or ovaries in those assigned female-at-birth and the testes in those assigned male-at-birth. LH has 3 main functions in those assigned-female-at-birth:  Oestrogen production LH works in tandem with FSH to stimulate the ovaries and surrounding cells to produce oestrogen. First, LH stimulates what’s known as theca cells in the ovaries, which then produce testosterone. Once testosterone is abundant, nearby granulosa cells are then stimulated by FSH to produce an enzyme called aromatase, which converts the testosterone into a type of oestrogen, oestradiol, or E2. Without the correct functioning of LH or FSH, testosterone and oestrogen production can become impacted. Ovulation LH is also crucial for successful ovulation. First, FSH stimulates the growth of follicles (small sacs that contain your eggs) in your ovaries. A number of eggs mature during the first half of your cycle, but only one gets released during ovulation—usually the ‘most mature’ follicle. In the days leading up to ovulation, this follicle increases its sensitivity to LH. It gradually produces more and more E2 and when this reaches a certain level, the pituitary gland releases a surge of LH. This LH surge is what causes the follicle to rupture and release the mature egg into the fallopian tube—triggering ovulation. Progesterone production After ovulation has occurred, LH stimulates the now empty follicle to start producing progesterone throughout the second half of the menstrual cycle—also known as the luteal phase. Both progesterone and E2 released by the empty follicle are intended to support conception, implantation and the early stages of pregnancy. However, if the egg is not fertilised and no embryo implants into the uterus, the empty follicle stops producing these hormones and eventually wastes away at the end of the menstrual cycle. What are normal LH levels in women? LH levels in women, or those assigned-female-at-birth, fluctuate during the menstrual cycle—so their levels will vary depending on where you are in your monthly cycle. LH levels can also vary depending on an individual’s age and whether they’re pregnant. Normal LH levels for women before menopause are around 5-25 IU/L, depending on the stage of the menstrual cycle. After menopause, normal LH levels range from around 14-52 IU/L. LH levels during the menstrual cycle Let’s take a closer look at how LH fluctuates during the menstrual cycle. As we mentioned earlier, a dramatic surge in LH around the middle of the cycle triggers ovulation. But after ovulation, LH production is dulled by rising levels of progesterone. If no pregnancy occurs and progesterone levels fall, LH production will start again anew at the beginning of the next cycle. LH levels during pregnancy During early pregnancy, LH levels remain low—blocked by continued progesterone production. High levels of human chorionic gonadotropin (hCG) released throughout pregnancy also ensure that they stay low throughout pregnancy, so no further ovulation is triggered. LH levels in menopause During menopause, LH levels become elevated, although this can vary from person to person. This increase in LH levels happen as a result of the general decline in hormone production by the ovaries. When the ovaries stop producing as much oestrogen and progesterone, the pituitary responds by increasing the production of FSH and LH, in an attempt to stimulate the ovaries. However, the ovaries become less responsive and, instead, LH levels rise. This rise in LH levels is associated with a lot of the typical symptoms of menopause, including hot flashes and night sweats. After menopause, LH levels can decline by around 30-40%. High LH levels High LH levels in females outside of normal menstrual cycle fluctuations can cause fertility problems, irregular periods and early puberty. High LH levels are often seen in people with primary ovarian insufficiency and in those with polycystic ovary syndrome (PCOS) often have elevated LH compared to their FSH. This unusual imbalance can lead to irregular periods and the overproduction of testosterone, both key symptoms of PCOS. Sometimes LH levels can become elevated due to dietary and lifestyle factors, including: Symptoms of high LH levels Symptoms of high LH levels in females are more related to the underlying cause than the LH itself. However, some of the most common symptoms associated with the causes of high LH levels include: How to lower LH levels If your LH levels are elevated and you are a regular smoker or drinker, consider taking steps to reduce these habits. If you’re trying to conceive, consider cutting alcohol and cigarettes completely as this will improve your chances of conception and prevent harmful effects to the baby during pregnancy. Low LH levels There are also a number of reasons why low LH levels might occur. Meningitis infections that have occurred in the last 12 months have been linked to low LH levels and so have eating disorders. Sometimes, LH levels can be decreased due to dietary and lifestyle factors as well as certain medications including: Low LH levels in females can lead to problems with ovulation. This includes anovulation, which is not ovulating at all. This can also lead to problems with menstruation, such as irregular, missing, or complete cessation of periods. Symptoms […]

If you’re trying to conceive, or thinking about trying soon, it’s a good idea to get clued up about how alcohol can impact fertility and your chances of conception. Read on to find out how drinking can impact female and male fertility. Quick facts: The relationship between alcohol and hormones If you’re trying to conceive, or beginning to think about starting a family, chances are you’ve probably recommended to stop, or at least cut down, drinking alcohol…  Not exactly the news most of us want to hear, but unfortunately alcohol consumption can affect our fertility (in both women and men) and therefore, our chances of conceiving. Although all alcohol can affect fertility, new research has indicated that in those assigned-female-at-birth, both the timing of alcohol consumption, in relation to where we are at in our menstrual cycles, and the quantity we drink can determine how bad it’s negative effects are.  But do we need to cut the vino out all together? Or is there space to find a happy medium? Let’s take a look at exactly how alcohol and fertility are linked and what the effects of drinking are at different stages of the menstrual cycle and conception. Can you drink while trying to get pregnant? Any form of alcohol consumption may impact our ability to get, and stay, pregnant.  