Before a patient sees a clinician for their first fertility workup, they have likely already done a great deal of research on fertility and hormone levels. However, their search for information may be misguided. They may rely on information from friends or get lost in the rabbit hole of online sources.
Between clickbait headlines and the wide variation in patient experiences, reproductive specialists have their work cut out for them. They are empathetic listeners and trusted providers, but they also serve as myth busters who clear the confusion and help their patients make informed choices.
How can you prepare for these conversations as a provider? It can help to understand what kind of misconceptions you are up against. Reviewing some common — but incorrect — beliefs patients hold related to fertility and hormone levels can help reproductive specialists be prepared to educate prospective parents.
1. Patients May Think There Is Only One Hormone That Matters
In any fertility workup, physicians will want to undergo imaging and lab work to evaluate a litany of different factors that could cause infertility, from assessing ovarian reserve to checking for tubal blockages or uterine malformations. Although some people may pass off the lab work as checking for their "hormone levels," or even more simply, their "estrogen levels," it is important to clarify that different hormones serve different purposes.
To diagnose diminished ovarian reserve, the American College of Obstetricians and Gynecologists (ACOG) recommends assessing for anti-Müllerian hormone (under 1 nanogram per milliliter) or estradiol plus follicle-stimulating hormone (more than 10 international units per liter) along with transvaginal ultrasonography to assess antral follicle count (6-10 count is normal, below 6 is low ovarian reserve). To diagnose ovarian dysfunction, measurements of serum progesterone or luteinizing hormone (LH) may be indicated as well.
This can all be confusing to patients. To help them understand, try comparing hormones to instruments in a symphony:
- Like violins and trumpets, they are in different sections (some are made in the ovaries, while others originate in the pituitary gland, for example).
- They play at different times (throughout the menstrual cycle).
- They have different melodies (some trigger egg release, while others prepare the uterine lining).
- If one is out of tune, it can disrupt the whole orchestra.
You can also direct patients toward a handout or glossary such as this patient Q&A from ACOG.
2. They May Try to Impact Their Hormones Through Diet
While a nutritious diet does play a role in fertility, patients cannot simply eat their way to optimal hormonal levels. While many studies have explored the links between nutrition and fertility — such as the positive effects of leafy greens and lean protein versus the potentially negative effects of saturated and trans fats — the underlying factors that affect hormone levels are multifaceted. Every case deserves a comprehensive workup that factors in medical and family history as well as potential lab tests and a diagnostic ultrasound.
And yet, some factors may play a greater role than your patients may think. For example, smoking can increase follicle-stimulating hormone (FSH) levels in women by up to 66 percent, according to the American Society for Reproductive Medicine. women who smoke also tend to experience menopause up to four years before nonsmokers.
3. They May Want to Strike "Hormonal Balance"
The phrase "hormonal balance" sounds good in headlines, but in reality, hormones fluctuate throughout the day and across phases of the menstrual cycle. It is only when clinicians assess hormone levels in combination with all other factors that they can get a good idea of the whole picture. Instead of referring to it as a balance — which implies a binary dynamic — it can be helpful to go back to that original symphony analogy: Hormones are one note in an overall line of music.
4. They May Not Know a Partner's Hormones Matter, Too
Male factor infertility is a challenge for up to 1 in 2 couples that include a cisgender male partner, according to ACOG. While most fertility workups involve at least some evaluation of the male partner's medical history (and potentially a semen analysis), patients with more advanced needs should see a male reproductive specialist. It can help to explain the role of male hormones in conception, why they matter and how testosterone is not the only one. (Some patients may be surprised to know that their partners share similar reproductive hormones that they do, like FSH and LH). This patient guide from Cleveland Clinic is a good resource to share.
Fertility Is a Symphony, and Every Instrument Matters
Above all, patients should understand that fertility does not ride on just a single hormone — or all of them, for that matter. It is a multidimensional process that deserves comprehensive assessment, including lab work, imaging, medical history and evaluation. Reproductive specialists play a critical role in shedding light on the misconceptions. With your support and guidance, patients will be able to feel confident they are making informed decisions, now and in the future.
