How Congenital Adrenal Hyperplasia Can Affect Fertility

Living with congenital adrenal hyperplasia (CAH) comes with challenges. You know that already.

And if you’re considering starting a family, you probably also know (all too well) that pregnancy for people with CAH can come with its own set of concerns — both for your own well-being, as well as for healthy fetal development.

The road to starting your family can be a long one when you’re living with CAH, but it is possible.

Ob/Gyn George Drake, III, DO, FACOG, shares how CAH affects fertility and shares advice for your best options for a healthy pregnancy

Does congenital adrenal hyperplasia cause infertility?

CAH can cause infertility for some people, but that doesn’t mean that you can’t get pregnant, if that’s your goal.

“Hormonal imbalances — particularly high levels of androgens and progesterone — can make it harder for women with CAH to get pregnant.”

Having excess testosterone and progesterone can affect female fertility by:

• Causing irregular periods, which makes your fertile window harder to predict
• Suppressing ovulation (anovulation), which needs to happen in order for an egg to be released and fertilized
• Making your cervical mucus thicker than it should be, which makes it more difficult for sperm to reach an egg
• Thickening the lining of your uterus and cervix, which can keep an embryo from attaching to your uterine wall

For men, excess androgens, like testosterone, can decrease sperm count and lead to fertility issues.

Of course, there are other things outside of your CAH diagnosis that can also impact your chances of getting pregnant. That includes risk factors like:

• Chronic health concerns: Including having obesity, underweight, diabetes, eating disorders and other conditions
• Age: Being older than 35 for women or 50 for men
• Lifestyle factors: Smoking, excessive alcohol consumption and other types of substance use

All that said, fertility challenges don’t have to mean giving up on your plans to have a baby. Here’s what could help.

Review your CAH medication regimen

Glucocorticoid therapy is a mainstay treatment for CAH. Dialing in your medications to just the right dosage can help your chances of conceiving.

For some women, that may mean increasing and decreasing your dosage throughout your menstrual cycle — specifically, taking more medication during the follicular phase (roughly days 14 to 21 of your cycle) and less outside of that window.

But your specific recommendations will vary based on the severity of your CAH and other factors.

“If you have CAH, talking with a healthcare provider, like a maternal-fetal medicine provider, can help ensure that your medication is optimized for your health and your fertility,” Dr. Drake recommends.

Maternal-fetal medicine specialists are also known as perinatologists. They’re specifically trained to help people with chronic conditions get pregnant and have a healthy pregnancy.

IVF

If medication adjustment doesn’t do the trick, assisted reproductive procedures like in vitro fertilization (IVF) could be an option. That’s when sperm and eggs are combined outside of your body and the resulting embryo is implanted in your uterus.

“IVF can be a successful route to pregnancy for people with CAH,” Dr. Drake encourages. “It can help overcome fertility challenges from irregular cycles, anovulation, hormonal imbalances and more.”

What’s more, embryos can be screened for CAH and other genetic markers before they’re implanted. So, if you’re concerned about passing CAH on, you can select embryos with that in mind.

Having a healthy pregnancy with CAH

Now, for the next logical question: Is pregnancy safe with CAH?

It can be, Dr. Drake states. But close monitoring is recommended. “People with CAH should typically be treated as being at high risk for complications so we can watch for concerns and meet their needs,” he emphasizes.

Working with a maternal-fetal medicine specialist can help lower your risk for conditions that are common during pregnancy for people with CAH, like:

• Infections
• Extreme morning sickness
• Poor weight gain
• Gestational diabetes
• High blood pressure
• Preterm labor

Pregnant women with CAH also have higher rates of C-section delivery. That’s especially true if you’ve had surgery to your genitals or pelvis.

Bottom line

Pregnancy is possible with CAH, but it may not come easily. And when you do get pregnant, there can be risks. Surround yourself with a supportive and knowledgeable healthcare team. They can help you every step of the way.