Less is known about alcohol’s effects on fertility and chances of conception than about its harmful effect on pregnancy, but overall the NHS currently recommends that alcohol should be avoided by women who are actively trying to conceive. This is to keep any possible risks to a baby that might be conceived to a minimum, as we may not know that we’re pregnant until a few, or more, weeks into a pregnancy.  If we’re drinking and do become pregnant, we may risk unintentionally exposing the baby to alcohol. Since there is no known safe level of alcohol for a developing foetus, the safest approach is to avoid it.  Additionally, as we mentioned before, alcohol will also affect our ability to get pregnant in the first place—so if we’re trying to conceive, it’s also best to reduce our drinking to a minimum. Does alcohol affect fertility? In short yes—any form of alcohol consumption has been found to affect both female and male fertility. Some studies suggest that even low to moderate alcohol consumption, which is classed as two drinks or less per day, can be associated with reduced fertility in both men and women.  However, there have been some recent studies that suggest in women, timing of alcohol consumption can play a part in determining its negative effects on our ability to conceive. Let’s take a look at female fertility and alcohol a little more closely… Female fertility and alcohol A recently published study by the University of Louisville was the first of its kind to investigate alcohol consumption’s effects on fertility during different phases of the menstrual cycle. Whilst researchers observed a significant association between heavy drinking and a reduced likelihood of conceiving at all points during the menstrual cycle, light to moderate drinking varied significantly.  The study found that when participants drank in moderation, around 3-6 alcoholic drinks per week, during the luteal phase (the second half of the menstrual cycle, after ovulation), it resulted in a 44% reduction in the chance of conceiving compared to non-drinkers.  However, during the follicular phase (the first half of the menstrual cycle, before ovulation) and during ovulation, only heavy drinking was associated with a reduced chance of conceiving. Light and moderate drinking during these phases did not impact the participants chances of conceiving compared to non-drinkers. Why does alcohol affect fertility? Although the exact cause isn’t known, it’s been suggested that alcohol disrupts hormone levels, which in turn, can have knock-on-implications for our fertility.  Studies have shown that alcohol intake is associated with an increase in levels of oestrogen, Follicle Stimulating Hormone (FSH) and  Luteinising Hormone (LH), in addition to a decreasing our progesterone levels. In those assigned-female-at-birth, disrupting just one of these sex hormones can disrupt the menstrual cycle and our ability to ovulate, thus reducing our chances of conceiving.  Aside from its effect on our hormone levels, alcohol also negatively impacts our general health—which can lead to knock-on impacts for our fertility, making it harder to get, and stay pregnant, in addition to raising the risk for foetal conditions and other birth complications. Male fertility and alcohol Despite most conversations centering on female responsibility when it comes to fertility—it’s important to remember that male fertility is also affected by alcohol consumption.  Similarly to those assigned female-at-birth, alcohol also disrupts the normal balance of hormones in men—including reducing testosterone levels, which again becomes more pronounced with heavy drinking over a longer period. Does alcohol affect sperm? A study of 1221 men in Denmark found that sperm quality decreased in men who reported drinking more than 5 units (around 3 small beers) of alcohol a week. This decrease in sperm quality became even more pronounced in men who reported drinking over 25 units of alcohol in a typical week (around 10 pints of beer). Can a man drink alcohol while trying to conceive? Although alcohol intake in men when trying to conceive will not harm any possible pregnancy that may occur, as mentioned above, it will likely affect their sperm quality, and thus, their sperm’s ability to fertilise an egg. Tips for reducing your alcohol intake  Understandably, cutting out alcohol all together can be a challenge for many of us, despite its health benefits. But if you’re keen to reduce your alcohol intake (for your fertility or just in general) here are some of our top tips to get you started: There are also a number of really great sources which provide more detailed advice for reducing your alcohol intake, including the NHS, Support Line and Drink Aware. Need some guidance on your fertility journey? Our clinically validated at-home hormone and fertility tests are tailored to you and your health needs, […]

Sex hormone-binding globulin (SHBG) is an important protein involved in the regulation of our sex hormones and in turn our ability to conceive. So what is a good, or ‘normal’ range for our SHBG levels? And how do we know when ours might be too high or too low? We’ve broken down all you need to know about SHBG levels, including what they mean, why they matter and what to do if you suspect yours might be out of range. Quick facts: What is SHBG? SHBG is an important protein that regulates the amount of testosterone and oestrogen available in the body by ‘binding’ to these hormones—which makes them inactive. This is because to bring about an effect in the body, hormones need to be unbound or free so they can enter cells and bring about their effect. The vast majority of testosterone and oestrogen in our bodies is bound to SHBG and other proteins. SHBG also controls the balance between testosterone and oestrogen, which is also important for the healthy functioning of our menstrual cycles. Why do SHBG levels matter? Because SHBG levels regulate the amount of testosterone and oestrogen available to be used by the body, if our SHBG levels are too high or low, this will have a knock on effect on our levels of both of these sex hormones.  If our SHBG levels are higher, we’ll have less free testosterone or oestrogen available. If our SHBG levels are lower, we’ll have more testosterone and oestrogen available.  