Evaluation Of Stress Hormones in Women with Primary Infertility
Keywords:
Cortisol, TSH, DHEA, ACTH, Primary InfertilityAbstract
Hormonal and neuroendocrinal factors play a major role in the etiology of infertility by disturbing reproductive homeostasis. This case-control study evaluated stress and thyroid hormones in women with primary infertility. A total of one hundred twenty women within the age range of 20 to 38 years were studied where seventy-six belonged to the category of primary infertility, and forty-four were normal controls. Early follicular phase morning fasting blood sample was used for estimation of serum cortisol, adrenocorticotropic hormone (ACTH), dehydroepiandrosterone (DHEA), and thyroid-stimulating hormone (TSH) through ELISA. The results indicated significantly higher mean values among the infertile group for cortisol (r=0.32, p=0.005), ACTH (r=0.28, p=0.01), and TSH (r=0.25, p=0.02) compared to the control group whereas DHEA did not show any significant association (r=-0.15, p=0.12). This implies that hyperactivation of the hypothalamic–pituitary–adrenal and thyroid axes may be involved in the pathogenesis of impaired fertility, thereby justifying expanded endocrine assessment in the workup of infertility. The results further support ongoing efforts directed at discovering hormonal biomarkers that can inform treatment strategies.
References
Adam, T. C., & Epel, E. S. (2007). Stress, eating, and the reward system. Physiology & Behavior, 91(4), 449–458.
Al-fahham, A. and Al-Nowainy, H. Q. The role of F SH, LH, and Prolactin Hormones in Female Infertility . American Journal of PharmTech Research, 2016; 6 (5), 110-118.
Al-Fahham, A.A. (2019) Effect of low dose vitamin C on public speaking stress during group presentation. IOP Conf. Series: Journal of Physics: Conf. Series 1294, doi:10.1088/1742-6596/1294/6/062054 .
Anderson, R. A., Schmidt, L., & Norman, R. J. (2010). Stress and infertility: psychological and biological interactions. Human Reproduction Update, 16(2), 103–116.
Araujo, M. N. F., Branco, J. C. C., & Brandão, L. V. (2013). Leptin, lipid profile, and thyroid function in obesity. International Journal of Endocrinology, 2013, 1–6.
Arnaldi, G., & Boscaro, M. (2006). Diagnosis and complications of Cushing’s syndrome. Journal of Clinical Endocrinology & Metabolism, 91(7), 2406–2415.
Charmandari, E., Tsigos, C., & Chrousos, G. (2005). Endocrinology of the stress response. Annual Review of Physiology, 67, 259–284.
Cizza, G., & Rifai, N. (1996). Neuroendocrine activation and cytokine activity: Implications for metabolic disease. Endocrinology & Metabolism Clinics, 25(4), 835–857.
Duma, D., Jewell, C., & Cidlowski, J. A. (2015). Multiple roles for glucocorticoid receptor isoforms in inflammation and metabolism. Physiological Reviews, 95(3), 755–797.
Gameiro, S., Boivin, J., Peronace, L., & Verhaak, C. M. (2014). Why do patients discontinue fertility treatment? A systematic review of reasons and predictors of discontinuation in fertility treatment. Human Reproduction Update, 20(5), 652–669.
González-Clemente, J. M., Ibáñez, L., de Zegher, F., & López-Bermejo, A. (2014). Adiposity, cortisol, and metabolic risk factors in children: A hormonal triad. Obesity Facts, 7(1), 10–17.
Greil, A. L., Slauson-Blevins, K., & McQuillan, J. (2011). The experience of infertility: a review of recent literature. Sociology of Health & Illness, 33(1), 1–21.
Hogue, S. J., et al. (2021). The cortisol to DHEA ratio as a marker of aging and cognitive decline. Neurobiology of Aging, 97, 42–52.
Kalantaridou, S. N., Makrigiannakis, A., Zoumakis, E., & Chrousos, G. P. (2004). Stress and the female reproductive system. Journal of Reproductive Immunology, 62(1–2), 61–68.
Krassas, G. E., Poppe, K., & Glinoer, D. (2010). Thyroid function and human reproductive health. Endocrine Reviews, 31(5), 702–755.
