Endocrine infertility

Endocrine Infertility – Endocrinologist Review

Endocrine infertility is a general term describing reproductive issues in women caused by ovarian dysfunction. This condition should be evaluated and treated by a qualified endocrinologist, as endocrine factors account for 30-40% of infertility cases in women.

Main Causes of Endocrine Infertility

• Hypothalamic-pituitary dysfunction – caused by head or chest trauma, tumors in the hypothalamic-pituitary region, or hyperprolactinemia, leading to impaired ovarian function.
• Ovarian and adrenal hyperandrogenism – elevated male hormones from ovaries or adrenal glands, often associated with polycystic ovary syndrome (PCOS), hirsutism, and menstrual irregularities.
• Thyroid dysfunction – hypothyroidism or toxic goiter can cause anovulation, secondary hyperprolactinemia, and endocrine infertility.
• Estrogen and progesterone deficiency – leads to incomplete endometrial preparation and prevents embryo implantation.
• Severe somatic diseases – cirrhosis, hepatitis, tuberculosis, autoimmune or systemic disorders, and various malignancies.
• Obesity or underweight – affects hormonal balance and endocrine function, contributing to infertility.
• Resistant ovarian syndrome (Savage syndrome) and premature menopause.
• Sex chromosome mutations – can lead to hormonal deficiencies, sexual infantilism, primary amenorrhea, and endocrine infertility.

Symptoms

Main symptoms include inability to conceive, menstrual cycle irregularities, anovulatory cycles, galactorrhea (due to hyperprolactinemia), hirsutism, acne, hair loss, obesity, and blood pressure fluctuations.

Diagnosis

A qualified endocrinologist performs thorough anamnesis and physical examination: height, weight, presence of obesity, hirsutism, breast development, and secondary sexual characteristics. Gynecologist consultation is included. Hormonal function of ovaries and ovulation is assessed through laboratory tests and follicle ultrasound monitoring. Progesterone and urinary pregnandiol levels confirm ovulation.

Treatment

Treatment follows a stepwise approach: normalization of endocrine gland function (correction of diabetes, obesity, adrenal or thyroid dysfunction, surgical removal of tumors if needed). Dominant follicle stimulation and ovulation induction follow if necessary. Most cases respond to hormonal therapy, while surgical correction or IVF may be required in complex situations.

Prevention

Prevention of endocrine infertility should start in childhood: prevent infections, rheumatism, flu, and toxoplasmosis; correct functional disorders in the hypothalamic-pituitary-ovarian axis early.