Knowledge | Irregular Periods and Pregnancy: Managing Ovulation Problems
Irregular or abnormal ovulation is a leading cause of infertility, accounting for approximately 30% to 40% of all cases. Irregular periods, absent periods, or abnormal bleeding often indicate that ovulation is not occurring, a condition called ovulatory dysfunction or anovulation.
Although anovulation can often be treated with ovulation-inducing medication, physicians must first evaluate other conditions that may interfere with ovulation, such as thyroid disease or adrenal and pituitary disorders.
1. Treating Ovulation Problems to Support Pregnancy
After ruling out other medical issues, a physician may prescribe medication to stimulate ovulation. Clomiphene (Clomid and Serophene) is commonly used because it is effective and has been prescribed for decades. Unlike many fertility medications, clomiphene is taken orally rather than injected. It induces ovulation and corrects irregular ovulation by increasing the number of eggs recruited by the ovaries.
Clomiphene is effective for most women with anovulation. About 10% of women using it for infertility may have a multiple pregnancy, usually twins, compared with a twin birth rate of about 1% in the general population.
A typical starting dose is 50 mg daily for five days, beginning on day 3, 4, or 5 of the menstrual cycle. Ovulation usually begins about seven days after the final dose. If ovulation does not occur, the monthly dose may be increased by 50 mg up to 150 mg. Once ovulation begins, most physicians recommend continuing clomiphene for 3 to 6 months. If pregnancy does not occur, another medication or referral to a fertility specialist may be recommended.
Ovulation-inducing medications can sometimes make cervical mucus less receptive to sperm, preventing sperm from entering the uterus. This may be addressed with intrauterine insemination (IUI), in which specially prepared sperm is placed directly into the uterus. These medications may also thin the endometrium.
Depending on the patient's circumstances, the physician may recommend other ovulation medications such as Gonal-F or other injectable hormones that stimulate follicle and egg development. Sometimes called superovulation medications, they are usually given by subcutaneous injection. These hormones can overstimulate the ovaries, causing bloating and discomfort. Severe cases can be dangerous and require hospitalization, so physicians monitor estrogen levels with frequent vaginal ultrasound examinations and blood tests. Approximately 90% of women ovulate with these medications, and 20% to 60% become pregnant.
2. Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a common ovulation disorder affecting approximately 5% to 10% of women of reproductive age. PCOS is a hormonal imbalance that can impair ovarian function. The ovaries are often enlarged and covered with small, fluid-filled cysts. Symptoms include:
Absent periods, irregular periods, or irregular bleeding
No ovulation or irregular ovulation
Obesity or weight gain, although women with a low body weight can also have PCOS
Insulin resistance, an indicator of prediabetes
High blood pressure
Abnormal cholesterol and high triglycerides
Excess body and facial hair (hirsutism)
Acne or oily skin
Thinning hair or androgenic alopecia
3. Becoming Pregnant With PCOS
For patients with PCOS who are overweight, weight loss may improve the chance of pregnancy. A physician may also prescribe medication to lower insulin levels because elevated insulin caused by insulin resistance is common in women with PCOS. Prolonged high insulin levels may lead to diabetes. Untreated PCOS may increase the risks of heart disease, type 2 diabetes, and endometrial cancer.
Although PCOS cannot be cured, treatments can reduce its symptoms and associated infertility. Stimulating ovulation, particularly in women trying to conceive, and treating insulin resistance can often restore regular ovulation and menstruation.
In vitro fertilization (IVF) is another potential option for women with PCOS.
4. Stress and Fertility
For couples experiencing infertility, stress is both a difficult reality and a possible influence on fertility. Research suggests that stress may contribute to ovulation problems. For many people, difficulty conceiving increases stress. Infertility concerns can also strain a relationship, which may further reduce opportunities for conception.
Although infertility can be highly stressful, support is available. If a physician cannot identify a medical cause for ovulation problems, a support group or counselor may help patients develop better ways to manage infertility-related anxiety.
The American Society for Reproductive Medicine (ASRM) offers these stress-reduction suggestions:
Maintain communication with your partner
Seek emotional support through a couples counselor, support group, or books
Try stress-reduction techniques such as meditation or yoga
Reduce caffeine and other stimulants
Exercise regularly to release physical and emotional tension
Agree with your partner on a medical treatment plan, including financial limits
Learn as much as possible about the causes of infertility and treatment options
Knowledge | Irregular Periods and Pregnancy: Managing Ovulation Problems
Knowledge | Irregular Periods and Pregnancy: Managing Ovulation Problems
Irregular or abnormal ovulation is a leading cause of infertility, accounting for approximately 30% to 40% of all cases. Irregular periods, absent periods, or abnormal bleeding often indicate that ovulation is not occurring, a condition called ovulatory dysfunction or anovulation.
