Knowledge Centre

You can test some of your hormones with Hertility regardless of the type of birth control you’re using. In this article, we run through the differences between hormonal and non-hormonal birth control and which hormones you can test with us depending on the type you’re using.  Quick facts: Different types of birth control Despite most of us only being able to reel off a handful, there are actually many different types of birth control, or contraception. These include both hormonal and non-hormonal options, plus, long-term and short-term methods. Whatever method of contraception works best for you is personal and will depend on your goals, your body and if you choose to use hormonal contraception, your hormones too.  So, from condoms to coils, let’s take a look at the different types of birth control, how they work, and how each will affect a hormone and fertility test. What is hormonal contraception? Hormonal contraception uses synthetic hormones, which are basically (wo)man-made versions of our natural hormones, to either prevent us from ovulating and/or to bring about bodily changes that prevent pregnancy. Types of hormonal contraception include: How does hormonal contraception work? To understand how hormonal contraceptives work (and how this might affect your test), it’s important to first understand exactly how your hormones control your menstrual cycle and overall fertility. Your menstrual cycle hormones, including oestrogen, progesterone, follicle-stimulating hormone (FSH), luteinising hormone (LH) and testosterone, all work together to ensure that each month you ovulate a healthy, mature egg from one of your ovaries.  If any of these hormone levels are altered, disrupted or suppressed, your overall menstrual cycle and ovulation can be affected—impacting your fertility and ability to conceive.  Hormonal contraceptives use either a combination of synthetic oestrogen and synthetic progesterone (called progestin), or simply just progestin (depending on the type) to alter the balance of your menstrual hormones.  This brings about a series of bodily changes that prevent pregnancy, including: Hormonal contraception can also be used to help relieve hormonal symptoms, like acne, and those related to your menstrual cycle, like heavy menstrual bleeding. Can I test my hormones if I’m on hormonal contraception? Technically, yes you can—but because your natural hormone levels will be altered due to the synthetic hormones in your system, you won’t be able to get an accurate result of your natural menstrual cycle hormone levels, including your FSH, LH, or oestradiol (E2). The good news is, with Hertility, even if you’re on hormonal contraception, we can still test you for Anti-Müllerian Hormone (AMH) and your thyroid hormones—Thyroid Stimulating Hormone (TSH) and Free Thyroxine (FT4).  Taking a advanced hormone and fertility test to test your AMH will give you insight into how many eggs you’ve got left (your ovarian reserve), giving you a good idea of your current fertility. Hormonal contraception can temporarily impact AMH levels, to determine your ovarian reserve more accurately. We would recommend retesting your AMH with your cycling hormones (FSH, oestradiol and LH) at least 3 months after coming off your form of contraception. Your thyroid hormone levels are a good indicator of your general hormone health and remain unaffected by taking any hormonal contraception.  If you’re using a long-term form of hormone contraception, such as the contraceptive injection (known as Depo Provera), you might have to wait up to 12 months for your menstrual cycle hormones to regulate and get back to their natural levels, so we can get an accurate result. What is non-hormonal contraception? These are your contraceptive types that don’t contain any synthetic hormones, and won’t alter your natural hormone levels if you use them.  Types of non-hormonal contraception include: How does non-hormonal contraception work? Non-hormonal contraceptives prevent pregnancy through several different methods, the difference being they tend to use just one method, rather than a combination, like in hormonal contraception. These include:  These include: Can I test my hormones if I’m on non-hormonal contraception? Yes, you’re good to go! Non-hormonal contraception does not alter any of your natural hormone levels, so with our advanced hormone and fertility test you can test all of your menstrual cycle hormones, AMH and thyroid hormones when you’re using non-hormonal contraception. Do I need a hormone test? Testing your hormones and fertility can give you important insights into both your overall and reproductive health.  Whether you’re experiencing possible hormonal symptoms, or planning ahead for your future family forming options—testing can help give you clarity into what’s going on inside your body.  