Ovulation Problems

There can be a number of reasons why a woman may have ovulation problems. If a woman has anovulatory periods there likely would be less than the normal number of menstrual cycles per year. If the sex partners are missing the few fertile days where trying to conceive a pregnancy would be most likely, it might appear that she is infertile. However, with hormone tests the gynecologist can often find a solution how to regulate the menstrual cycle.

With polycystic ovary syndrome there often is an association with obesity or dietary imbalance and the zone diet plan would be a good first treatment approach as in a significant portion of cases this might regulate the problem. However, the physician should closely watch the patient and follow her along.

If the dietary approach does not lead to ovulation, a gynecologist would need to carefully use a combination of progesterone followed by a few days of clomiphene to induce ovulation and conception. Another approach is to use human menopausal gonadotropin (=HMG). However, there are risks associated with fertility treatments, both for clomiphene and HMG therapies. Too many cycles induced with clomiphene can increase ovarian cancer risk. Overuse of HMG can lead to multiple pregnancy in about 25% (as can clomiphene). HMG has been associated in about 15% with ovarian hyperstimulation syndrome.

With this syndrome the ovaries are extremely large associated with it there are major fluid shifts and ascites (=fluid in the abdomen), which can be so severe that it can become life threatening. If this happens, the physician withholds the medicine, the fluid shifts are corrected, if necessary, in a hospital setting where this can be achieved more easily with intravenous rehydration and close observation for a few days. Finally, progesterone that has been given as injection birth control for contraception can accumulate and lead to prolonged anovulatory periods for many months. The treatment for this is witholding the hormone and to follow the LH levels to see when ovulation reoccurs. Occasionally a short trial of ovulation stimulation through a gynecologist may be necessary.

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Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

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Last Modified: Jan. 17, 2008