Hormones
IVF, fertility drugs and hair: the shed that comes with the treatment
Nobody going through fertility treatment has hair at the top of their list, and nobody at the clinic mentions it. But a surprising number of women notice thinning during or after treatment, and it helps to know that it is expected, that it is temporary, and which of the many things you are taking is responsible.
What the drugs do to hair
Down-regulation (buserelin, leuprorelin, nasal sprays) switches the ovaries off temporarily. Oestrogen falls to menopausal levels for two to four weeks. Follicles that were being held in growth are released into rest. A cohort will shed two to three months later, whatever happens next.
Stimulation (the FSH injections) drives oestrogen to many times its natural peak for ten to fourteen days. Hair usually looks and feels wonderful for a fortnight. Then, after egg collection, oestrogen crashes. Another cohort into rest; another shed on a delay.
Luteal support (progesterone pessaries or injections) is mildly androgenic in some formulations and can add to thinning at the temples in women who are prone to it. Usually a small effect.
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Start the quiz →Clomifene and letrozole, used for milder stimulation, both suppress oestrogen’s effect at the receptor and are more often associated with shedding than the injectables. Again, temporary.
Add the stress, the disrupted sleep, the appetite that comes and goes, and the frequent scans and blood draws that lower iron a little, and the result is that most women who go through more than one cycle notice their hair is thinner by the end of it.
After a cycle that did not work
The shed arrives two to three months after the oestrogen crash, at the point where you may be about to start the next cycle. If the next cycle starts before the shed is visible, the new stimulation holds the follicles again and the shed is deferred. This is why women who do several cycles back to back sometimes see very little until the end, and then a large shed several months after the last one. It is one shed for the whole course, delayed.
After a cycle that worked
Pregnancy holds everything, and the treatment shed is absorbed into the pregnancy glow. The postnatal shed afterwards is usually somewhat larger than average, because it includes the deferred treatment cohort. The postnatal article applies; the timeline may be a little longer.
What is safe to use during treatment
Ordinary haircare, anti-dandruff shampoos, colour: all fine. Iron, vitamin D and a good pregnancy multivitamin: fine and sensible. Minoxidil, finasteride, spironolactone: no, and stop them before a cycle. Peptide scalp serums: the large peptides are not absorbed systemically and I am comfortable with them, but a woman who wants to keep her regime minimal during treatment loses nothing by pausing until after. Rosemary and other essential oils in treatment doses: pause. Supplements with saw palmetto, high-dose vitamin A or herbal “hormone balancers”: stop.
What to do
Ferritin checked before you start, and corrected if it is under 70; you will be having bloods anyway, so ask for it to be added. Protein at every meal through the injections. Photographs before the first cycle, because you will otherwise not know, a year later, whether the hair came back. Gentleness with what you have. And if the shed is still going nine months after the last cycle ended, or has become a pattern rather than a general thinning, the treatment is no longer the reason and this article is where to look.
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