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Hormonally Speaking

How Hormones Affect the Fertility Cycle

By Teri Brown

"In the PCOS, all the components of normal function are present, but they are having a family fight, so to speak, where no one is listening but everybody is yelling," says Dr. Shapiro. "The instigator of the fight is the hormone insulin, which is primarily responsible for blood sugar control. When insulin levels are abnormally high (a condition called insulin resistance, which is a precursor to diabetes), insulin butts its nose into the ovary's business and convinces it to overproduce a male hormone called androstenedione (AS)."

AS is actually a necessary component, but when AS is overproduced, it washes into circulation. Unfortunately, fat cells have the ability to convert AS to a form of estrogen called estrone, which messes up the whole process, as it fools the brain into thinking that an egg is trying to ovulate.

"Consequently, the brain and pituitary shut off the FSH and keep the LH turned on all the time," says Dr. Shapiro. "The LH goes to the ovary and asks to ovulate, but the ovary basically says: 'Why are you here? Can't you see I don't have an egg ready? I'm too busy with this AS to get my act in gear.' The LH misunderstands the ovary's annoyance and figures it just needs a jumpstart to get the ball rolling again."

In the worst case scenario, the afflicted woman will never get off this vicious cycle of PCOS, and will never ovulate or get a period.

In the second form of hormone dysfunction, hypothalamic amenorrhea, the brain doesn't send out enough GnRH, and the pituitary remains dormant with respect to FSH and LH secretion. Women can be born with this disorder, but most commonly they acquire it by excessive aerobic exercise or an eating disorder such anorexia or bulimia. Since the pituitary fails to make enough FSH/LH, the ovary doesn't start the egg ripening process and estrogen levels never rise.

Want to see more?

• Making Sense of PCOS: Answers to Common Questions
• When Life Is a Pain: The Facts on Endometriosis
• At Your Cervix: A Lifetime of Cervical Health
• Talk about it!