Congenital adrenal hyperplasia
Irregular menses are common in females with CAH. The number of pregnancies among women with CAH is related to the severity of the mutation. Reports in women with classical CAH suggest that elevated progesterone concentrations play an important role in preventing menstrual cyclicity and fecundity.
Non-Classical Congenital Adrenal Hyperplasia (NCAH)
Women with Non-Classical Congenital Adrenal Hyperplasia (NCAH) often present reduced fertility due to secondary PCOS and hyperandrogenism (elevated concentrations of male sex hormones), which inhibit the normal hormonal cycle resulting in anovulation. Persistently elevated levels of progesterone during the follicular phase (oocyte and follicle development) in women with NCAH may interfere with the quality of cervical mucus (protective substances located in the cervi of the uterus), preventing sperm penetration. In addition, elevated levels of progesterone (female sex hormone) during the preovulary (follicular) phase of the menstrual cycle may result in inadequate endometrial maturation (maturation of the inner layer of the uterus) and impaired embryo implantation (“nesting” f an egg into the uterine wall).
It is characterized by deficiency of cortisol, aldosterone and androgen hormonal precursors, usually caused by an autoimmune reaction towards the adrenal cortex. The loss of adrenal androgens could possibly influence fertility and increase in spontaneous abortions and has been associated with Addison’s disease present in pregnancy, but the prognosis of pregnancies in patients with known Addison’s disease has usually been considered good. Concomitant diseases, such as autoimmune thyroid disease and premature ovarian insufficiency (POI; preterm cessation of ovarian function) are possible causes of reduced fertility in these patients, as well as inappropriate treatment of adrenal insufficiency and the burden of disease, with loss of energy and vitality required for wanting and planning a pregnancy and to rear children.
Excess stress raises cortisol levels and drops progesterone levels (both potential signs of infertility). The adrenals produce progesterone before converting it into cortisol. If the adrenals are exhausted, they will rob other sources of progesterone, notably ovarian. This impacts on the reproductive cycle. Stress can cause anovulation and miscarriages. Patient suffering from AI is at increased risk of experiencing those symptoms due to stress conditions.
Increased levels of cortisol may lead to altered sperm production resulting in decreased sperm motility and concentration. Yet men’s fertility is usually less affected by AI then women’s fertility potential.