How Hormonal Conditions Affect Fertility (And What To Do About It)

Medically reviewed by Dr. Stacy Hengisman MD and Felice Ramallo MSRD.

Besides manifesting an array of unpleasant physical and emotional symptoms, hormonal conditions can also negatively affect fertility. Unfortunately,  infertility is a relatively common occurrence, with 12% of couples having difficulty conceiving or staying pregnant. The psychological impact of infertility cannot be underestimated: the American Psychiatric Association has noted that “the psychological impact of being unable to conceive is a profound loss and significant life crisis” for many, with individuals experiencing a spectrum of emotions, from anger, to sadness, shame, and grief. What’s more, unexplained infertility can be extremely difficult to understand and accept, given its ambiguous nature (and often surprising discovery, for individuals and couples who had no reason to believe they would have difficulty getting pregnant). The Cleveland Clinic explains rates of unexplained infertility vary by source, but there is evidence to suggest between 10% and 30% of couples who have fertility test results that return ‘normal’ aren’t able to find the reason behind their difficulty getting pregnant. 

For those with a hormonal imbalance, they may already be aware of infertility as a potential outcome of their condition, while for others they may have discovered a hormonal health condition as a result of sustained efforts to conceive which have not been successful. In either case, infertility is a scary potential side effect of a hormonal imbalance, which is why we’re going to go through the most common hormonal imbalances, discuss whether and how they affect fertility, as well as potential treatment paths that are available.

Defining infertility 

Before we dive in, let’s quickly go over what we mean when we say “infertility.”

According to the CDC, infertility is “defined as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex” in a woman under the age of 35. In women older than 35, 6 months of unprotected sex without conceiving is the definition of infertility. This is the time when infertility diagnosis and treatments should be discussed.  

If you or someone you know has struggled to get pregnant, you may be familiar with the term “reproductive endocrinologist,” a term used to describe a doctor who specializes in managing infertility.  

Hormonal conditions affecting fertility

Like we touched on earlier, a hormonal imbalance can impact fertility. Let’s discuss why that might be, and the potential treatment options. 


What is PCOS?

PCOS stands for polycystic ovarian syndrome, and it is characterized by a dominance of androgens (male sex hormones). Very commonly insulin resistance is linked to PCOS. Symptoms of PCOS may include excess hair growth on the face, back, legs, and chest, as well as acne, hair loss on the center of the scalp, and an irregular or absent menstrual period. 

How does PCOS affect fertility?

The United States’ Office on Women’s Health reports that PCOS is “one of the most common, but treatable causes of infertility in women.” The reason PCOS is thought to be linked to infertility is because PCOS can impact your ability to ovulate; and if you can’t ovulate, then you can’t get pregnant. Many women with PCOS report absent or irregular periods, which is often a sign PCOS may be interfering with ovulation each month.

Treatment options  

Unfortunately, there is no known cure for PCOS. 

However there are measures one can take to try to balance hormones again, and trigger ovulation. This may include lifestyle changes, such as increased exercise and lowering stress in your daily life, as well as dietary changes, and potentially medication and supplements. Overall, “for infertility caused by PCOS, treatment involves correcting any ovulation issues and tackling metabolic problems, such as insulin resistance.” 


What is hypothyroidism?

Hypothyroidism  means you have an underactive thyroid, which essentially means your thyroid is not producing enough T3 and T4. One possible cause of hypothyroidism is Hashimoto’s disease, an autoimmune disorder that can cause an underactive thyroidism (and rarely, an overactive thyroid). Common symptoms of hypothyroidism include tiredness, weight gain, being cold easily, and a puffy face, though there are many others

How does hypothyroidism affect fertility?

In the case of hypothyroidism, since the thyroid doesn’t produce enough thyroid hormone, this can interfere with the release of an egg from your ovary - otherwise known as ovulation - which can result in not being able to conceive.  

Treatment options 

For many women who struggle to get pregnant as a result of hypothyroidism, addressing the cause is a positive step in the direction of trying to conceive. Treating an underactive thyroid typically involves taking Levothyroxine, which is also safe to take during pregnancy, although your dosage may need to be adjusted once you get pregnant, in consultation with your doctor.