Fertility and Pregnancy With Congenital Adrenal Hyperplasia (CAH)

Posted by AweSamo March 19, 2026
The Path to Pregnancy: Navigating Fertility With Congenital Adrenal Hyperplasia (CAH)

There are several treatment routes, including CAH-specific ones and general fertility therapies. Your doctor can help you decide on the right treatment for you.

Optimizing Steroid Treatment

Steroids are the mainstay treatment for most people with CAH, and working with your doctor to make sure you’re getting just the right amount is the first step toward upping your pregnancy odds.

“Optimizing [steroid] medications can help to bring back regular ovulation and periods, which can help with fertility,” says Dr. Ryan. For many women, that may mean increasing the dosage at certain times of your menstrual cycle and dialing back at others.

“In some cases, the actual steroid being prescribed may also need to change,” says Dr. Moravek.

Clomiphene Citrate (Clomid) or Letrozole to Stimulate Egg Release

If adjusting your steroid treatment isn’t enough to help you get pregnant, your doctor may recommend additional tools for managing your fertility, including drugs that stimulate ovulation, like clomiphene citrate (Clomid) or letrozole. These prompt your body to release an egg that can then potentially be fertilized by sperm.

“All fertility treatments that are offered to women without CAH are also options for women with CAH,” Moravek says.

Metformin for Insulin Resistance

If your body isn’t as sensitive to insulin as it should be, your doctor might recommend an oral medication like metformin to lower your blood sugar and potentially help you ovulate more regularly, making it easier to conceive.

IVF and Other Forms of Assisted Reproductive Technology

When fertility medications haven’t helped you get pregnant, assisted reproductive technologies like in vitro fertilization (IVF) can be another option. The procedure involves combining eggs and sperm outside of your body and implanting a fertilized embryo into your uterus.

The American College of Obstetrics and Gynecology recommends that women with CAH who are trying to become pregnant, especially those undergoing IVF, should be offered the option of having genetic carrier screening.

Genetic testing can determine whether your child may also be affected by CAH.

Future children are only at risk if the patient’s male partner or sperm donor also carries a gene mutation that can cause CAH, Moravek explains.

“In couples who both carry a CAH-causing mutation, embryos created by IVF can be screened to see if they will be affected by CAH with relatively high accuracy, or a diagnosis can be made by genetic testing of a pregnancy,” she says.

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