The human body is a well-tuned but complex system where hormones play an integral part in its optimal functioning. Hormones are chemicals that ensure smooth functioning from menstruation, ovulation, to pregnancy. They play an important role in optimising reproductive processes and determine whether pregnancy is possible. Female fertility is a complex interaction of many hormones. Chief among them are the follicle-stimulating hormone (FSH), luteinizing hormone and estrogen. These hormones coordinate with each other for follicular development, ovulation and maintaining reproductive health. Read to know more about their interplay.
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If you are wondering what is FSH hormone, then you should know that it is a chemical produced by the pituitary gland. This hormone is essential for egg development in the ovaries. When your period starts, FSH levels go up to help the follicles grow. Follicles are small sacs that hold immature eggs. Once the follicles mature, usually one main follicle releases an egg during ovulation. When FSH levels are not optimal, the ovaries are unable to produce mature eggs, making conception difficult.
● FSH promotes the development and maturation of the ovarian follicle, ensuring the development of mature viable eggs. Optimal FSH levels are required for follicular growth and for choosing the follicle that can ovulate.
● FSH is not only important for women; it is equally important for men, as it supports spermatogenesis.
● High FSH: It may mean that the ovaries are not responding optimally to your brain signals. This can happen due to premature ovarian insufficiency or menopause. In response to it, the pituitary gland overcompensates and produces more FSH to stimulate the ovaries, leading to high FSH levels. In men, high FSH means the testicles are not functioning properly, causing low sperm quality and quantity.
● Low FSH: Low FSH in men may indicate pituitary or hypothalamic problems, which can affect sperm production and fertility.
Like the FSH, the pituitary gland produces the luteinizing hormone. It works with FSH to manage ovulation. While FSH helps follicular growth, LH triggers ovulation and signals the release of a mature egg from the ovary. The LH surge occurs mid-cycle in your periods and is a key factor in determining when you are fertile.
● LH role in ovulation: LH plays a key role in your periods by triggering ovulation and the release of a mature egg. Tracking the levels of LH using ovulation predictors can help you know the most fertile days, as an increase in LH means ovulation is near, making conception easy.
● After the LH surge triggers the release of a mature egg, the ruptured follicle becomes the corpus luteum, and it then stimulates the production of progesterone. Progesterone is a hormone needed to prepare the uterus by ensuring the uterine lining is intact for a potential pregnancy.
● High LH: It may be an indication of PCOS (polycystic ovary syndrome), where it can disrupt ovulation, cause hypogonadism and irregular or absent periods. High LH in men may be due to the testes not functioning properly, and cause low testosterone.
● Low LH: Could signal hypothalamic or pituitary gland issues that impact ovulation. Low LH in men may also be due to genetic problems or chronic illness.\
Estrogen is a sex hormone associated with women. Along with progesterone, it plays an important role in a woman’s reproductive health. Produced by the ovaries, adrenal glands and fat tissue, it plays a role in the formation of secondary sex characteristics such as breasts, hips, etc, menstruation, pregnancy and menopause.
● Estrogen increases before ovulation and is at its highest during the most fertile period. It thins the cervical mucus, making it easier for sperm to swim through and fertilise the egg. These changes make pregnancy easy.
● Estrogen makes the uterus receptive for embryo implantation. The endometrial tissue becomes thick to support pregnancy.
● Estrogen is essential for the regular flow of the menstrual cycle and is needed for conception.
● High Estrogen: It can increase the risk of uterine cancer, insulin resistance and pain from endometriosis.
● Low estrogen: Can be an indication of fertility issues or menopause.
● The menstrual cycle is regulated by the HPO (hypothalamic-pituitary-ovarian) axis using hormones like FSH, LH and estrogen.
● The hypothalamus releases gonadotropin-releasing hormones, which stimulate the pituitary gland to release FSH and LH.
● The ovaries produce estrogen and progesterone from the corpus luteum, forming the feedback loop.
● Estrogen controls the negative and positive feedback. It keeps LH and FSH low, preventing too many eggs from maturing, which is the negative feedback of the cycle.
● High estrogen levels are created prior to ovulation, causing an LH surge that triggers ovulation (the cycle's positive feedback), during which follicles burst and an egg is released.
● After ovulation, progesterone and estrogen are secreted by the corpus luteum to keep LH and FSH levels low until the start of the next menstrual cycle.
● PCOS: This is associated with high levels of LH, which impacts ovulation. Symptoms include infrequent periods, hirsutism (growth of body hair) and infertility.
● Premature ovarian insufficiency (POI): It is triggered by increased levels of LH and FSH along with an estrogen deficit. Symptoms range from vaginal dryness, mood swings, to the cessation of periods.
● Hypothalamic amenorrhea: It is due to the failure of the HPO axis to release hormones. Symptoms and signs include the lack of menstrual cycles.
● Imbalanced hormone levels inhibit or slow down reproductive processes and, therefore, make pregnancy challenging.
● Hormone test for fertility: Your levels of FSH, LH and estrogen are measured on the third day of your menstrual cycle to evaluate your ovarian reserve and follicular growth.
● LH surge test: LH levels on day 14 of your cycle are measured to determine whether ovulation will take place.
● Pelvic ultrasound: To determine the follicular count, quantity and quality of eggs.
● Semen analysis: Determine semen quality and quantity.
● Other hormone tests like S. AMH (Anti mullerian hormone) can be done to test egg reserve, it can be done on any day of menstrual cycle.
● Medications such as clomid and gonadotropins are recommended to regulate fertility hormones and induce ovulation.
● Estrogen therapy, along with medications
● Lifestyle modifications like stress management, weight management, taking supplements and consuming a healthy diet.
● When the above methods fail, you can choose IUI (intrauterine insemination), where healthy sperm are placed in the uterus during ovulation. When this is not successful, assisted reproductive technology such as IVF, in which mature eggs are retrieved, have their fertilisation done with sperm in a laboratory, and the embryo is implanted into the uterus.
The combination of FSH, LH and estrogen is crucial in controlling the menstrual cycle, inducing ovulation and enhancing fertility. Understanding their impact on your reproductive system informs you of steps to help maintain their balance and enhance your chances of conceiving. If treatment and support fail, advances in reproductive endocrinology enable couples to achieve their dream of having a baby through ART.
Follicle-stimulating hormone, FSH, helps eggs in the ovaries to grow and mature, which is crucial for fertility, as without enough FSH, eggs won’t develop and ovulation may not happen.
Yes. Low LH levels cause infertility.
Regular exercise, weight management, stress reduction and following a healthy diet are ways to improve estrogen levels naturally.
Yes. FSH and LH levels increase, and estrogen levels decrease with age in women.
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