Ovulation Dysfunction and Infertility

• Overview: Ovulation dysfunction (also called ovulation disorders) is one of the most common causes of infertility in women and is due to an issue with ovulation, which is the release of a mature egg for potential fertilization during a woman’s menstrual cycle.
• Types of ovulation disorders and causes: Of the several types, the most common are polycystic ovary syndrome (PCOS), hormone imbalance, hypothalamic dysfunction and premature ovarian insufficiency. These are most often caused by problems with the ovaries or the essential reproductive hormones, as well as some lifestyle factors, medications and health conditions.
• Diagnosis: Some ovulation disorders can be diagnosed with an examination or discussion with the woman about her menstrual and medical history. Diagnosing other disorders may require laboratory blood testing or ultrasound to assess the ovaries.
• Ovulation disorder symptoms and treatments: The primary symptoms are irregular periods, absence of a period (amenorrhea) and infertility. Most ovulation disorders can be treated with lifestyle changes or medication.

What is ovulation dysfunction?

Ovulation dysfunction, also called ovulation disorders, is a condition that affects the normal ovulation process resulting in failure to ovulate (anovulation) or irregular ovulation. Ovulation is the phase in a woman’s menstrual cycle when a mature egg (usually one) is released from one of her ovaries each month and travels to one of the two fallopian tubes for possible fertilization by sperm.

Ovulation dysfunction is one of the most common causes of infertility in women. The American Society for Reproductive Medicine (ASRM) reports that approximately 25% of all infertility problems are ovulation related.

A woman’s ovulation can be affected by the health of her ovaries and by her endocrine system, which plays an essential role in her menstrual cycle. During a normal menstrual cycle, the endocrine system prepares the body for pregnancy by secreting hormones, most notably gonadotropin-releasing hormone (GnRH) and follicle stimulating hormone (FSH), which both promote egg maturity, luteinizing hormone (LH) that causes the release of the egg, and progesterone that helps prepare the uterine lining for possible pregnancy.

Ovulation can be diminished if there is a change in production of these hormones or the delivery of them at the proper time. Disruption to the reproductive hormones can be caused by disruption in the part of the brain or the glands that produce the hormones.

Primary types of ovulation disorders

• Hormone imbalances.
• PCOS.
• Hypothalamic dysfunction.
• Primary ovarian insufficiency.
• Hyperprolactinemia.

Anovulation is sometimes mistaken as an ovulation disorder but it is actually an ovarian dysfunction, commonly caused by a hormonal imbalance.

Below are the main types of ovulation dysfunction and their causes.

Hormone imbalance

Hormones play a crucial role in female reproduction, specifically those hormones that control the menstrual cycle. If a woman’s reproductive system produces less than or more than the amount of hormones necessary for ovulation, this creates an improper balance.

Pregnancy occurs when the proper hormones regulate an egg’s growth inside an ovary, the release of the egg into the fallopian tube for fertilization, and the thickening of the uterine lining for implantation. An irregularity in one or more hormones during this process can result in difficulty conceiving.

The thyroid gland produces hormones that regulate the body’s metabolism and can affect its vital function. Thyroid disorders such as hypothyroidism (too little thyroid hormone) and hyperthyroidism (too much) can negatively impact a woman’s hormone balance and fertility. Men can also experience a hormonal imbalance of testosterone that can affect their fertility.

One of the most important forms of hormonal imbalance affecting ovulation is PCOS.

Polycystic ovary syndrome (PCOS) & its cause

PCOS is a type of a hormonal imbalance that affects a woman’s insulin responsiveness and testosterone and luteinizing hormone levels. It is the leading hormonal imbalance cause of infertility and a common ovulation dysfunction. When a woman’s testosterone levels are elevated, she can experience irregular or absent periods or anovulation. This can prevent a woman’s mature eggs from releasing and they may turn into ovarian cysts.

Over time, the production of multiple cysts can block ovarian follicles from producing mature eggs, and an imbalance of testosterone can disturb ovulation and cause infertility.

Hypothalamic dysfunction & its cause

Hypothalamic dysfunction is when the hypothalamus, an area in the brain that manages the pituitary gland and regulates various functions in the body, is working improperly. Hypothalamic dysfunction causes an absence of menstruation, which is called amenorrhea. This is due to the brain not properly signaling the secretion of follicle-stimulating hormone (FSH) that prompts the ovary to release a mature egg.

At times, the hypothalamus will stop producing GnRH, which reduces the amount of other hormones produced (FSH, LH and estrogen) causing infertility.

