Menstrual Cycle and Hormone Imbalances

It is crazy to me how much stuff is missed in health class. For those who never embark on the infertility pathway pregnancy seems to be something that just happens. Sure you have some concept that there must be an egg and a sperm but how does the egg come to be?

One night I was talking with my sister on the phone. It was during my conversation with her that she thought she had kidney stones, or appendicitis and after describing the pain and some questions I asked of her in regards to her cycle I told her she was likely ovulating. She was relieved but upset. This was never explained to her and such is the case for many women.

Infertility is more common than people let on. 1 in 3 couples struggle with infertility and yet it’s not talked or discussed in the public community. With infertility comes a great deal of shame and feeling of “taboo” so it’s not always realized by those around you.  My condition, PCOS, is the most common cause of infertility in women. While common it doesn’t make it any less of a battle. For two years we have suffered largely in silence. For two years fought and battled. There is a lot of shame surrounding infertility. I started this blog post (not public) as a way to get out my feelings but it was after a fellow friend of mine shared her struggle to become pregnant that she showed me the only way to change this seemingly taboo topic, the only way to one day have insurance recognize it as a medical condition, the only way to maintain sanity is to create awareness.

So bear with me and be warned the remainder of this post is a little technical and but I feel it important because like my sister (and me too, before I started this journey) a lot is left out of health class.

A women’s cycle begins on the first day of her period. . The lining of the uterus is shed and this is the first part of the cycle called menstruation. This occurs since there are no pregnancy hormones to tell the lining to stay.  The shedding of the lining takes about 5-7 days. During the time of your period follicle-stimulating hormone (FSH) is released by the hypothalamus. This brings about the growth of follicles on one or both of the ovaries. Typically each follicle will contain one egg, and typically only one follicle is grown each cycle. However just because there is a follicle does not guarantee and egg. Some follicles are empty and others don’t make it to maturity. The follicles push out the hormone estrogen into the bloodstream. It is the rising level of estrogen in the bloodstream that causes the hypothalamus to reduce a second substance, luteinizing hormone (LH). When the LH hormone is at it peak it causes one of the follicles to burst and release an egg. The egg then is swept down the Fallopian tubes where it hopefully meets a sperm to result in fertilization.

This whole process takes about a month. There are so many hormones involved that if even one component is off it can halt the whole process. For me I never created follicles on my own. I also suffer from hypothyroidism. The thyroid is part of the endocrine (hormonal) system and is under control of the hypothalamus and the pituitary gland in the brain. This is a big deal since the hormones hypothalamus is in charge of pushing out FSH, and with thyroid imbalance its like a bad hand dealt that prohibits me from naturally creating and releasing eggs.  Clomid helps to send signals to grow follicles but that is not the end of the struggle. After being on Clomid for eight rounds my OB/GYN discovered that I was never getting a strong LH surge to signal a release of the eggs from my follicle. My doctor pin-pointed this back to my thyroid issue and that is when I was referred to a Reproductive Endocrinologist.

Infertility is complex and for many it’s not just a single issue. I my case it’s PCOS, hypothyroidism, and hormone imbalances all working against me. The hidden secret of infertility needs to be changed if we are to help the 1 in 3 couples struggling and provide a supportive public view. I’m hopeful that in another decade infertility would be identified and the stigma released as with the current change for mental illness. These are real conditions and they are common if we are honest to look around ourselves.

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