HPA Axis Dysfunction And Low AMH and High FSH

Embarking on the journey of fertility often leads women to confront the intricacies of their hormonal health. The balance between Anti-Mullerian Hormone (AMH) and Follicle-Stimulating Hormone (FSH) becomes crucial when pursuing conception. Recognizing the importance of balanced hormone levels, we aim to guide women through the maze of assessments, lifestyle changes, and diet modifications that can pave the way for a healthier reproductive journey.

AMH and FSH work in tandem to regulate the menstrual cycle and support the development of healthy eggs (1). Understanding their roles provides insight into potential issues that may arise during the fertility journey.

HPA axis dysfunction can significantly impact hormonal balance. It stems from the compromised function of the adrenal glands, leading to insufficient production of hormones vital for conception (2). Several interconnected factors contribute to the development and exacerbation of HPA axis dysfunction, each playing a distinctive role in the intricate web of hormonal regulation. By treating the dysfunction, fertility issues can be resolved.

Firstly, imbalances in blood sugar levels can strain the adrenal glands significantly (3). These glands are pivotal in regulating glucose, and when blood sugar fluctuates extensively, it places an additional burden on the adrenals to maintain stability. Chronic exposure to such demands can contribute to HPA axis dysfunction over time.

Secondly, the intricate relationship between adrenal function and thyroid health plays a significant role in HPA axis dysfunction. The adrenal glands and the thyroid gland work in tandem to regulate metabolism and energy production. Dysfunction in one can lead to a cascade effect, impacting the other (4). HPA axis dysfunction may exacerbate thyroid issues, and vice versa, creating a cycle that can be challenging to break.

Moreover, autoimmune disorders can contribute to HPA axis dysfunction (5). In some cases, the immune system mistakenly identifies the adrenal glands as foreign entities and launches an attack. This autoimmune response can impair the adrenal glands' ability to produce hormones efficiently, further contributing to HPA axis dysfunction.

Another pivotal factor is sleep. Adequate and restorative sleep is fundamental for maintaining optimal adrenal function. Chronic sleep deprivation places undue stress on the adrenal glands, disrupting the delicate balance of hormone production (6). The adrenal glands follow a circadian rhythm, and disturbances in the sleep-wake cycle can hinder their ability to function optimally.

Assessing Your Current Hormone Levels & Other Factors Affecting Fertility

Various tests are available to gain a comprehensive understanding of hormone function. Blood chemistry, genetic testing, fertility monitoring, and hormone testing via urine sample are valuable tools that provide insights into your hormonal picture.

Beyond hormonal tests, assessing other factors such as the vaginal microbiome, semen analysis, and the gut microbiome can offer a deeper look at possible issues influencing fertility.

Lifestyle and Diet Changes to Normalize Hormone Levels

Addressing HPA axis dysfunction through lifestyle changes is pivotal for supporting hormonal health. In terms of nutrition, prioritizing a nutrient-rich, well-balanced diet is crucial. Incorporating specific nutrients and foods known to support hormonal balance—such as omega-3 fatty acids, antioxidants, and vitamin-rich foods—can positively impact Anti-Mullerian Hormone (AMH) and Follicle-Stimulating Hormone (FSH) levels (7, 8). Fish, nuts, seeds, berries, and vegetables are some examples. Implementing an elimination diet to identify and remove potential food sensitivities is an additional strategy to alleviate stress on the body and promote hormonal harmony. For more information on the elimination diet listen to episode #153 of Get Pregnant Naturally.

Focusing on a diet that promotes balanced blood sugar by consuming fiber and protein-rich meals, vegetables, fish, legumes, lean meats, eggs, and healthy fats like avocado, extra virgin olive oil, nuts, and seeds is essential (9). As well as whole grains for those who don't have celiac or a gluten sensitivity. 

Eating a diet like the one described above eliminates processed foods, sugar-sweetened items, and refined carbohydrates (10). To further limit blood sugar spikes, pair carbohydrates in general with a protein or fat (10). And lastly, incorporating movement, such as a 10-minute walk after meals can stabilize blood sugar levels (11). 

Stress management is another key aspect of combating HPA axis dysfunction. Recognizing the connection between chronic stress and hormonal imbalance is vital. Chronic stress can disrupt the endocrine system, leading to imbalances in AMH and FSH levels (12). Implementing stress-reducing techniques, such as meditation, yoga, and mindfulness, becomes essential to contribute to emotional well-being and support overall hormonal health (13).

Prioritizing quality sleep is an indispensable component of lifestyle changes to address HPA axis dysfunction. Establishing a consistent sleep routine and creating a conducive sleep environment can positively influence AMH and FSH levels, contributing to hormonal regulation (6).

