All about ovulatory disorders

Approximately 15% of infertility is secondary to ovulatory disorders. It is very important to figure out what the dysfunction is, as different causes have different treatments. First and foremost comes obtaining adequate information from a patient’s history. If a woman is having irregular periods or lack of periods or bleeding all the time, she is likely not ovulating in a normal manner.

Factors in ovulatory disorders

Some of the things that can impact ovulation are abnormalities include the following:

• Thyroid function
• High levels of the hormone prolactin
• Polycystic ovary syndrome (PCOS)
• Lack of appropriate hormone production from the brain (hypothalamic amenorrhea)
• Obesity
• Premature ovarian failure
• Eating disorders
• Extreme stress.

A deeper look at these issues

Causes of ovulatory disorders like thyroid disorder are easily treatable using synthetic thyroid hormone replacement. Often normalizing thyroid function will cause normalization of the ovulatory function.

For women with PCOS, often medications to induce ovulation such as Clomid, letrozole (Femara) or gonadotropins, help. Many women with PCOS are obese and have glucose intolerance. Such women would benefit from weight loss and use of a medication called Metformin. This drug improves the sensitivity to the actions of insulin in the body.

In general, if someone is going to get pregnant with oral medication, it will happen within the first 4 cycles. After that, it would be of benefit to consider other options. For women with hypothalamic causes of ovulatory disorders, they should consider gonadotropins.

Those women who have premature ovarian failure (i.e. premature menopause), there are not any good options other than IVF with donor egg.

For those women with hyperprolactinemia, an MRI of the brain is necessary to see if they have a benign tumor of the pituitary gland. If the tumor is small, it can be treated with oral medications.

Of course, healthy lifestyle, good eating habits, maintaining a normal weight and minimizing stress as much also help. As you can see, there is no “one size fits all” when it comes to  ovulatory disorders. At TFC we try very hard to determine the root of the problem and tailor treatment to have the best outcome for each individual patient. Contact us to learn more.