Interlink between Infertility and Ovulation Disorders
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A process where the matured egg is released from the ovary is called ovulation. These eggs may or may not be fertilized by the sperm. If fertilized, the egg may travel to the uterus and occurs a higher chance of pregnancy. If unfertilized, the egg falls apart and the uterine lining is shed during your period. Ovulation is a crucial part of the menstrual cycle (month-to-month changes a woman’s body goes through devising for pregnancy).
You can find out if you are ovulating by figuring out when your next period is due and counting back 12-16 days. For women with a 28 days cycle, the 14th day is often the day of ovulation. Also, pregnancy is absolute proof of ovulation.
Being said, almost 25% of total infertility problems are caused due to ovulation disorders. Problems with the diminished secretion of reproductive hormones through the pituitary gland or issues within the ovary can lead to ovulation disorders. Dysfunctioning of the ovary is a common causative factor of infertility. Anovulatory infertility impacts a bigger share of reproductive-elderly women.
One’s lifestyle factors, being over or underweight, affects the hormone level and can damage ovaries, resulting in ovulation disorders. Menstrual disturbances cause infertility in 25% of couples. WHO (World Health Organization) categorizes ovulation disorders into three :
- Hypothalamic Pituitary Failure
- Dysfunctioning of the Pituitary ovarian axis
- Ovarian failure
Hypothalamic Pituitary Failure
Conditions such as hypothalamic amenorrhea are included in this category. Women present with amenorrhoea (absence of menstruation), primary or secondary, which is categorized by low gonadotrophins. Gonadotropins may improve the chances of becoming pregnant with IVF treatment treated under a reputed IVF clinic by stimulating the ovaries to produce more than one follicle.
Absence of menstrual cycle for more than six months without evidence of organic abnormalities. Hypothalamic amenorrhea results from a change in the normal pattern of episodic secretion, with ovulation failure. Hypothalamic injury manifests dysfunctions, including body temperature, growth, sex drive, weight, milk production, emotions, etc.
Its effects are primarily carried out by hormones released from the hypothalamus to their targeted organs, such as the pituitary gland, thyroid gland, and ovaries. Three main types recognized are stress, weight loss, and exercise. Around 10% of ovulation disorders are categorized under hypothalamic-pituitary failure.
Dysfunctioning of the Hypothalamic-Pituitary-Ovarian Axis
This category includes conditions such as polycystic ovarian syndrome, widely known as PCOS. Endocrine disorders, such as diabetes and others, affecting women might cause ovulatory dysfunction. PCOS is said to be the leading cause of anovulatory infertility, i.e., 85% of the total ovulation disorder is caused by this category. Also, women with PCOS have an increased risk of miscarriage.
The HPO (hypothalamic-pituitary-ovarian) axis is a tightly regulated system controlling female reproduction. Interlinkage between the hypothalamus, pituitary gland, and adrenal glands is what HPO is described as. The location of adrenal glands is on top of the kidneys and the hypothalamus and the pituitary gland is just above the brainstem. It combines signals derived from upper cortical inputs (controls bodily movement), autonomic function, and environmental signs such as light and temperature.
Being overweight and body fat distribution influences the regulation of ovulation. Obesity interferes with endocrine and paracrine mechanisms involved in reproductive cycle regulation. PCOS can be controlled and treated. Required dedicated programs of diet using dieticians who work with diabetics helps in reducing your body weight and can help in focussing on your health.
Increased PCOS might result in early pregnancy loss, gestational diabetes, and pregnancy-induced hypertension. Women with PCOS undergoing IVF in any fertility clinic should be counseled prior to starting the treatment, and be aware of factors including
- availability, cost, and convenience
- Increased risk of ovarian hyperstimulation syndrome
- Methods to decrease the risk of ovarian hyperstimulation.
Ovarian Failure
5% of total ovulation disorder is caused by ovarian failure. Ovarian failure is a condition in which the ovaries stop working and menstrual periods stop before age 40. Women possess a finite number of oocytes, a cell in an ovary that may undergo meiotic division to form an ovum, that gradually declines to result in critically low levels in the mid to late 40s leading to clinical menopause by the early 50s.
Early depletion of ovarian function before the age of 40 is defined as premature ovarian insufficiency or failure (POI or POF ). Signs and symptoms of primary ovarian insufficiency include irregular or skipped periods, night sweats, vaginal dryness, dry eyes, decreased sexual desire, and difficulty getting pregnant.
Age, family history, and ovarian surgery involve in increasing the risk of primary ovarian insufficiency. POF is a condition characterized by amenorrhea and elevated serum gonadotropin levels (FSH & LH ) in women younger than 40 years. Secondary ovarian insufficiency occurs due to eating disorders, extreme physical exercise, pituitary, and hypothalamic tumors, and more.
Women with POI/POF should be well-educated about the nature of their disease and the treatment methods and technologies. Knowing the disease and understanding the problems helps the patient in coping up with the situation much better. Ovarian failure is a challenging issue as women are delaying having families and this should be handled well physically and psychologically by reputed doctors. IVF-specialized doctors can sit with you and explain the cons of your situation and find the best suitable solution for you.
The basic goal for anovulation caused by ovulation disorders is to observe, diagnose and treat the cause. Depending on the type of anovulation different drugs are employed which have to be consumed only after the prescription of the specialist. Later, even if the medical treatment fails, laparoscopic ovarian drilling is the next recommended option which is being done along with the tuboperitoneal assessment.
Kokoori IVF clinic recommends on behalf of the IVF doctors.
A structured approach must be guaranteed for anovulatory infertility treatment starting off from low-cost interventions to higher resources. Inadvertent and aggressive Laparoscopic Ovarian drilling (LOD) is associated with the risk of ovarian tissue damage. those with extensive skills in laparoscopic surgery only are supposed to do this procedure. Fertility consultants and laparoscopic surgeons at KOKOORI clinic are well experienced in these procedures.
The ovulation methods should be selected considering many factors such as the cause of anovulation, costs, risks & complications associated with the methods, drug availability, or accessibility of the patient.