Our advanced hormone and fertility is personalised to you and based on your unique biometrics, medical history, cycle and symptoms. Our test will screen you for up to 18 reproductive health conditions and give you insights into your ovarian reserve. This can help you to identify any potential underlying health conditions or hormonal imbalances that could affect your chances of conceiving. We recommend regular testing—once a year, or every six months if you’re above 35 or have an underlying condition that might affect fertility. Because our hormones are constantly changing, regular testing helps to ensure you’re tracking any changes over time. This can help you to better manage any symptoms and measure the success of any lifestyle changes or medication if you need to. So, whether you’re curious about your health, planning for future children or trying to conceive, regular hormone testing with our advanced hormone and fertility test could be an essential step toward understanding your reproductive health. If you’re on contraception, hormonal or non-hormonal, and want to test your hormones and fertility, you can get started today by taking our online health assessment today. References:

Anti-Müllerian Hormone (AMH) is one of the most talked-about fertility hormones, but also one of the most misunderstood. Because AMH is closely linked to your eggs, testing it can offer valuable insight into your ovarian reserve (the number of eggs you have left). But it’s not a fertility “yes or no” test. In this guide, we break down exactly what AMH testing can and can’t tell you about your reproductive health.  Quick facts: What is AMH and why is it so important? Anti-müllerian hormone (AMH) is made by small fluid-filled sacs in the ovaries called follicles, each of which houses an immature egg. Because AMH is made by these follicles, your AMH level gives an indication of how many eggs you may have remaining at a given time. However, this is only one piece of the fertility puzzle. There are a few myths out there about what exactly AMH testing can tell us. In this article, we cover the main things an AMH test can and can’t tell you. Let’s get into it. What can AMH testing tell me? Whether your ovarian reserve is a normal for your age AMH testing will give you insights into whether your ovarian or egg reserve is what is expected with other healthy people in your age group. It helps you understand whether your egg reserve is higher, average, or lower than expected for your age. If you are not using any hormonal contraception, testing other hormones, like follicle-stimulating hormone (FSH) and oestradiol alongside AMH can also help to build a more complete picture of egg reserve. Generally, people with low egg reserves are known to have higher levels of FSH and lower levels of oestradiol. Whether you have polycystic ovaries or polycystic ovary syndrome AMH testing can also be used as an indicator of whether you could have polycystic ovaries (PCO). PCO is a common reproductive health condition affecting around 30% of reproductive-aged people assigned female-at-birth. PCO is benign and does not affect fertility, but it can cause other unwanted symptoms.  People with PCO have a higher-than-expected number of immature follicles in their ovaries. More follicles mean a higher level of AMH in the blood.  Some people with PCO also have the syndrome that can be associated with it polycystic ovary syndrome (PCOS), which often presents as symptoms like irregular periods, acne, hair thinning or loss and high testosterone levels. According to updated guidelines, AMH can now be used as an indicator for polycystic ovaries in place of doing an ultrasound scan for the diagnosis of PCOS. However, at Hertility, we would always recommend getting a pelvic ultrasound scan to further assess your ovarian reserve. During this scan, your ovaries are assessed to determine your antral follicle count (the number of eggs sacs seen within your ovaries) and to confirm the diagnosis. Whether IVF or egg freezing could be right for you In fertility treatment settings, AMH plays an important role in guiding decisions around interventions such as IVF and egg freezing . It is commonly used to estimate how the ovaries may respond to stimulation and to guide medication dosing.  Lower AMH levels are generally associated with retrieving fewer eggs during IVF, while higher levels may indicate a stronger response but also carry a risk of developing a rare but potentially life threatening condition called OHSS (ovarian hyperstimulation syndrome). This makes AMH a valuable tool for planning treatment safely and effectively. Many NHS-funded and private IVF clinics therefore require a minimum AMH level for you to be eligible for a free IVF treatment cycle. The minimum level on the NHS will depend on where in the UK you are currently residing. Whether you may be perimenopausal or menopausal or have POI Menopause marks the point at which your periods stop permanently, typically between the ages of 45 and 55, with the average age for menopause in the UK being 51. After menopause, natural conception is no longer possible. It is associated with a very low, or completely depleted, ovarian reserve. Clinically, menopause is usually diagnosed retrospectively, after 12 consecutive months without a period in someone not using hormonal contraception. In individuals under the age of 45, follicle-stimulating hormone (FSH) is more commonly used as a diagnostic marker, as levels tend to rise when ovarian function declines. While AMH is not currently recommended as a standalone test to diagnose menopause, it is well established that AMH levels fall to very low levels as