Hormones regulate, almost unknowingly, much of a woman’s life. One of the first questions that we receive in consultation from a woman or couple who undergoes stimulation for the first time is related to the hormones of assisted reproduction. For this reason, we wanted her to be the doctor Irene Rubio, Embryologist & Project Manager – Medical Affairs de IVI Madrid who answers this question on our blog.
One of the first doubts that appear in an assisted reproduction treatment are hormones and how they will affect our body. It is a very correct question because you are probably going to notice changes at all levels, physical yes, but also emotional. The process you start is not just a medical treatment, it is much more, it is part of your life project. It is a journey full of questions, fears, uncertainties and surprises, with enormous hope in the background at all times. And in this roller coaster, in addition, hormones come into play. If the nerves before an exam could make your cycle alter … How is this situation not going to affect you? Hormones play a fundamental role in our body, but in addition to that “organic” role, they have an enormous influence on our perception of the situation and the associated emotions.
We are going to try to explain both aspects to you, the physiological and the emotional, with the intention that, with information in hand, everything will be easier for you.
What exactly are hormones?
Hormones are the messengers and regulators of the human body, it is the simplest way to define them. They are chemical substances that are secreted in the endocrine glands and released into the blood, and thus reach those organs or tissues where they must activate or regulate some mechanism. For example, there are hormones that speed up metabolism, others trigger milk production, some speed up the heart rate, and others initiate and regulate the development of the sexual organs.
Most hormones are proteins, although some of them are fatty substances derived from cholesterol. Its action can be immediate, but sometimes its effect takes several days to occur and can last for weeks, months or even years.
Those responsible for producing hormones are the endocrine glands, as we have already mentioned.
The main one is the pituitary gland or pituitary, which is located next to the hypothalamus, at the base of the brain. It is very small but extremely important since it controls the secretion of almost all the endocrine glands. In Assisted Reproduction it is enormously important, since it intervenes in practically all processes: it regulates the secretion of hormones involved in the growth and maturation of ovarian follicles (the cavities within the ovary where the ovules grow), the preparation of the uterine tissue for the pregnancy (called the endometrium), ovulation, menstruation… and many more.
Will I receive hormones during assisted reproduction treatment?
Yes, they will vary in type and dose depending on the treatment you are going to follow, but in all of them we need your body to respond in a certain way, and this is achieved with the administration of hormones externally.
We are going to explain a little about each one since, in these weeks, you will often hear about them:
- Oral contraceptives: they are a type of hormones that allow us to control the cycle, have the ovaries at rest and anticipate the arrival of menstruation (which marks the beginning of treatment to stimulate the ovaries). In this way we ensure a better response to subsequent medication. In the form of oral pills.
- GnHR agonists and antagonists (Gonadotropin-releasing hormone): in general, its function is to better control ovarian stimulation and to have a better response to gonadotropins. Among other advantages, they avoid the body’s own LH surge, which can trigger spontaneous ovulation that cancels the cycle. It also prevents premature luteinization, which produces poor quality eggs. They are usually administered in the form of subcutaneous injections, which you can inject yourself at home, intramuscularly, or as a nasal nebulizer.
- Gonadotropins (FSH: follicle-stimulating hormone, LH: luteinizing hormone, hMG: human menopausal gonadotropin and hCG: human chorionic gonadotropin): these hormones help us to cause the multiple growth of ovarian follicles and the maturation of the ovules they contain, as well as to trigger the ovulation. They are usually given as subcutaneous injections.
In the image you can see a drawing of one of the ovaries, where several follicles are growing and, inside, the ovules. The black and white image is an ultrasound, like the one you will see in consultation: each sphere in black is a fluid-filled follicle (the ovum is in that fluid).
- E2 (Estradiol): this hormone is responsible for the formation of a mature egg in each natural cycle and for activating the production of the hormone LH, which causes ovulation. In addition, it helps prepare the endometrium. During the stimulation treatment we will measure the estradiol levels in your blood several times because its value, together with the ultrasound scans, allows us to evaluate the growth of the follicles.
- Progesterone (P4): Provides hormonal support to the luteal phase of the cycle (after ovulation) when it is insufficient or the treatment performed requires it. Its function is to promote the thickening of the tissue inside the uterus, where the embryo implants (adheres) and the fetus develops in pregnancy. The doses are variable, usually it is administered vaginally in the form of ovules, but it can also be taken orally in the form of tablets.
What are the effects of hormones that I can notice?
It must be taken into account that some women are more susceptible than others to the effects associated with the administration of hormones, so not all will experience them or, if they do, it may be with different intensity.
As physiological effects you may notice drowsiness, swelling in the abdomen and chest, fluid retention, mild headaches, hot flashes and discomfort derived from the enlargement of the ovaries … Sometimes small local reactions also occur in the injection area, such as erythema or stinging. In the case of intravaginal ovules, some local irritation and an increase in the amount of flow can sometimes be noticed.
If any of them happen to you, notify your medical team, who will verify that everything is going well and will give you guidelines to alleviate them.
On a psychological level I am also varied. The most common is to experience mood swings, feelings of depression and some anxiety, as well as a decrease in libido. It is difficult to know to what extent it is due to the hormonal treatment and how much derived from the stress and anxiety of the situation itself. But, keep one thing in mind, just as in case of noticing physical discomfort we advise you to have our medical team to solve them, we recommend the same in this situation. In our clinics we have a specialized psychology team, and they are at your complete disposal to give you the tools you need and make the process easier for you.
If you need more information in this regard, do not hesitate to contact us, we will be happy to help you answer any questions. And calm down, you will be guided at all times, it is part of our commitment.
Embryologist & Project Manager – Meddical Affairs
IVI Madrid
