Ocular Implications of Fertility Therapies

Do Fertility and Hormonal Treatments Cause Ocular Complications?

Fertility therapies generally amend the reversible etiologies of one’s infertility. This largely includes in vitro fertilization techniques, ovulation induction agents, and hormonal replacement therapies. These therapies target only infertility, but the hormonal effects caused by such treatments have been shown to show some ocular disorders. Nevertheless, ocular complications following fertility therapies are not very common.

What Are the Fertility-Based Therapies Causing Ocular Complications?

The therapies that can cause eye health problems include:

• Hormonal replacement therapy (HRT).

• Aromatase inhibitors.

• Clomiphene citrate.

• Progesterone.

• Hormonal contraceptives.

• In vitro fertilization (IVF).

What Are the Ocular Implications of Fertility Therapies?

The possible ocular implications associated with fertility and hormonal therapies are as follows.

Keratoconus:

Keratoconus is an eye health condition where the cornea becomes thinner while gradually bulging outward, making a cone shape. One experiences blurred vision due to thinning and bulging of the cornea. The role of hormones in this condition is still undetermined, though the studies reveal the contributing factors.

Nevertheless, there can be heightened corneal thickness during the mid-term of ovulation and the terminal phase of the menstrual period, showing a significant correlation with estrogen and progesterone hormones. Moreover, post-menopausal women taking estrogen supplementation have been reported to have increased corneal thickness. Certain evidence also shows that people experienced keratoconus progression after IVF therapy.

Dry Eyes:

Females are more likely to encounter dry eye syndrome than men. Moreover, hormones play a significant role in the gender prevalence of dry eye syndrome (DES), making it markedly high. The studies signify that women using hormone replacement therapy (HRT) have an increased risk for this syndrome. Long-term therapy use can be associated with a significantly higher risk of dry eyes. For instance, one clinical finding states that about 15 percent of increased DES can be associated with a three-year duration of HRT. According to clinical evidence, dry eye syndrome is significantly linked to aromatase inhibitors.

Central Retinal Vein Occlusion:

Most individuals taking Clomiphene citrate in fertility therapy have been reported with central retinal vein occlusion. Central retinal vein occlusion is a potentially serious condition in which the vein draining the blood from the retina occludes (closes off) either partially or fully. This results in blurred vision and the associated symptoms.

The occurrence of this condition seems to be dependent on the dosage and duration of the drug. The symptoms can gradually improve following the termination of drug therapy. Certain cases have been reported as concurrent incidences of central retinal vein occlusion and cilioretinal vein occlusion after the commencement of hormone replacement therapy.

Maculopathy:

Maculopathy, also known as macular degeneration, is a condition affecting the central part of the retina called the macula. Macula is associated with Clomiphene citrate use in women. Moreover, one case has been reported with complete vision loss secondary to macular degeneration after prolonged use of Clomiphene citrate. In such a case, there was no return of vision even after hormone and fertility treatments were terminated.

Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION):

This condition refers to a decline in blood flow to the optic nerve (the nerve connecting the eye and brain). Multiple cases report this condition following the commencement of Clomiphene citrate. The mechanism behind this is that the increased estradiol causes an increase in blood viscosity.

Retinal Periphlebitis:

Retinal periphlebitis refers to vasculitis of the peripheral retinal vascular system. So, it is a subtype of retinal vasculitis that significantly affects the retinal veins. This condition has been reported following hormonal treatment in men. The individual experienced a serious and unilateral decline in visual acuity. The treatment for this condition includes systemic corticosteroids to improve visual acuity.

Meningioma:

The clinical findings show that the hormone progesterone can influence intracranial meningiomas (tumors from the meninges). This is because women are more likely to get meningioma tumors than men. So, meningioma is known to contain high progesterone receptors. Moreover, meningiomas tend to grow with pregnancy while regressing during childbirth.

The studies state that the individuals undergoing hormone replacement therapy carried a greater risk of meningioma tumors than those nerves that had exposure to HRT. Certain findings signify that hormonal changes are not the attributable factors for meningioma, though. The link between this condition and hormones remains biased.

Neovascularization of Retina and Choroid:

In vitro fertilization therapy is known as one of the risk factors for the emergency condition of retinal detachment (retune is pulled away or detached from its actual position). This is more prevalent following the commencement of Clomiphene citrate treatment for ovulation induction.

Though the absolute mechanism is undetermined, it is known that IVF therapy can increase vascular endothelial growth factor (VEGF) levels. Other clinical findings also show the link between the levels of VEGF and follicle-stimulating hormones (FSH).

Certain reports also indicate choroid neovascularization following IVF with increased VEFF levels. In such a case, anti-VEGF treatment has proven effective against neovascularization and vision impairments.

Palinopsia:

Palinopsia is a condition characterized by abnormal persistence of images and sensitivity to light (photophobia). Fertility treatment is known to cause palinopsia due to the inhibitory action of estrogen in gamma-aminobutyric acid synthesis. This results in visual hallucinations and associated effects.

What Are the Less Common Ocular Implications of Fertility Therapies?

The other ocular implications of fertility and hormonal treatment include the following.

• Scotomas (blind spot or visual field abnormality).

• Vision changes.

• Dry eyes.

• Less visual acuity.

• Retinal damage.

• Photosensitivity.

• Decreased tear production.

Conclusion:

The hormonal and fertility therapies can lead to several ocular problems like dry eyes, vision changes, or retinal vein occlusions due to hormonal fluctuations. Certain fertility therapies can even influence the production and composition of tears, resulting in potential discomfort. It is vital to report to the professionals in case of any changes in eye health after or during the fertility treatment.