Anovulation
Ovulation disorders
Problems at ovulation time are the most frequent cause for female infertility (25%) and are produced as a consequence of hormonal imbalances versus ovarian misdevelopment. It is one of the causes for sterility with the best prognosis, once the diagnosis and treatment are established. Approximately 35% of women experience anovulation at some time during their lives. The origin for this hormonal disorder may be in the hypothalamus, pituitary gland, or in the ovary itself. Among the determining factors for this situation are: stress, significant weight gain or loss, excessive production of prolactin (hormone responsible for producing breast milk) and polycystic ovaries, which deserve special mention due to their complexity and frequency.
Polycystic Ovaries
About 20% of women have polycystic ovaries (PCO).This PCO term refers to the appearance of the ovary in ultrasound scans, because one can observe an increase in the number of small cysts (antral follicles) on the ovary surface. However, there are a great many women with PCO who have no problems in ovulating and getting pregnant.
However, some of these women who have this characteristic ultrasound scan pattern, also have the Polycystic Ovarian Syndrome (PCOS) condition. In these women, the hormonal disorder implies irregular menstrual cycles or even a lack of menstruation (amenorrhoea); therefore they will have problems in getting pregnant, due to their lack of ovulation. To better understand the process, we must consider that a normal woman usually experiences ovulation 12 times a year. If menstruation appears every three months, in theory there will be only four ovulations a year, and even though menstruation occurs, there may often be anovulation, so this problem will probably appear throughout the year.
The first step for treatment normally implies restoring weight back to normal and doing physical exercise, if it is associated with being overweight or hypertension. If normalisation of menstrual cycles and ovulation is not achieved, the next step is medical treatment to normalise the hormonal functions and stimulate ovulation. There is also talk of ovarian drilling (to make small holes in the ovarian surface by using heat or laser) to improve the ovarian hormonal microenvironment. In our group, this is considered to be the last option; the IVF cycles are considered first.