THE OVULATION PROCESS
During the menstrual cycle, one of the ovaries releases a mature egg. This is known as ovulation. Ovulation dates may vary widely from woman to woman and also month to month. Many women use one or more methods to pinpoint their ovulation day. Methods include:
- Checking for several days of stringy cervical mucus
- Charting basal body temperature changes
- Checking luteinizing hormone changes with urine test kits
PROBLEMS WITH OVULATION?
If the Eggs don’t mature in the ovaries or if the ovaries fail to release a mature egg, then this is a sign of an ovulation problem. This is common in women with infertility issues.
Ovulation disorders are disorders where you ovulate infrequently or not at all. They account for infertility in about 25% of infertile couples. The causes of these disorders might be flaws in the regulation of reproductive hormones by the hypothalamus or the pituitary gland, or by problems in the ovary itself.
Ovulation disorders include:
- Polycystic ovary syndrome (PCOS):This is a common endocrine system disorder among ladies of the reproductive age. Women with PCOS during an ultrasound exam show up enlarged ovaries that contain small collections of fluid — called follicles — located in each ovary.Complex changes occur in the hypothalamus, pituitary gland and ovaries which results in a hormone imbalance which affects the ovulation process. This condition is associated with insulin resistance, obesity, abnormal hair growth on the face or body and acne. PCOS is the most common cause of female infertility.
- Hypothalamic dysfunction: Follicle-stimulating hormone (FSH) and Luteinizing hormone (LH) are hormones that are responsible for stimulating ovulation every month. They are produced by the pituitary gland in a specific pattern during the menstrual cycle. Several factors such as excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt this pattern and affect the ovulation process. The main sign of this problem is irregular or absent periods.
- Premature ovarian insufficiency: Typically cause by an autoimmune response where your body attacks ovarian tissues or by premature loss of eggs from your ovary due to genetic problems or environmental factors such as chemotherapy. This results in the loss of the ability to produce egg as well as a decreased oestrogen production below the age of 40.
- Too much prolactin: Less commonly, the pituitary gland causes an excess in prolactin production (hyperprolactinemia) which reduces oestrogen production and may cause infertility. This is most commonly due to a problem in the pituitary gland. However, it can also be related to medications you’re taking for another disease.
WHEN THE THYROID’S TO BLAME
Your doctor may prescribe a thyroid hormone if an underactive thyroid is at the root of an ovulation disorder. Women with PCOS have abnormal insulin production; therefore, a diabetes drug called metformin may be used to treat the condition. In other cases, a simple change of lifestyle is recommended. A small amount of weight reduction and exercise can go a long way towards inducing ovulation naturally in some women.
- Absent or infrequent periods
- Unusually light or heavy menstrual bleeding
- Lack of such premenstrual symptoms (bloating or breast tenderness)
Fertility drugs are normally the first line of treatment used to treat ovulation disorders. There is a variety of fertility drugs designed to stimulate follicle growth and egg development and all them work towards the same goal which is to induce ovulation. Your doctor will determine which type of drug or combination of drugs should be used to best address your specific infertility issue.
Generally, these are short-term treatments that can range anywhere from a few days to a few weeks. If you have good quality eggs and there are no other fertility problems, medication alone can pave the way towards pregnancy.
ORAL FERTILITY DRUGS
Clomiphene citrate (Clomid or Serophene) is one of the most common fertility drugs on the market. It works to trigger the pituitary gland to release hormones that help ripen a follicle and produce an egg. It comes in a form of a tablet and is taken for five days during your menstrual cycle.
Clomid requires little or no monitoring with ultrasound or blood tests and is usually well tolerated. Some of the side effects may include hot flashes, headaches, and bloating. However, it only occurs in less than 10% of patients.
With Clomid, there is a chance of developing ovarian hyperstimulation syndrome. The ovaries become enlarged and incidence of twins increases slightly because more than one egg may be released.
Studies have shown that more than 50% of women treated with Clomid do ovulate. Those who don’t respond on the first try will consume a higher dose during the next cycle and possibly once more after that.
INJECTABLE FERTILITY DRUG
If Clomid is still ineffective or the patient can’t tolerate it, your doctor may move onto injectable fertility drugs called gonadotropins to induce follicle growth. This therapy costs more than Clomid and carries the added cost of ultrasound and blood monitoring. The treatment is normally tried for 6 to 12 months. It also carries the risk of ovarian hyper stimulation syndrome and an increased chance of multiple births.
Success rates with injectable medications vary and are influenced by several factors including quality of egg.
- History taking and physical exam: Your doctor can normally tell from discussing the details regarding previous menstrual cycles whether there may be an ovulation disorder.
- Blood testing and ultrasound: Monitoring of the ovaries at various times of the menstrual cycle can clarify whether ovulation is occurring.