In addition to lifestyle changes, foundational supplements contribute to addressing HPA axis dysfunction and promoting hormonal balance. Probiotics, CoQ10, magnesium, omega-3 fatty acids, vitamin D3, and methylfolate are integral supplements that support overall reproductive health.

A Path Forward

Achieving normalized AMH and FSH levels and resolving HPA axis dysfunction and underlying issues is multifaceted. Recognizing the interplay between hormones and lifestyle and dietary factors empowers women on their fertility journey. Regular check-ups, monitoring, and reassessing are crucial for tracking progress on the path to conception. Adjustments to lifestyle and treatment plans can be made based on the evolving needs and responses of the individual.

Let’s connect and talk more about how the Fab Fertile Program could help you and your partner achieve pregnancy success! Book your free 15 minute call here.

References

1. Butler, W. J., Pico, A., Hawkins, K. C., & Younis, A. I. (2021). Discordance between day-3 follicle stimulating hormone & anti-Müllerian hormone is predictive of clinical pregnancy during fertility treatment.Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 37(9), 798–801. https://doi.org/10.1080/09513590.2020.1862788

2. Huecker MR, Bhutta BS, Dominique E. Adrenal Insufficiency. [Updated 2023 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.Available from: https://www.ncbi.nlm.nih.gov/books/NBK441832/

3. Chan, O., Inouye, K., Riddell, M. C., Vranic, M., & Matthews, S. G. (2003). Diabetes and the hypothalamo-pituitary-adrenal (HPA) axis.Minerva endocrinologica, 28(2), 87–102. 

4. Koyyada, A., & Orsu, P. (2020). Role of hypothyroidism and associated pathways in pregnancy and infertility: Clinical insights.Tzu chi medical journal, 32(4), 312–317. https://doi.org/10.4103/tcmj.tcmj_255_19

5. Kasperlik-Załuska, A. A., Czarnocka, B., & Czech, W. (2003). Autoimmunity as the most frequent cause of idiopathic secondary adrenal insufficiency: report of 111 cases.Autoimmunity, 36(3), 155–159. https://doi.org/10.1080/0891693031000095871

6. White N. D. (2016). Influence of Sleep on Fertility in Women.American journal of lifestyle medicine, 10(4), 239–241. https://doi.org/10.1177/1559827616641386

7. Al-Safi, Z. A., Liu, H., Carlson, N. E., Chosich, J., Harris, M., Bradford, A. P., Robledo, C., Eckel, R. H., & Polotsky, A. J. (2016). Omega-3 Fatty Acid Supplementation Lowers Serum FSH in Normal Weight But Not Obese Women.The Journal of clinical endocrinology and metabolism, 101(1), 324–333. https://doi.org/10.1210/jc.2015-2913

8. Safiyeh, F. D., Mojgan, M., Parviz, S., Sakineh, M. A., & Behnaz, S. O. (2021). The effect of selenium and vitamin E supplementation on anti-Mullerian hormone and antral follicle count in infertile women with occult premature ovarian insufficiency: A randomized controlled clinical trial.Complementary therapies in medicine, 56, 102533. https://doi.org/10.1016/j.ctim.2020.102533

9. Amankwaah, A. F., Sayer, R. D., Wright, A. J., Chen, N., McCrory, M. A., & Campbell, W. W. (2017). Effects of Higher Dietary Protein and Fiber Intakes at Breakfast on Postprandial Glucose, Insulin, and 24-h Interstitial Glucose in Overweight Adults.Nutrients, 9(4), 352. https://doi.org/10.3390/nu9040352

10. Nesti, L., Mengozzi, A., & Tricò, D. (2019). Impact of Nutrient Type and Sequence on Glucose Tolerance: Physiological Insights and Therapeutic Implications.Frontiers in endocrinology,10, 144. https://doi.org/10.3389/fendo.2019.00144

11. Reynolds, A. N., Mann, J. I., Williams, S., & Venn, B. J. (2016). Advice to walk after meals is more effective for lowering postprandial glycaemia in type 2 diabetes mellitus than advice that does not specify timing: a randomised crossover study.Diabetologia,59(12), 2572–2578. https://doi.org/10.1007/s00125-016-4085-2

12. Dong, Y. Z., Zhou, F. J., & Sun, Y. P. (2017). Psychological stress is related to a decrease of serum anti-müllerian hormone level in infertile women.Reproductive biology and endocrinology : RB&E,15(1), 51. https://doi.org/10.1186/s12958-017-0271-4

13. Nidhi, R., Padmalatha, V., Nagarathna, R., & Amritanshu, R. (2013). Effects of a holistic yoga program on endocrine parameters in adolescents with polycystic ovarian syndrome: a randomized controlled trial.Journal of alternative and complementary medicine (New York, N.Y.),19(2), 153–160. https://doi.org/10.1089/acm.2011.0868