Although anovulation can often be treated with ovulation-inducing medication, physicians must first evaluate other conditions that may interfere with ovulation, such as thyroid disease or adrenal and pituitary disorders.
1. Treating Ovulation Problems to Support Pregnancy
After ruling out other medical issues, a physician may prescribe medication to stimulate ovulation. Clomiphene (Clomid and Serophene) is commonly used because it is effective and has been prescribed for decades. Unlike many fertility medications, clomiphene is taken orally rather than injected. It induces ovulation and corrects irregular ovulation by increasing the number of eggs recruited by the ovaries.
Clomiphene is effective for most women with anovulation. About 10% of women using it for infertility may have a multiple pregnancy, usually twins, compared with a twin birth rate of about 1% in the general population.
A typical starting dose is 50 mg daily for five days, beginning on day 3, 4, or 5 of the menstrual cycle. Ovulation usually begins about seven days after the final dose. If ovulation does not occur, the monthly dose may be increased by 50 mg up to 150 mg. Once ovulation begins, most physicians recommend continuing clomiphene for 3 to 6 months. If pregnancy does not occur, another medication or referral to a fertility specialist may be recommended.
Ovulation-inducing medications can sometimes make cervical mucus less receptive to sperm, preventing sperm from entering the uterus. This may be addressed with intrauterine insemination (IUI), in which specially prepared sperm is placed directly into the uterus. These medications may also thin the endometrium.
Depending on the patient's circumstances, the physician may recommend other ovulation medications such as Gonal-F or other injectable hormones that stimulate follicle and egg development. Sometimes called superovulation medications, they are usually given by subcutaneous injection. These hormones can overstimulate the ovaries, causing bloating and discomfort. Severe cases can be dangerous and require hospitalization, so physicians monitor estrogen levels with frequent vaginal ultrasound examinations and blood tests. Approximately 90% of women ovulate with these medications, and 20% to 60% become pregnant.
2. Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a common ovulation disorder affecting approximately 5% to 10% of women of reproductive age. PCOS is a hormonal imbalance that can impair ovarian function. The ovaries are often enlarged and covered with small, fluid-filled cysts. Symptoms include:
Absent periods, irregular periods, or irregular bleeding
No ovulation or irregular ovulation
Obesity or weight gain, although women with a low body weight can also have PCOS
Insulin resistance, an indicator of prediabetes
High blood pressure
Abnormal cholesterol and high triglycerides
Excess body and facial hair (hirsutism)
Acne or oily skin
Thinning hair or androgenic alopecia
3. Becoming Pregnant With PCOS
For patients with PCOS who are overweight, weight loss may improve the chance of pregnancy. A physician may also prescribe medication to lower insulin levels because elevated insulin caused by insulin resistance is common in women with PCOS. Prolonged high insulin levels may lead to diabetes. Untreated PCOS may increase the risks of heart disease, type 2 diabetes, and endometrial cancer.
Although PCOS cannot be cured, treatments can reduce its symptoms and associated infertility. Stimulating ovulation, particularly in women trying to conceive, and treating insulin resistance can often restore regular ovulation and menstruation.
In vitro fertilization (IVF) is another potential option for women with PCOS.
4. Stress and Fertility
For couples experiencing infertility, stress is both a difficult reality and a possible influence on fertility. Research suggests that stress may contribute to ovulation problems. For many people, difficulty conceiving increases stress. Infertility concerns can also strain a relationship, which may further reduce opportunities for conception.
Although infertility can be highly stressful, support is available. If a physician cannot identify a medical cause for ovulation problems, a support group or counselor may help patients develop better ways to manage infertility-related anxiety.
The American Society for Reproductive Medicine (ASRM) offers these stress-reduction suggestions:
Maintain communication with your partner
Seek emotional support through a couples counselor, support group, or books
Try stress-reduction techniques such as meditation or yoga
Reduce caffeine and other stimulants
Exercise regularly to release physical and emotional tension
Agree with your partner on a medical treatment plan, including financial limits
Learn as much as possible about the causes of infertility and treatment options
Story source:
Collected online