ovarian reserve diminishes. This makes AMH a useful indicator of overall ovarian activity. Declining or very low AMH levels can suggest that you are approaching menopause, although it cannot predict the exact timing. In younger individuals, particularly those under 40, significantly low AMH levels may raise suspicion of premature ovarian insufficiency (POI), a condition in which the ovaries stop functioning earlier than expected. What can’t AMH testing tell me? While AMH testing is a useful tool for understanding your ovarian reserve, it only represents one part of your overall fertility picture. There are several important limitations to be aware of, and understanding these can help you interpret your results more accurately and avoid common misconceptions. It can’t determine your egg quality One of the biggest limitations is that AMH cannot tell you anything about your egg quality. Although AMH reflects the number of eggs you may have remaining, it does not provide any insight into how healthy those eggs are. Egg quality is one of the most important factors influencing fertility and pregnancy outcomes, and it is largely driven by age and genetics. At present, there is no reliable test to measure egg quality directly, except through assessing embryos during IVF treatment. It can’t determine your exact egg quantity AMH also cannot determine your exact number of eggs. While it gives an indication of the size of your ovarian reserve, it is not a precise measurement. This is because AMH is made by ovarian follicles, and each follicle can release different amounts of the hormone depending on its size and […]

Can smoking cause hormonal imbalances? Just like the negative consequences to heart and lung health, smoking can also negatively impact our reproductive health. Read on to find out.  Quick facts: How smoking affects the body It’s a well-known fact that smoking can have a negative impact on health, with both active and passive smoking being associated with multiple forms of cancer, diabetes and heart disease. Despite this, in the UK, as of 2019, 28% of men and 22% of women aged between 25 and 34 years are current smokers, according to published health data in England (1)—and a whopping 175 million people assigned-female-at-birth (AFAB) smoke worldwide. But whilst smoking’s effects on the heart and lungs are fairly common knowledge, fewer people are aware that it can also influence the body’s hormones. But how exactly are hormones and smoking linked? In this article we’ll look at: Does smoking affect hormones? Despite the lack of public awareness, there is plenty of research that shows how smoking can impact and even wreak havoc on our hormonal health. The chemical components of cigarette and cigar smoke can disrupt the normal functioning of our bodily systems, including the endocrine system. The endocrine system is a network of glands which influence the production, secretion and regulation of hormones throughout the body, such as the hypothalamus, thyroid, adrenal gland, and even the ovaries.  This disruption might lead to lasting effects on all kinds of hormonally regulated processes, including sexual function and reproductive potential, our metabolism and even our sleep.  As mentioned, both active and passive smoking (also known as second-hand smoking) can cause these nasty effects, with some research even indicating that prolonged exposure and inhalation of cigarette smoke can even affect the onset of menopause (3). There are over 4,000 substances in cigarettes that display reproductive toxicity. How does smoking affect different hormones? Smoking has been linked to abnormal changes and fluctuations in various hormone levels, including: Let’s take a look at each of these in detail. Smoking and testosterone Studies have consistently shown that smoking increases testosterone in AFAB individuals. Those who smoke have been found to have higher serum testosterone levels in their blood than those who don’t (4).  This is because smoking is inherently pro-androgenic, meaning it has a positive effect on androgen hormones like testosterone. Increased testosterone levels can bring on side effects such as excess body hair growth (hirsutism), acne, greasy hair and skin, irregular periods and low libido. The main reason for smoking’s pro-androgenic effects lies with nicotine. As tobacco is metabolised, the nicotine within it produces a compound known as cotinine, which inhibits testosterone breakdown (17). However, it’s interesting to note that similar studies performed on ageing men have indicated that, over a long enough timespan, smoking can reduce testosterone levels in those assigned-male-at-birth (AMAB) (16). Smoking and oestrogen As well as being pro-androgenic, smoking is also anti-oestrogenic, which means it has a negative effect on oestrogen levels. Studies have shown that women who smoke have  lower progesterone and oestrogen levels in both their blood and follicular fluid (the fluid which surrounds the developing egg, important for egg growth) (2,5).  Smoking even affects the conversion of androstenedione to oestradiol by cells within the eggs (2). This switch is mainly driven by the effects smoking has on the production of these hormones.  