Both of these sex hormones have important roles in the regulation of the menstrual cycle, ovulation, libido, energy levels and our mental health. Low SHBG When our SHBG levels are low, our levels of free unbound testosterone and oestrogen can become high. Let’s take a look at some of the symptoms, causes and what can be done to help. Symptoms of low SHBG These symptoms can often mirror those of excess testosterone including: Or excess oestrogen: Causes of low SHBG There is no single cause for abnormal SHBG levels, although increases in insulin, prolactin and androgens have been found to block SHBG production which could be a factor for those with low SHBG levels.  Low SHBG can also be caused by a number of lifestyle factors, certain medical conditions and genetics. Here are several conditions, as well as other factors, that low SHBG has been found to be associated with: How to raise low SHBG If you have low SHBG there are a number of lifestyle changes that may help to increase your levels. These include: High SHBG  On the flip side, when our SHBG levels are too high, our unbound testosterone and oestrogen can become abnormally low. Here are some symptoms, causes and what can be done to reduce high levels of SHBG. Symptoms of high SHBG These symptoms can often mirror those of low testosterone including:  Or low oestrogen: Causes of high SHBG Again, there is no single cause for abnormal SHBG levels, although as we mentioned previously, increases in oestrogen and thyroxine (T4) have been found to increase SHBG production, which could be a factor for those with high SHBG levels. There are also a number of conditions associated with high SHBG which include: How to lower SHBG Dietary changes are the most effective way to lower SHBG levels. Decreasing alcohol consumption, gaining weight if you have a low BHM and following a high-fat, low fibre diet may help decrease levels of SHBG. One study involving 48 premenopausal women showed that maintaining a high-fat, low diet decreased SHBG. However, more clinical studies are required to confirm this association. If the levels are elevated due to contraception use, this will usually return to normal levels once you stop using that contraception. Other possible causes such as type 1 diabetes and an overactive thyroid will need further investigation and will require medication specific to these conditions. SHBG tests Ultimately, if you suspect you may have abnormal levels of SHBG, the only way to definitively get a diagnosis is via a blood test. Because symptoms of abnormal SHBG levels can mimic those of high or low oestrogen and testosterone, your SHBG levels should be tested in tandem these hormones. You can test all of these hormones and more, with a Hertility at-home Hormone and Fertility Test. Resources:

Follicle-stimulating hormone (FSH) is really important for our reproductive health. In this article, find out how to know what normal FSH levels look like, what the symptoms of high and low FSH levels are and how to balance your FSH levels. Quick facts: What is FSH?  FSH stands for Follicle-Stimulating Hormone and is one of the main hormones involved in the regulation of your menstrual cycle and ovulation—making it an important hormone not only for your health but your fertility too. FSH is what’s known as a gonadotropin hormone. It’s released by the pituitary gland in the brain and then acts on the ovaries.There is only one other gonadotropin hormone in the body—luteinising hormone (LH). True partners in crime, there’s no FSH without LH, and they act in tandem to bring about changes which essentially regulate ovulation. Normal FSH levels in women Because our FSH levels are intricately linked to our ovarian reserve, what’s considered a ‘normal’ FSH level changes as we age. This is because our ovarian reserve declines as we age which makes our FSH levels increase.  Gonadotropic hormones are hormones released from the pituitary gland in the brain and released into the bloodstream. Gonadotropins then go on to act on the ovaries. There are two types of gonadotropins, follicle-stimulating hormone (FSH) and luteinizing hormone (LH).  The pituitary gland produces FSH which acts on the ovaries to stimulate the growth of follicles containing your eggs. As well as growing the ovarian follicles, FSH stimulates the granulosa cells that surround the follicle to produce oestrogen from testosterone, an essential hormone for regulating the menstrual cycle (1). You can read more about oestrogen here.  What does FSH do? FSH has two primary functions:  Follicular development FSH does pretty much exactly what it says on the tin—it stimulates the growth of follicles which contain your eggs.  You’re born with ‘immature’ eggs. So each month, a number of them start maturing before one is released during ovulation. Your eggs are housed in tiny follicles inside your ovaries, and it’s these follicles that FSH signals to prepare your eggs for ovulation (2). Oestrogen production FSH also stimulates the cells that surround the follicles to make an enzyme called aromatse, which converts testosterone into oestrogen, another essential hormone for regulating the menstrual cycle and reproductive health (1). The relationship between FSH and LH When your eggs are fully mature and ready to be released during ovulation, LH steps in. A surge of LH is released, again by the pituitary gland in the brain, causing the most mature follicle to rupture—releasing an egg into your Fallopian tube. This is ovulation.  Despite FSH causing numerous follicles, and therefore numerous eggs, to mature each cycle, only one follicle will release an egg each month. This is because FSH and LH are both involved in negative feedback loops, controlled by E2. But what does negative feedback loop mean? Increasing FSH levels in the early stages of your menstrual cycle leads to more oestrogen being made, but this ha, a negative feedback effect on FSH levels. In other words, when you have lots of oestrogen, it feeds back to the brain that it needs to stop making more FSH. Similarly, with LH, oestrogen levels keep increasing through the cycle and once they reach a peak around the middle of the cycle, it causes a sudden surge in LH that promotes ovulation. After ovulation, the empty follicle that once contained the egg makes another hormone, progesterone, to support conception, implantation and the early stages of pregnancy. High levels of progesterone tell the brain to stop making more FSH. Now if a pregnancy doesn’t happen, there is a drop in oestrogen and progesterone which triggers your period. It also tells the brain it needs to start making FSH to start the whole process all over again in the next menstrual cycle (5). High FSH levels Okay, but what happens when we have high FSH levels? Let’s take a look at the causes and symptoms of high FSH levels. What causes high FSH levels? The most common reason for high FSH levels is a low ovarian reserve (egg count), or ovaries that aren’t functioning properly. When we have a low ovarian reserve, this essentially means we have a smaller number of immature follicles available in our ovaries and our bodies will produce less oestrogen.  