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Ovulatory Dysfunction Overview
Ovulatory problems account for 20 to 30% of infertility cases.
If you suffer from Ovulatory Dysfunction and would like a free e-mail
consultation, please complete our Ovulatory
Dysfunction Consultation Form.
A normal adult women ovulates every 25 to 32 days. Ovulation
is actually a process of maturing eggs that have been “resting” in
the ovaries since birth. Each day throughout a woman’s life until
she reaches menopause, a few eggs move from the “resting” state
into an “active” state. Even though eggs attempt to become “active” continuously
through childhood, they can not mature since there are no hormones
to drive their development. Hormones that can allow the “activated” eggs
to mature only become available after a women reaches puberty. Once
the eggs begin to mature they compete with each other to become “the” egg
that will ovulate. After eggs commit to the maturation process, there
is no turning backwards, they either achieve successful ovulation or
they die.
Ovulatory Dysfunction Causes
Prematurely Aging Ovaries
The aging ovary is the most common cause
of ovulatory problems. In the 10 years before menopause fewer and
fewer eggs are present in the ovaries. When the remaining eggs fall
below a critical level, cycles can become irregular. Eggs that mature
during the last decade of reproductive life, are not as likely to
establish a continuing pregnancy. For women who experience irregular
cycles secondary to ovarian aging, it may be necessary to use much
more fertility medication to achieve ovulation. At CHR we have a
special program for Prematurely
Aging Ovaries.
Hormonal
Some women have irregular menstruation because their ovaries
produce too much androgen (male hormones). These women are often overweight,
and have a history of irregular periods, acne, and infertility. This
syndrome has been called the Polycystic ovary syndrome(PCO), because
of the multiple small follicle cysts that can be seen on ultrasound
lined up just under the surface of the ovary. In some cases the excess
male hormone does not represent PCO. The adrenal gland or the ovary
may be sources of abnormal androgen production. Some of these conditions
may be dangerous and require further investigation and treatment.Women
who do have PCO may benefit by using insulin sensitizing medications,
like metformin (Glucophage). Clomiphene citrate (Clomid) is the most
common medication used to treat ovulation abnormalities among women
with symptoms of PCO. Sometimes these two drugs can be used simultaneously.
Your doctor will usually first give you medication such as medroxy-progesterone
(Provera) to induce menses. After menstrual flow begins, clomiphene
citrate is taken daily from the 3 rd through the 7 th day of the cycle.
Patients may need clomiphene citrate doses of up to 5 pills per day
to induce ovulation. It is helpful to monitor the response to this
treatment. Acceptable ways of monitoring range from following basal
body temperature charts and urinary ovulation predictor kits to daily
sonogram monitoring and blood tests.
Stress
Physical or mental stress can result in ovulatory problems.
It is not unusual for college or professional school students to stop
ovulating. Extreme weight loss, exercise training, even preparation
for a piano recital can all result in ovulatory problems. In many cases,
these problems are temporary and normal cycling returns when the stressor
is no longer present. For women with extreme weight loss an internist,
reproductive endocrinologist and psychologist or psychiatrist are often
all needed to help correct the problem. Although one could treat this
type of anovulatory problem with fertility drugs, most people believe
that it is safer and more effective to correct the underlying stressor.
Thyroid
If a woman has either an underactive or over active thyroid
(Hypo or Hyperthyroidism) ovulatory problems may occur. Proper treatment
of the thyroid abnormality will often restore ovulation.
Prolactin
Prolactin is a pituitary hormone that is normally secreted
during and after pregnancy to prepare a woman’s body to produce
milk for her baby. Sometimes too much prolactin is secreted from the
pituitary when a woman is not pregnant. Not surprisingly, women with
this condition often begin to lactate. Discharge of milk and loss of
menstruation are the major symptoms associated with this condition.
In some cases menses do not stop, but cycles become irregular and there
is a shorter interval between menses. Women with this condition need
to have a CT scan or MRI to make sure their pituitary is normal. Although
in the past these cases sometimes required pituitary surgery, today
excess prolactin production can almost always be effectively treated
with medication.
Abnormal ovarian development
Some women are born with ovaries that
can not produce eggs. Women with this condition do not go through puberty
and usually never have a period.
Ovulation Dysfunction Treatment
The good news is
that many ovulatory problems can be effectively treated. Once ovulation
is restored the chance of pregnancy returns to normal. We
are fortunate today that the availability of egg donors can provide an
opportunity even for women with ovarian aging or abnormal ovarian development
to achieve pregnancy.
The medications used to treat ovulatory problems will depend on their
cause. Some medications are known as fertility drugs. These medications
are oral medications like clomiphene citrate and injectable medications
such as recombinant FSH, highly purified FSH, human menopausal gonadotropins,
and human chorionic gonadotrophins. A special class of medications,
such as bromocriptine or cabergoline, is used to treat hyperprolactinemia.
Treatment Qualifications
If you have ovulatory dysfunction and unable to get pregnant
after trying for one year, complete the Ovulatory
Dysfunction Consultation Form to
determine if you qualify for our Treatment Program.
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