As well as negatively affecting oestrogen production and metabolism by your liver, smoking increases the levels of a hormone called sex hormone-binding globulin (SHBG) which binds to oestrogen—preventing it from performing its essential functions around the body. Symptoms of low oestrogen can include low libido, fatigue, and negative mood changes. Smoking and gonadotropins Follicle-stimulating hormone (FSH) and luteinising hormone (LH) are both gonadotropin hormones. These are hormones released from the hypothalamus (a part of the brain) to regulate the menstrual cycle and induce ovulation.  Unsurprisingly, smoking has been found to affect gonadotropin levels as well. Studies have shown that habitual smokers tend to have higher levels of FSH and LH in the first half of their cycle and during their periods, than non-smokers (6,7).  Disrupted FSH and LH levels can lead to problems with both fertility and menopause. Smoking and Anti-müllerian hormone Anti-müllerian hormone (AMH) is produced by granulosa cells within the ovarian follicles. It’s used as an indicator of ovarian reserve, sometimes referred to as egg count. Research has shown that smokers generally have lower AMH levels. One study in particular found that current smokers have  44% lower AMH levels than non-smokers (8), indicating that smoking can be directly toxic to the eggs within the ovaries. Another study showed that, in smokers, the fluid produced by the granulosa cells (known as follicular fluid) also contains increased levels of harmful nicotine toxins (9). Chemicals derived from cigarettes and smoking have even been detected in the cervical mucus (10). Smoking and thyroid hormones Cigarette smoke has been found to have both inhibitory and stimulatory effects on thyroid hormones. Both active and passive smoking have been linked to decreased levels of thyroid-stimulating hormone (TSH) and increased levels of free thyroxine (T4) and triiodothyronine (T3) (11,12).  Because the thyroid gland plays an important role in the regulation of many different bodily functions such as growth and development, disruption in thyroid level can have huge knock on effects all around the body. The thyroid can also affect fertility.Smoking is consequently a known risk factor for thyroid-related disorders, especially Grave’s disease and Goitres (13,14). Smoking and prolactin Prolactin is produced by the pituitary gland in the brain and is most commonly associated with milk production and altering breast physiology, but it also has a number of different roles throughout the body.  Chronic long-term smoking has been found to be associated with decreased prolactin levels (14), which can cause irregular menstrual cycles, difficulty breastfeeding and negative mood changes. Smoking and cortisol Smoking has also been linked to increased cortisol levels in the blood. It also affects hormones involved in the production of cortisol (2), which can disrupt the regulation of its levels. Cortisol […]

Prolactin has several important functions in the body. But what exactly does prolactin do and how do we know if our levels have become imbalanced? In this article, we’ll dive into exactly what prolactin is, what its functions are in the body, discuss imbalances in its levels and the importance of testing prolactin levels for reproductive and overall health. Quick facts: What is prolactin? Prolactin is a hormone that encourages breast growth and milk production during and after pregnancy, as well as maintaining our metabolism, regulating our stress response, maintaining a functioning immune system and in the development of our reproductive organs.  Similarly to follicle-stimulating hormone (FSH) and luteinising hormone (LH) it is secreted by the anterior pituitary gland, located at the base of the brain. From there, it’s released into the bloodstream where it travels around the body to carry out its functions.  Prolactin interacts with FSH and LH, and other cycle hormones, in a complex negative feedback loop. After ovulation prolactin production increases to prepare the body for a potential pregnancy. Prolactin’s role in breastfeeding In pregnant women, prolactin stimulates milk production in the mammary glands of the breasts—allowing for the secretion of breast milk. After birth, there is a postnatal rise in prolactin, which gets things started—but this isn’t enough to maintain breast milk development. When a baby suckles, prolactin levels in the blood increase in response, which stimulates the production of more milk. Prolactin levels spike around 30 minutes after the start of the feed, so this positive feedback effect is important for ensuring there is enough milk for the next feed.  This can also be stimulated by breast pumping, if you choose not to, or are unable to breastfeed. Prolactin levels Just like all of our hormones, from time to time, our prolactin levels can get off balance. This can cause a whole range of different symptoms and effects throughout the body, including affecting our thyroid hormones, stress hormones, menstrual cycles and ovulation. What are normal prolactin levels? Reference ranges for what is a normal prolactin level will be specific to the lab that is testing your sample.  