Because oestrogen controls how much FSH we produce (remember that negative feedback loop), when we have less oestrogen, our FSH levels may go up.  High FSH levels can therefore indicate that our ovaries aren’t functioning properly, be an indicator of low ovarian reserve or an indicator of the onset of menopause. Other reasons for high FSH levels can be ovarian cancer (although this is very rare) (9) and Premature Ovarian Insufficiency (POI) which is the loss of ovarian function before the age of 40 (6,7). In some cases, dietary and lifestyle factors can moderately raise FSH levels. Symptoms of high FSH levels Symptoms of high FSH levels usually mimic symptoms of menopause and are related to low oestradiol levels —which is why it’s so important to test a range of your reproductive hormones to get to the bottom of symptoms. Symptoms can include: How to lower FSH levels? It is important to understand that if high FSH levels have been caused by menopause or a low egg reserve, modifications to your diet or lifestyle will not be able to reverse this. However, there are some dietary lifestyle factors associated with a higher FSH, such as smoking and high alcohol consumption.  If you’re trying to conceive, consider cutting alcohol and cigarettes completely as this will improve your chances of conception and prevent harmful effects to the baby during pregnancy (17). For advice on how to quit smoking, see the full list of NHS quit smoking services here. Nutrition can be a really powerful tool in balancing hormones and helping to alleviate symptoms. You can book a nutritional health consultation with one of our registered nutritionists via your health hub. […]

A common symptom of endometriosis is fertility issues. Up to 50% of people with endometriosis will struggle to conceive, with the causes still relatively unknown. Here take a deep dive into what you need to know about your fertility if you have diagnosed or suspected endometriosis. Quick facts: What is endometriosis? Endometriosis is a reproductive health condition where tissue similar to the lining of the womb grows in other places. This is called endometrial tissue. This tissue can grow in the ovaries and fallopian tubes and can cause painful symptoms.  It’s one of the most common reproductive health conditions. 1 in 10 women and those assigned female-at-birth (AFAB) will develop endometriosis, yet its definitive cause is still unknown.  As a long-term condition, endometriosis can significantly impact some people’s lives. One of the most common concerns is how does endometriosis affect fertility? Will endometriosis affect my fertility? In short, it might. Fertility problems are common in those with endometriosis, with 30-50% experiencing fertility problems (1). But having endometriosis does not automatically mean you will have fertility problems—every case is different. It will depend on the severity of your symptoms and any structural or hormonal issues you may have.  Is it possible to get pregnant with endometriosis? Yes, it’s possible to get pregnant with endometriosis. However, you may experience difficulty getting pregnant. Those with endometriosis have a lower chance of getting pregnant with each monthly cycle (2). This can result in it taking longer for people with endometriosis to conceive (3).  Infertility is also common in those with endometriosis, and in subfertile (failure to conceive after one year of trying) women the prevalence seems to be considerably higher, ranging from 20% to 50%, but it varies with time and age (1). How does endometriosis affect fertility? Again, not necessarily. But those with endometriosis are at an increased risk of miscarriage, ectopic pregnancy and other obstetric complications compared to those without (4). How does endometriosis affect fertility? Exactly why and how endometriosis affects fertility is still unknown. But here are the latest theories of possible links and causes.  Structural issues One of the ways endometriosis is likely to affect fertility is by distorting the position of reproductive organs. Growth of endometrial tissue and adhesions around the uterus and Fallopian tubes can cause this distortion. In turn, this may block mature eggs from reaching the uterus to be fertilised. The risk of blocked Fallopian tubes, in particular, increases in the more advanced stages of endometriosis.  Endometriomas The presence of cysts on your ovaries, called endometriomas, could also affect fertility and ovulation. Endometriomas can damage ovarian tissue and the precious ovarian follicles which house immature eggs.  Immune reaction Another theory is an immune reaction to endometrial tissue growing outside the uterus. This is because this tissue is recognised as ‘foreign’ to these parts of the body. The immune system responds by attacking it, causing inflammation. Inflammation leads to harmful toxins which may affect Fallopian tube function, sperm function and egg quality (5). Womb reciprocity There is also debate about whether endometriosis affects the receptivity of the womb to a fertilised egg. However, there is currently no conclusive evidence to prove this theory.  Painful sex Painful sex is one of the symptoms associated with endometriosis. Pain during or after intercourse can negatively impact your sex life and make the trying-to-conceive process difficult. Can treating endometriosis improve fertility? Various treatments for endometriosis that aim to improve fertility. The right ones for you will depend on the location and severity of your endometriosis and what your symptoms are.  One treatment that aims to improve fertility is laparoscopic surgery. This is surgery to remove the endometrial tissue deposits and adhesions. It aims to free the pelvic organs of any structural issues or blockages and reduce inflammation.  