Ovulatory Disorders

Your hypothalamus, the small gland at the base of the brain, is essentially your reproductive hormone thermostat. It regulates the levels of several hormones by providing feedback to the pituitary gland.

If everything is working right, the hypothalamus produces gonadotropin-releasing hormone (GnRH), which signals increased hormone production during the first phase of your ovulatory cycle. In response, the pituitary increases FSH production, which causes follicles to develop. As healthy follicles develop, they produce estrogen, which is monitored by the hypothalamus. As estrogen levels increase, FSH levels decrease. Once the follicles are mature, the hypothalamus signals a spike in luteinizing hormone (LH) production to stimulate ovulation 36 hours later.

If something within this process is irregular or absent, infertility occurs.

Irregular ovulation can be caused by several factors, most commonly by ovarian failure, which occurs when the ovaries can no longer release eggs that are capable of fertilization and development. It is a natural consequence of aging that culminates with menopause. Unfortunately, it occurs earlier in some women. In this instance, the only fertility treatments available are donor eggs or adoption.

Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS) commonly causes irregular ovulation and infertility. Women with PCOS are often overweight; they ovulate irregularly, and may have an increased risk of miscarriage.

Because PCOS causes a resistance to insulin, and elevated insulin levels stimulate the ovary to produce androgens, women with PCOS are not only at risk of infertility, but also diabetes, heart disease, and high cholesterol. Insulin-sensitizing medications like Metformin can help to increase the body’s sensitivity to insulin, helping to resume normal ovulation.

Are there tests that can accurately assess my ovarian function?

Yes. You can assess and monitor ovarian function through:

  • Day 3 Measurements
    Tests FSH and estrogen levels to confirm whether FSH levels are abnormally elevated and therefore diminishing ovarian reserve
  • Clomiphene Citrate Challenge Test
    More sensitive of ovarian function and may be necessary to uncover how the ovaries will respond to FSH stimulation
  • Urinary hormone test kits
    Accurate measurements of luteinizing hormone excreted into the urine
  • Ultrasound evaluation<
    Measures the ovaries and number of follicles in the ovary to predict response to fertility medications and treatment
  • Progesterone hormone measurements
    Measurement to confirm ovulation

What causes irregular ovulation?

Although ovarian failure is the most common cause of irregular ovulation, problems can also be caused by:

  • Abnormally elevated prolactin levels (hyperprolactinemia)
    High prolactin levels in non-pregnant women lead to irregular ovulation and are often caused by a small tumor on the pituitary. This can be treated with medications and/or surgery.
  • Thyroid dysfunction
    Abnormally high (hyperthyroidism) or low (hypothyroidism) thyroid levels can cause irregular ovulation. Correction of the thyroid dysfunction usually fixes this problem.
  • Environmental factors
    Excessive exercise and stress can also lead to irregular ovulation.
  • Adrenal disorders
    Androgens are male hormones, such as testosterone, produced by the ovaries and adrenal glands, and abnormally high levels lead to oligoovulation. Increased androgens are associated with elevated levels of prolactin, and/or tumors on the ovary, pituitary, or adrenal gland.

What are the most common symptoms of PCOS?

  • Infertility
  • Male-pattern hair growth
  • Acne
  • Obesity
  • Insulin resistance
  • Irregular Menstrual Cycles

Are there any effective treatments for PCOS?

Yes! There are several ovulation-inducing medications, such as Clomiphene citrate or FSH. Often very little medication is needed.

If I have PCOS but not interested in getting pregnant at this time, are there any treatments?

Yes. Treatment is often aimed at the specific symptoms. Commonly, the oral contraceptive pill may be used to regulate the menstrual cycles and protect the uterine lining from overgrowth. Additionally, the oral contraceptive pill is effective in decreasing the hormones responsible for dermatologic problems related to PCOS, like facial hair growth and acne.

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