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Ovulatory Dysfunction Causes and Treatment

One of the primary symptoms of ovulatory dysfunction is irregular or absent menses (periods). In a normal ovulatory cycle, the hypothalamus signals the pituitary to produce the hormone FSH. FSH causes the recruitment, and supports the development, of the ovarian follicles each of which contains an egg.

As healthy follicles develop increasing amounts of estrogen are produced. This is the basis for the estradiol hormone tests conducted during an FSH stimulated IVF cycle. The hypothalamus “reads” estrogen, and other hormones, levels and adjusts hormonal production accordingly. FSH production declines as the follicles mature and approach the ovulatory stage.

Once the follicles mature, the hypothalamus signals the pituitary to release a surge of luteinizing hormone (LH) which finally prepares the eggs for ovulation and induces ovulation approximately 36 hours later. In an FSH stimulated IVF cycle, hCG is injected to mimic the LH surge and the retrieval is scheduled. The ovulatory cycle reacts to hCG in the same manner as it does to LH.

After ovulation, the leftover follicular structures, known as the corpus luteum, begin to produce progesterone. Progesterone stimulates the endometrium (lining of the uterus) to thicken and become more vascular. This vascularization must occur so that the endometrium can supply nutrients to the developing embryo/fetus. Once the placenta is formed, it starts to produce progesterone.

Ovulatory disorders occur when any of the processes above are “disrupted”. For example, PCOS causes increased androgen levels that ultimately inhibit ovulation. Women are born with a lifetime’s supply of eggs and as they age the eggs begin to lose their ability to fertilize and develop leading to ovulatory dysfunction. Eventually, none of the eggs will develop properly signaling the menopause. Many of these women are candidates for our Jacksonville, FL, donor egg program.

Abnormal levels of many different hormones can lead to ovulatory dysfunction including FSH, LH, thyroid hormones, androgens, estrogen, prolactin, and many others. The OB/GYN sometimes chooses to treat ovulatory dysfunction with Clomid. Clomid is helpful for many women but should generally be avoided in older women. Fertility can decline rapidly and older women may not have time for “Clomid trials”.

Dr. Shaykh will conduct the necessary fertility tests to identify the cause(s) of ovulatory disorders. For example, ovulatory dysfunction due to PCOS can be treated with Clomid. However, PCOS is caused by elevated androgens and most fertility specialists prefer to treat the specific cause of anovulation instead of a applying a broad, general” treatment.

This treatment principle ultimately results in higher pregnancy rates and reduced chances for negative medication side effects. Other factors that can cause ovulatory irregularities include excessive exercise, stress, obesity, and an abnormally low body weight. Most ovulatory disorders can be effectively treated with fertility medications.