For people with endometrioma, laparoscopic ovarian cystectomy can remove the endometriosis-related cysts on the ovaries (6). This has been shown to lower the recurrence rate of both cysts and pain symptoms.  However, there are risks associated with any surgery. For example, ovarian cystectomy can also negatively affect ovarian reserve by the removal of healthy tissue.  It’s important to discuss the potential for surgery with a specialist. And to explore the individual risks. How can I improve my chances of conceiving with endometriosis? If you’re trying to conceive with endometriosis, there are options to improve your chances. These include expectant management and assisted reproductive techniques (ARTs).  Expectant management  This is for heterosexual people who are trying to conceive naturally and:  To improve your chances of conceiving with every menstrual cycle, it is recommended to have sex every 2-3 days so there is a good chance of catching your fertile window.   Assisted reproductive techniques (ARTs) ART options include ovarian stimulation (COS), intrauterine insemination (IUI), and in-vitro fertilisation (IVF).  Depending on your age, ART is recommended if: IUI is usually offered to couples with minimal or mild endometriosis if their partner has normal semen quality and is typically not offered to those with moderate/severe endometriosis, because of a probable effect on the Fallopian tubes. IVF can be offered to those with moderate or severe endometriosis. It can also help those with a very low egg reserve. IVF has been found to be less successful in people with endometriosis compared to those without endometriosis. However, lots of factors influence IVF success, like age, whether you’ve been pregnant before, if you’ve had treatment before body mass index, underlying health conditions, lifestyle and your partner’s sperm quality.  Resources:  

Around 2 in 3 people assigned female-at-birth will develop a fibroid at some point in their lifetime. But what are fibroids, how do we look out for symptoms and what are the treatments if we’re diagnosed? Read on to find out.  Quick facts: What are fibroids? Uterine fibroids are benign or non-cancerous growths in and around the uterus, or womb. They are made up of fibrous muscle tissue and are extremely common. Around 2 in 3 people assigned female-at-birth will develop a fibroid at some point in their lifetime (1). Your risk of developing a fibroid increases with age and if you: Where do fibroids grow? Fibroids can vary in size and you may have one or multiple fibroids. They can develop as singular fibroids or as clusters. There are three different types of fibroid, depending on where in the body they grow: Signs and symptoms of fibroids Not all people who develop fibroids experience symptoms. Most are actually asymptomatic and have no symptoms at all. Only approximately 1 in 3 people with fibroids will experience symptoms. The symptoms of fibroids can include: What causes fibroids?  Unfortunately, like many reproductive health conditions, the exact cause of fibroids is unknown. What we do know though, is they’re affected by oestrogen and progesterone—two hormones important for regulating the menstrual cycle. After menopause, when oestrogen and progesterone levels drop, fibroids tend to shrink (3). How are fibroids diagnosed? To diagnose fibroids you’ll need a pelvic ultrasound scan. Usually, your doctor will discuss any symptoms you’ve been experiencing with you first. Then they’ll carry out an abdominal examination to look for any areas of tenderness or masses in your abdomen, before referring you for a scan.  The ultrasound will look at your reproductive organs including your uterus, Fallopian tubes, ovaries and general pelvic area. This can be done either transvaginally (through the vagina) or transabdominally (looking at your uterus through your abdomen). A scan is the only way to definitively diagnose fibroids and to determine their size and location. You may also be offered a blood test to screen for iron deficiency anaemia, which is a condition that can occur as a result of heavy bleeding.  Because lots of people with fibroids don’t experience symptoms, often fibroids are found coincidentally. This could be during an ultrasound for a pregnancy or another suspected condition. Black women have an increased risk of developing fibroids Black women are three times more likely to develop fibroids than white women. They’re also more likely to be diagnosed with fibroids at a younger age, have a longer duration of symptoms and have larger, more rapidly growing fibroids. Although the increased risk of fibroids in Black women is known, there’s been little research conducted to understand why this is. Some research suggests genetics, such as Vitamin D deficiency in Black women (4) could be a link. Other research has suggested certain environmental factors could be linked. These include exposure to chemical relaxers, used for afro-textured hair, which have been linked to a higher risk of developing fibroids (5). Will fibroids affect my fertility? Some fibroids can cause problems with fertility (6). This largely depends on their size and where they are located.  Fibroids can affect the structure of the uterus and its surrounding organs. Meaning they can prevent sperm from fertilising an egg or prevent an embryo from implanting. However, lots of people with fibroids do not have any difficulties getting pregnant. How are fibroids treated?  Treatment for fibroids depends on:  If you have fibroids that are not causing symptoms and aren’t likely to affect your fertility, then generally no treatment is required. But if you begin to experience any new symptoms, it is really important to go back to the doctor to have a check-up.  The treatment methods for fibroids can be broken down into non-surgical and surgical methods. Non-surgical methods If you commonly experience heavy periods as a result of your fibroids, you may be given medications such as tranexamic acid. This is a medication which breaks down blood clots in the womb. You may also be given anti-inflammatory medications, like ibuprofen or an oral medication called Ryeqo. The combined oral contraceptive pill and hormonal IUD can also be prescribed to help you have lighter, less painful periods.  As well as treating heavy periods directly, you may also be given a gonadotrophin-releasing hormone (GnRH) analogue. This is to try and shrink your fibroids and is also commonly prescribed before any surgical treatment.  