Higher prolactin levels are usually present in those assigned-female-at-birth than those assigned-male-at-birth. In general, prolactin levels are expected to be less than 25 μg/L in those assigned-female-at-birth, who are not pregnant or breastfeeding. High prolactin levels Too much prolactin can stop our brains from producing FSH and LH—two key hormones involved in regulating our menstrual cycles and bringing about ovulation.  If FSH and LH are affected, ovulation can stop leading to the loss of periods, which is called amenorrhoea. No ovulation means no chance of a pregnancy, and therefore big issues for our fertility. Disruption to our menstrual cycle can also cause knock-on effects on our oestrogen levels, causing oestrogen deficiency. Some of the most common symptoms of high prolactin levels to look out for are milky white discharge from the nipples when not breastfeeding (galactorrhea), disturbances to the menstrual cycle, visual disturbances, headaches and symptoms of oestrogen deficiency. High prolactin levels can be caused by a variety of reasons, including imbalances in our thyroid and stress hormones. Additionally, a growth or tumour present in our pituitary glands, called a prolactinoma, can also cause persistent or increasing prolactin levels. Symptoms of high prolactin levels can include: Note: If you are experiencing any form of nipple discharge when not breastfeeding, get this checked by a physician or GP as it can be a symptom of breast cancer. Symptoms of high prolactin levels after menopause Although high prolactin levels are not common in those postmenopausal, it can occur. Excess prolactin after menopause often causes hyperthyroidism, when the body doesn’t make enough thyroid hormone. Symptoms can include: How to lower prolactin levels If you’re wondering how to reduce prolactin levels, this is very much dependent on the cause of your excess prolactin levels.  Your doctor may prescribe you medications like bromocriptine or cabergoline to lower your prolactin secretion. Surgery may also be recommended as the best treatment option for you.  Persistently high prolactin that has been caused by chronic stress, over-exercising or poor sleep may be lowered by lifestyle modifications. Low prolactin levels On the flip side, low prolactin levels is called hypoprolactinemia. Sometimes there aren’t any obvious symptoms of low prolactin levels, other than not being able to produce or release much breast milk after giving birth. Breastfeeding can increase our prolactin levels naturally—as the more we stimulate the nipples, more prolactin is produced.  Most people with low prolactin levels don’t have any specific medical issues, although there is preliminary evidence that suggests they might have reduced immune response to some infections and it could indicate that the pituitary gland isn’t functioning properly. Why should we test our prolactin levels? Like all of our reproductive hormones, it’s good to check in with prolactin regularly, especially if we’re trying to conceive or having any problems with our menstrual cycles or experiencing hormonal symptoms.  Testing our prolactin levels with a prolactin blood test can help us to determine if there are any hormonal issues affecting our fertility or menstrual cycle, or investigate any symptoms of prolactinoma. With a Hertility advanced hormone and fertility test, we can test your prolactin levels alongside your Anti müllerian hormone (AMH), thyroid hormones and cycling hormones (FSH, LH and oestrogen) to help you gain a full insight into your hormonal health and fertility. If you’ve already done a test and received an abnormal prolactin result, you can book an appointment with one of our Private Gynaecologists specialising in hormone and fertility concerns to discuss your results and get a personalised care plan. Appointments are available daily, with no GP referral required. Prolactin FAQs Can I get an FSH, LH, Prolactin test all in one? Luckily, you’re in exactly the right place. With our Hormone and Fertility test we will test you for up to 10 reproductive hormones, including your FSH, LH, prolactin and more.  Do prolactin levels change with age? Unlike hormones like Anti Müllerian […]

Luteinising hormone (LH) is one of the key hormones 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 is a hormone made by the pituitary gland in the brain. It forms part of a communication system between your brain and reproductive organs known as the hypothalamic-pituitary-gonadal axis (HPG axis). The hypothalamus (also in the brain) makes gonadotrophin-releasing hormone (GnRH), which tells the pituitary gland to make two key reproductive hormones: luteinising hormone (LH) and  LH and, follicle-stimulating hormone (FSH). These two hormones work closely together. FSH helps the follicles (the small sacs in your ovaries containing immature eggs) develop during the first half of the menstrual cycle. LH then becomes particularly important around the middle of the cycle, when a sharp rise in LH helps trigger ovulation, the release of a mature egg from the ovary. What does luteinising hormone do during the menstrual cycle? Luteinising hormone (LH) works alongside FSH and oestradiol to coordinate the menstrual cycle and regulate ovulation. At the beginning of the cycle, LH levels are relatively low. During this follicular phase, FSH helps