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POI & Optimizing Fertility

  • June 28, 2023
  • Doctor Lawrence

Today we’re diving into a topic that many women with Primary Ovarian Insufficiency (POI) who are trying to conceive (TTC) want to know: How do I optimize fertility while using hormone replacement therapy (HRT)? Thank you to our group member who requested more details. Let’s explore the evidence together.

First and foremost, it’s important to note that we are not giving medical advice. It would be best to discuss your care with your healthcare team who know your situation. However, we can share some evidence from the medical literature that may be helpful for you to discuss with your healthcare team.

One step you should discuss with your provider is getting on the National Institutes of Health Physiologic HRT regimen (NIH P-HRT). This regimen will give you regular menstrual cycles so you will know to get a pregnancy test if your cycle is late. If you are TTC, evidence suggests you should not take birth control pills for your HRT. These change the cervical mucous and lining of your womb creating an inhospitable environment for fertilization and implantation.

Your chances to conceive are less than average, so it’s essential to prioritize preconception health. Optimally, have intercourse two or three times per week, so there will always be sperm present for the occasional ovulation women with POI experience. Keep a menstrual calendar and get a pregnancy test if your period is late. Set a reasonable time for TTC before moving on to other solutions, such as egg donation, adoption, or non-parenting.

Published evidence has demonstrated the most common problem preventing normal ovarian follicle function and ovulation in women with POI is inappropriate luteinization of growing follicles. Additionally, published evidence has shown the NIH P-HRT regimen suppresses serum LH levels to normal in women with POI. Lowering the LH level in your blood should improve the chances of ovulating by reducing the circumstances of the follicles becoming luteinized. This perspective has yet to be proven by prospective studies, however. As a group, women with POI should advocate for more studies about improving their natural fertility.

Please discuss anything you read here with your healthcare team to determine if this evidence applies to your situation.

Best of luck on your TTC journey!

In health,

Doctor Lawrence logo

Dr. Lawrence M. Nelson, MD, MBA
Director, My 28 Days® Initiative
President, Mary Elizabeth Conover Foundation, Inc.

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