GnRH analogues work by reducing your levels of oestrogen. Low levels of oestrogen can lead to several other long-term complications, so this method can only be used for a short period.If you have larger fibroids, you may be offered a procedure called Uterine Artery Embolisation. This is used to block the arteries which supply blood to the fibroids. If you have smaller fibroids, you may also be offered a procedure which removes the lining of the womb called Endometrial Ablation. Surgical methods There are various surgical techniques which can be used to treat fibroids. Surgery can be explored if medical treatments don’t work for you or aren’t suitable in the long term.  You may be offered one of the following surgical treatments for fibroids:  What type of procedure is most suitable for you depends on the location, size and number of your fibroids. Each varies in terms of invasiveness, risks and its potential effect on fertility. Some people’s fibroids may grow back after surgery, known as ‘recurrence’.  Suspect you may have fibroids? As the symptoms mentioned above are commonly experienced in various types of pelvic issues, they may be linked to other causes apart from fibroids.  If you’re suffering from painful periods or any of the above symptoms, it’s important to get your hormones tested, to rule out a hormonal cause. This, alongside a pelvic ultrasound scan, can help you get to the bottom of symptoms and get a recommended care plan based on your biology.  If you’ve been diagnosed with fibroids, you can also talk to our team of […]

On Wednesday, the 15th of February, we hosted our first community event to launch our Black Women’s Health Initiative. It was a privilege to have brought together so many people who were actively engaged in the topic.  The event provided us with such insightful information and has helped us not only hone our commitments to change but also acted as the first step in our journey as a company. We are still learning and growing as a young seed-stage start-up, but that doesn’t stop us from having big aspirations, and we hope to build on these year after year. We are so thankful to everyone who attended the event. We really appreciate the time, energy and support each person gave.  It was an incredibly proud moment to be able to share the findings from our recent research looking into the role that ethnicity played in access to fertility testing and reproductive healthcare. A roundtable discussion followed, moderated by Hertility’s CEO and founder Dr Helen O’Neill, where we heard from clinical gynaecology experts, community leaders, and patient advocates Dr Christine Ekechi, Dr Stephanie Kuku, Noni Martins and Sophia Ukor. In case you missed it, here’s a rundown of what was covered: The changes to Black women’s reproductive healthcare over the years All the panellists agreed that they are seeing a positive trend, with more conversations being had around women’s health in general, and increased awareness and advocacy from colleagues within the healthcare system and doctors for their patients. We heard about positive interactions with healthcare providers  or seeing positive changes in healthcare delivery in the last five years.  “I feel there is a change with the language, culture and even the way they listen to you. They listen and you feel understood. I felt seen, I did not feel alone. The language, the care and the attention is evident.” – Sophia Ufy Ukor, Founder & CEO of Violet Simon We heard from Dr Christine Ekechi that not only is there an increased awareness of conditions that are more prevalent in Black women, but they are more cognisant of their experiences.  We briefly touched on the current state of the healthcare system and what needs to be done to support healthcare professionals further to provide compassionate care. As the healthcare system becomes more stretched and there is continuous pressure to shorten GP appointments, there will be limitations on the capacity of doctors. It is no surprise that the average GP appointment in the UK lasts just 9.2 minutes, with an average of 2.5 health concerns being discussed (1), and there is not enough time to allow for a  comprehensive discussion about someone’s reproductive health or pregnancy history. Women whose first language is not English and/or who have had a negative experience with a healthcare practitioner are at more of a disadvantage.  “We all swear on the Hippocratic oath to do no harm, but if the system works such that the resources and the human capacity are lacking, there is a dearth of compassion. As a result, unfortunately, I think that, as with everything in life, some people are going to suffer more than others, and the human reflexes are that when you have no capacity, you are less likely to treat people the same” –  Dr Stephanie Kuku Advisor, Consultant and Health Technology Executive (MBCHB MRCOG MD) However, Dr Christine Ekechi also highlighted that the majority of UK-based doctors are willing to learn to improve the care of Black women and there is room for positive impact.  Looking to the future, we heard from both the event and post-event feedback about the importance of framing positive conversations around Black women’s reproductive health to stop the further victimisation of Black women and ethnic minority groups and to empower them so that we can help give women strength and power in healthcare situations, instead of reinforcing currently accepted narratives. The power of knowledge and tips on advocacy Throughout the discussion, a salient theme that shone through was the value and power of having the right information in a healthcare setting, especially when it comes to advocating for ourselves. Noni Martins emphasised the importance of going into GP appointments with symptom diaries and the knowledge about what is going on with your body, as no one knows your body better than you. Dr Christine Ekechi also highlighted that everyone deserves a right to a second opinion if they feel they do not understand or agree with the outcome of their appointment.   “One thing about doctors, particularly doctors now, is that we are cognisant about working in partnership with you…Of course, you’re not going to go into a consultation and understand everything about gynaecology, but you should leave with an understanding of what the concerns are and what the approach is going to be. For me the key is if you come away thinking I have no idea what they said, then you ask for a repeat explanation or ask for a second opinion” – Dr Christine Ekechi Consultant Obstetrician & Gynaecologist and Co-Chair, Race Equality Taskforce, Royal College of Obstetricians & Gynaecologists. We briefly spoke about the prevalence of myths in reproductive health, fertility and women’s health more generally. We know from the Women’s Health Strategy that many women get their information from the NHS website (2), so as Dr Christine Ekechi said, “it’s about going to the trusted sources and addressing those gaps by filling it in with the correct information”. “I think my biggest concern when we have these kinds of discussions is for people who don’t have that voice. I worry about the people who, in their homes and in their communities, cannot speak out about the fact that they have been trying to conceive and it is not working out. I’m always thinking about how we can get to those people, I don’t have the answers. I hope that by being someone who looks like them and talking about it, we can draw them out. Even if you are having a […]

Fertility testing is much more common than it used to be. But with the growth in the at-home fertility testing market, how do you know which one is best? In this article, we explain why Hertility is a cut above the other at-home tests available.   Quick facts: What at-home testing can tell you Whilst there is no way to 100% definitively determine how fertile you are, testing our hormones can give us key insights into the functioning of our reproductive health and ovarian reserve (egg count).   There are a whole range of different hormones that can work hard to regulate the menstrual cycle and ovulation. If just one becomes imbalanced, it can throw the whole system off.  At Hertility, we’ve spent years building the most accurate diagnostic tool in female health and our tests can give indicative diagnoses within just 10 days of testing.  We don’t believe in doing things in halves—so unlike a lot of other at-home tests on the market, we provide full end-to-end care. Here’s what to expect with each step of our test.  Online Health Assessment  Your test starts with an Online Health Assessment. It takes around 5 minutes to complete and is essentially everything you would cover in an initial private gynaecologist appointment before being referred for a hormone test.  Up to 60 questions cover your medical history, period and cycle, symptoms and individual biomarkers. Each question has been carefully selected to build a 360-degree view of your health and fertility.  Our proprietary algorithm will then determine your risk factors, using 835,000 data variables, for various conditions or hormone imbalances. You’ll then be recommended a personalised hormone panel for your test, based on the analysis of your Online Health Assessment results.  Some other at-home tests don’t include this crucial step and will simply test you for a generic hormone panel. Which hormones do Hertility test? Depending on the outcome of your recommended panel, your test could include the following hormones:  Some fertility tests will only look at E2, LH, FSH and testosterone. These are all very useful in determining how your menstrual cycle is working, but without looking at the full picture and the interplay between different hormones, you’ll only be able to get half the picture.  That’s why we take a comprehensive, whole-body approach when it comes to your hormones and fertility.  You’ll receive your at-home test kit with your personalised panel 3-5 days after you place your order. Our kits are easy-to-use with detailed instructions on each step with links to video instructions. Anti-Müllerian Hormone (AMH) A key part of any fertility test is measuring the levels of a hormone called Anti-Müllerian Hormone or AMH. Produced by the cells in your developing eggs, AMH can be used as a really powerful indicator of how many eggs you have left.  Studies comparing the levels of AMH with the number of eggs seen on a pelvic ultrasound scan (when done on the same day of your cycle) have shown AMH to be a reliable way to gauge egg count.  After peaking in your 20’s, AMH levels decline, dropping more rapidly after your mid-30s. However, this rate of decline differs from person to person so it’s important to test regularly to understand what this rate of decline looks like for you.  Based on over 10 years of clinical research, AMH is established as the single most important marker of ovarian reserve and forms a core part of our advanced hormone and fertility test. AMH will always feature in your hormone panel, however, it’s important to know that if you’re currently taking hormonal contraception this can temporarily suppress your AMH. Although you can still test AMH while on contraception and get valuable insights, we recommend waiting three months after coming off contraception to give the most accurate results.  Furthermore, research has found that AMH has the potential to be used as an indicator of when someone will go through menopause, a predictor of fertility treatment success and can be used when diagnosing reproductive health conditions such as PCOS & POI.   A fertility test isn’t all about AMH. AMH alone cannot give you the entire picture, it’s just one piece of the puzzle. So, when looking at your fertility, and overall reproductive health, it’s crucial to take a whole-body approach.  Results and follow-up doctor-written report Just 10 days after sending your test kit back to us, you’ll be able to access your hormone results in your online health hub. Each hormone result comes with an explanation, so you can easily understand what your result means.  Along with your results, you’ll receive a doctor-written report that will consider your Online Health Assessment results alongside your blood work. Your dedicated doctor will outline a care plan based on any symptoms you might be experiencing and will recommend any onward care or treatments should you need them. The takeaway At Hertility, we care deeply about your health and well-being. Our mission is to arm women with the answers they need about their reproductive health so that they can make informed decisions about their futures. Our Online Health Assessment and at-home test kits have been rigorously quality tested and are CQC-approved, MHRA-regulated and CE-marked. Start your Health Assessment here.