Hyperprolactinemia and causes

Hyperprolactinemia is the excess production of prolactin, a hormone produced by the pituitary gland that regulates milk production. This excess reduces the estrogen level and can disrupt ovulation and result in infertility.

Hyperprolactinemia can be caused by pregnancy and is most often related to a problem with the pituitary gland. It can occur due to a prolactin-secreting tumor (prolactinoma) or a large pituitary tumor that constricts the rest of the gland. Pregnancy and the use of various medications can also cause hyperprolactinemia.

Premature ovarian insufficiency

Premature ovarian insufficiency (POI), previously called premature ovarian failure, is when a woman’s ovaries stop working and producing estrogen before she begins menopause. When this happens, a woman’s menstrual cycles become irregular and eventually end.

Subsequently, her ovaries stop making hormones such as estrogen and progesterone and she stops ovulating regularly or at all. This results in an early onset of menopause and infertility. Women between the ages of 35 and 40 have a greater risk of premature ovarian insufficiency.

According to ASRM, in almost half of women affected by POI, the exact cause is never known. Genetic disorders, autoimmune disease, radiation or chemotherapy are linked to causes of premature ovarian insufficiency.

Diagnosing ovulation disorders

Our fertility specialists can diagnose some ovulation disorders with a medical examination and a discussion of the woman’s medical and menstrual history. Tests may be required to help diagnose ovulation disorders, to check the ovarian reserve, to confirm that ovulation has occurred, or to monitor the development of ovarian follicles and the thickness of the uterine lining.

Based on the symptoms that a woman shows, our specialists will test for different hormone levels. For example, if a woman has PCOS symptoms, our specialists will likely test her testosterone and insulin levels to make a diagnosis.

PCOS symptoms & treatment

Polycystic ovary syndrome includes the following symptoms:

• Excessive hair on the face, chest, upper thigh and stomach.
• Weight gain.
• Severe acne and oily skin.
• Male-pattern baldness or thinning hair.
• Decrease in sexual desire, anxiety and depression.

Treatments for PCOS vary depending on age, severity of the symptoms and overall health. A woman with PCOS who would like to become pregnant in the future will need a treatment that includes a change in diet and activity to help with weight loss and reduce symptoms, which in turn can help with ovulation. Medications can help the ovaries release eggs normally.

For women who do not plan to become pregnant, birth control pills can help control menstrual cycles, reduce acne and lower androgen levels. Diabetes medicine can be used to reduce insulin resistance in women with PCOS and can also slow hair growth, increase ovulation and lower androgen levels.

Our specialists may recommend fertility treatments for women who have severe symptoms. This can solely involve medications to help stimulate ovulation, or it can include a combination of medications with assisted reproductive technology procedures like intrauterine insemination (IUI) or in vitro fertilization (IVF).

Symptoms of hypothalamic dysfunction and treatment

Symptoms include the following:

• Irregular or absent periods.
• Fatigue.
• Weight gain.
• Hair loss.

Treatment for hypothalamic dysfunction is based on the cause of the condition. If the dysfunction is caused by a tumor, surgery or radiation may be required. For hormonal deficiencies, hormone therapy may be an option. Medicines can induce ovulation and also help with appetite regulation.

Hormone imbalance symptoms & treatment

Hormone imbalance symptoms are:

• Fatigue.
• Sleep problems.
• Irregular menstrual cycles.
• Chronic acne.
• Weight gain.

Depending on the cause, treatment for hormonal imbalances can vary. Medications with estrogen or progesterone can help relieve some symptoms. Medications can also help regulate symptoms or replace hormones. Making lifestyle changes may be recommended as well, such as regular exercise and maintaining a healthy weight to keep hormones in balance.

Hyperprolactinemia symptoms & treatment

Symptoms of hyperprolactinemia include:

• No period or irregular periods.
• Vaginal dryness.
• Producing breast milk when not pregnant.

Treatments depend on the cause of hyperprolactinemia and can include medications to lower prolactin levels. Radiation and surgery may be suggested if a tumor is the cause. Additionally, vaginal creams with estrogen can help with the dryness symptom.

Symptoms of premature ovarian insufficiency & treatments

Symptoms include:

• Trouble conceiving.
• Hot flashes.
• Vaginal dryness.
• Irritability.
• Decreased sex drive.
• Irregular or absent menstrual cycles.

There is no proven method to treat premature ovarian insufficiency, but there are treatments available to address the symptoms, including hormone replacement therapy. Calcium supplements, regular exercise and maintaining a healthy weight are options as well. For a woman with POI trying to conceive, IVF using donor eggs can be an alternative.