Labrie, F. (2010). DHEA and aging: A biochemical perspective. Seminars in Reproductive Medicine, 28(5), 359–368.
Labrie, F., Luu-The, V., Labrie, C., Bélanger, A., Simard, J., Lin, S. X., & Pelletier, G. (2005). Endocrine and intracrine sources of androgens in women: inhibition of breast cancer and other roles of androgens and their precursors. Endocrine Reviews, 26(4), 313–340.
Langer, R. D., et al. (2019). Sex hormone binding globulin and adiposity. Journal of Endocrinology, 240(2), 79–91.
Livingstone, D. E. W., et al. (2000). Mechanisms of insulin-mediated regulation of 11β-HSD1. Diabetologia, 43(2), 273–280.
Luo, Y. H., et al. (2014). Cortisol-to-DHEA ratio and metabolic syndrome. Metabolic Brain Disease, 29(3), 635–641.
Maninger, N., Wolkowitz, O. M., Reus, V. I., Epel, E. S., & Mellon, S. H. (2009). Neurobiological and neuropsychiatric effects of dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS). Frontiers in Neuroendocrinology, 30(1), 65–91.
Mascarenhas, M. N., Flaxman, S. R., Boerma, T., Vanderpoel, S., & Stevens, G. A. (2012). National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Medicine, 9(12), e1001356.
McAdams-DeMarco, M., et al. (2020). HPA–HPT axis interactions in obesity: The role of cortisol and thyroid regulation. Clinical Endocrinology, 92(4), 289–297.
McEwen, B. S., & Stellar, E. (1993). Stress and the individual. Archives of Internal Medicine, 153(18), 2093–2101.
Meier, C. A., et al. (2015). Impact of insulin resistance on deiodinase activity. Thyroid, 25(11), 1219–1225.
Michalaki, M., Vagenakis, A. G., & Leonardou, A., et al. (2006). Changes in thyroid function with weight loss. European Journal of Endocrinology, 155(6), 651–657.
Miller, G. E., Chen, E., & Zhou, E. S. (2007). If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychological Bulletin, 133(1), 25–45.
Moretto, T., Zamo, M., & Conte, F. (2010). Roles of leptin in obesity-related thyroid axis regulation. Endocrine Reviews, 31(5), 493–515.
Pearce, E. N. (2008). Does obesity affect thyroid function? Journal of Clinical Endocrinology & Metabolism, 93(11), 3523–3525.
Poppe, K., & Velkeniers, B. (2004). Female infertility and the thyroid. Best Practice & Research Clinical Endocrinology & Metabolism, 18(2), 153–165.
Putignano, P., et al. (2001). Cortisol/DHEA ratio and aging. Journal of Clinical Endocrinology & Metabolism, 86(2), 656–662.
Rafacho, A., et al. (2014). 11β-HSD1 inhibition improves metabolic profile in obesity. Endocrinology, 155(5), 1846–1857.
Roelfsema, F., van Heemst, D., Iranmanesh, A., Takahashi, P., Yang, R., & Veldhuis, J. D. (2017). Impact of age, sex and body mass index on cortisol secretion in 143 healthy adults. Endocrine Connections, 6(7), 500–509.
Seeman, T. E., et al. (2001). Allostatic load as a predictor of health decline in later life. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(5), M325–M335.
Tsigos, C., & Chrousos, G. P. (2002). Hypothalamic–pituitary–adrenal axis, neuroendocrine factors and stress. Journal of Psychosomatic Research, 53(4), 865–871.
Walker, B. R., & Tomlinson, J. (2015). Visceral fat and cortisol: A vicious cycle. Current Opinion in Endocrinology, Diabetes and Obesity, 22(3), 171–176.
Weghofer, A., Dietrich, W., Barad, D. H., & Gleicher, N. (2012). Live birth chances in women with extremely low serum anti-Müllerian hormone levels. Human Reproduction, 27(2), 548–552.
Whirledge, S., & Cidlowski, J. A. (2017). Glucocorticoids and reproduction: traffic control on the road to reproduction. Trends in Endocrinology & Metabolism, 28(6), 399–415.