Hertility partners with Pearl & Dean for the launch of #MeToo film, ‘She Said’, to rally women in the UK for the next women’s rights movement, the Reproductive Revolution.   Women’s health company Hertility’s award-winning film, ‘Ooh Someone’s Hormonal,’ spotlighted the lack of research on women’s bodies and called out society for using women’s hormones against them. Now, they’re teaming up with Pearl & Dean, the UK’s best-known cinema advertising contractor, to take the “Mother of all movements” to the next level in a bid to urge millions of women across the UK to get to know their bodies. For 5 weeks from November 25th, ‘Ooh Someone’s Hormonal,’ created by female-founded creative content agency Be The Fox, will be shown before every screening of ‘She Said’ in Pearl and Dean cinemas nationwide, the film starring Carey Mulligan and directed by Maria Schrader telling the story of the #MeToo movement.  Founded by women and powered by an (all female) research team, Hertility is setting a new standard of scientific rigour in female health by empowering women with information about exactly what’s going on under their skin using at-home diagnostic testing, telemedicine and treatment. By joining forces with cinema ad sales firm Pearl & Dean, the partnership aims to fuse science and art in the fight for equality. ‘The #MeToo movement was such a huge step forwards in women’s rights but from a reproductive perspective, women are still second-class citizens. We want to inspire women watching ‘She Said’ to join us in our fight in the next revolution – the Reproductive Revolution – by getting to know their bodies and taking control of their life choices. For themselves and for all women worldwide.’ – Dr Helen O’Neill, CEO and Founder of Hertility Carey Mulligan, has spoken openly about the lack of support for women in the film industry but as a middle finger to the male-dominated Harvey Weinstein era, ‘Ooh Someone’s Hormonal’, produced by female-led production company, Be The Fox, shows Hollywood how it’s done. Echoing the equality seen in the production of ‘She Said’, the female-powered cast and crew of ‘Ooh Someone’s Hormonal’ worked to the soundtrack of female artist Rebecca Taylor of Self-Esteem, complete with childcare on set, changing the outdated landscape and showing what’s possible when women, fully supported, come together. Diana Ellis Hill, Co-Founder, Be The Fox comments: “Empowering women and having true representation is an important cause that’s close to our hearts. We gathered an 80% female team to make the film from DOP and Director to Editor and Colourist as we wanted it to be real and authentic. We are immensely proud of what’s been produced and to see our film on screens at cinemas nationwide ahead of She Said.” Kathryn Jacob OBE, CEO at Pearl & Dean, said: “Cinema is a unique advertising medium in the sense that it is both a personal and shared experience. Cinema has the power to truly reach an individual, and to speak to them one on one, as well as spark a conversation. We are honoured to be working with Hertility to launch its first ever cinema campaign and to be a part of helping to better articulate an important issue that is often hidden or ignored by wider society.” Watch the cinema advert ‘Ooh Someone’s Hormonal’ More information on ‘She Said’

Pioneering new egg-freezing research has been published by Hertility Doctors, Dr Lorraine Kasaven and Dr Benjamin Jones. Read on for a summary of their findings on the optimal age to freeze your eggs. Quick facts: Is it worth freezing your eggs in your 40s? This is one of the most frequent questions our Doctors get asked by women over 40. The answer, to date, has been—there really isn’t enough data to answer this confidently.  So, in true Hertility fashion, where the data doesn’t exist, we make it our mission to change that. This month, two of our Hertility Doctors, Dr Lorraine Kasaven and Dr Benjamin Jones, published a new study, ‘Reproductive outcomes from ten years of elective oocyte cryopreservation,’ using data from 373 women over ten years to find out the answer to this question once and for all. Their findings suggest that women should get their eggs frozen before the age of 36 to increase their chances of successfully conceiving.  Whilst previous research focused on the number of good quality eggs successfully frozen, Dr Lorraine and Dr Ben’s research looked at the real-world outcomes. Basically—what happened when women tried to use those successfully frozen eggs to get pregnant?  The research outcomes Of the 373 women who froze their eggs, only 36 returned to use them. Those 36 women went through a total of 41 frozen embryo transfers which resulted in 12 live births.  None of those who froze their eggs after the age of 40 had a baby. 82% of the babies were born to women who froze their eggs between the ages of 36 and 39 years of age. This research therefore suggests that egg freezing is a viable option for having children later in life but it’s not a ‘fail-safe’ way of preserving your fertility.  This research indicates: One step closer to closing the gender data gap We are immensely proud to have our doctors flying the flag with such important research. This research directly arms our doctors with the most up-to-date research for patient consultations.  It’s another small step forward in our universal understanding of female reproductive health and a giant step towards empowering the lives of women everywhere to have kids (or not) on their terms.  Read the full paper here.  References:  Kasaven, L.S., Jones, B.P., Heath, C. et al. Reproductive outcomes from ten years of elective oocyte cryopreservation. Arch Gynecol Obstet306, 1753–1760 (2022). https://doi.org/10.1007/s00404-022-06711-0