several follicles (the sacs with the immature eggs) begin developing. As one follicle becomes dominant, it produces increasing amounts of oestradiol. The rise in oestradiol tells your pituitary gland to stop making FSH and to start making more LH. This is known as the LH surge. The LH surge helps the egg complete its final maturation and triggers the dominant follicle to rupture, releasing the egg from the ovary. This process is called ovulation. After ovulation, LH levels fall as the cycle enters the luteal phase. LH helps the emptied follicle develop into the corpus luteum, which produces progesterone alongside oestradiol. These hormones help prepare and maintain the uterine lining in case pregnancy occurs. If pregnancy doesn’t occur, the corpus luteum eventually breaks down. Progesterone and oestradiol levels fall, your period begins and the cycle starts again. You can read more about how all of these hormones work together in our Menstrual Cycle 101 guide. What is the LH surge? The LH surge is a rapid rise in luteinising hormone that happens shortly before ovulation. This is exactly what at home ovulation predictor kits, or OPKs, are designed to detect. Urinary LH tests can identify the mid-cycle surge that generally occurs around 24-36 hours before ovulation, which is why they can be useful for identifying when your fertile window may be approaching. But an LH surge predicts that ovulation may happen. It doesn’t prove that an egg was actually released. How does luteinising hormone affect fertility? LH is essential for fertility because it helps coordinate ovulation. Without appropriate LH signalling, the final stages of follicle maturation and egg release may not happen. But this doesn’t mean a single LH result can tell you whether you are fertile. Fertility depends on many factors, including your age, whether you’re ovulating, ovarian reserve, fallopian-tube and uterus health, sperm health and whether underlying health conditions such as endometriosis or PMOS are present. LH is therefore usually interpreted as one part of the fertility picture. Current NICE guidance recommends measuring FSH and LH in people with irregular menstrual cycles who are undergoing fertility investigation, helping doctors understand whether disrupted ovulation may be part of the problem. If you’re tracking ovulation at home, LH can also help identify when your fertile window may be approaching, although, again, it can’t confirm ovulation by itself. Why do I need an LH test? An LH test can be useful for several different reasons. One of the most common is investigating irregular or absent periods. Because LH is involved in ovulation, looking at it alongside hormones such as FSH and oestradiol can give clues about how the communication between your brain and ovaries is working. LH may also be measured if you’re having difficulty conceiving, particularly if your cycles are irregular or there is reason to think you might not be ovulating consistently. It can also form part of the investigation of conditions such as PMOS, hypothalamic amenorrhoea, primary ovarian insufficiency or pituitary disorders, although LH cannot diagnose any of these conditions on its own. For example, lower LH and FSH alongside low oestradiol can point towards reduced signalling from the hypothalamus or pituitary gland, while raised gonadotrophins alongside low ovarian hormone levels can suggest reduced ovarian function. LH testing is therefore most useful when it is interpreted alongside your symptoms, menstrual-cycle pattern and other hormone results. How can I find out my LH level? LH can be measured through a blood test or, for ovulation tracking, through a urine test. A blood test measures the amount of LH circulating in your bloodstream. This is usually the more useful approach when LH is being investigated as part of a wider hormone assessment. Urinary ovulation tests have a different purpose. They’re designed specifically to detect the rise in LH that happens shortly before ovulation. Standard OPKs generally show a positive or negative result once LH passes a particular threshold, while some digital or quantitative monitors show more information about changing urinary LH levels. Can an LH test tell you if you’re ovulating? An LH blood test can measure how much LH is circulating at one moment in time. An ovulation predictor kit measures LH in urine and looks for the surge that usually happens before ovulation. A positive ovulation test therefore suggests that ovulation may be approaching. But LH testing doesn’t directly confirm that an egg was released. For clinical confirmation of ovulation, mid-luteal progesterone is generally more useful. If you have PMOS and are using LH strips, interpretation can be trickier […]

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: Any form of alcohol consumption may impact your ability to get and stay pregnant When trying to conceive it’s recommended to completely abstain from alcohol Alcohol can disrupt normal hormone functioning and cause subsequent imbalances in reproductive hormone levels Alcohol can also affect male fertility and sperm quality Start my assessment 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 […]

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 […]