Anovulatory infertility is a kind of infertility in women in which a woman does not produce an egg during her menstrual cycle. This makes it difficult to get pregnant naturally. An ovum or egg, which can fuse with the sperm released from the male reproductive organ during fertilization, is crucial in pregnancy. Over a period of time, anovulation can be a common cause of infertility in women.
Symptoms Of Anovulation
Anovulation can cause the following symptoms, which are given below:
- Irregular periods: Individuals may experience a change in the length of the menstrual cycle
- Very heavy or light mensuration: You may experience heavy or light menstrual bleeding during the menstrual cycle.
- Lack of periods (amenorrhea): An individual may experience an absence of a period for one or more time without being pregnant.
- Lack of cervical mucus: Individuals may experience a lack of cervical discharge (cervical mucus), which is more likely during ovulation.
- Irregular basal body temperature: You may have irregular body temperature when you are at rest.
Causes of anovulation
Anovulation can be caused by various factors affecting our bodies' natural mechanisms. Some of the causes of anovulation are given below:
- Polycystic ovarian syndrome (PCOS): It is the common cause of anovulation in women.
- Premature ovarian insufficiency (POI): Individuals who are experiencing premature menopause may have an increased chance of getting anovulation.
- Hypothalamus or pituitary gland dysfunction: Women who have a hypothalamus or pituitary gland dysfunction may have a chance of getting anovulation.
- Diminished ovarian reserve (DOR): Individuals with a loss of normal reproductive potential in the ovary can experience anovulation.
- Functional hypothalamic amenorrhea (FHA): Women who have an FHA (menstrual problem due to hypothalamus disorder) may have an increased risk of getting anovulation.
- Menopause: Women who are in the stage of menopause may experience anovulation.
Diagnosis
Anovulation can be diagnosed by the following methods which are given below:
- Pregnancy test
- Tests of certain hormone levels [progesterone, FSH, LH levels]
- Thyroid tests
- Glucose tolerance test
- Vaginal ultrasound
Elements of Anovulation Infertility Treatment
1. Medication management:
- Clomiphene citrate: It is a selective estrogen receptor modulator (SERM) used to treat anovulation or oligo-ovulatory infertility by inducing the process of ovulation in patients. It works by stimulating the hormone which is involved in the growth and release of the mature ovum in women.
- Gonadotropin: It is given as a second-line treatment in anovulation after clomiphene citrate and letrozole are given. It helps to stimulate the release of an egg in women. For example, Hucog HP 5000IU Injection is an antineoplastic medication belonging to the class of luteinizing hormone analog, containing the active ingredient gonadotropin. It is mainly used in fertility treatments to stimulate ovulation in women.
- Human chorionic gonadotropin (hCG): It is often used with clomiphene citrate or follicle-stimulating hormone treatments. It helps release an egg from the ovary, but it can also result in false positives in pregnancy tests.
- Follicle-stimulating hormone (FSH): FSH is a natural hormone in women that helps stimulate the growth and release of eggs from the ovary. Medications like Bravelle, Fertinex, Follistim, and Gonal-F can help to replicate the natural FSH hormone in women.
- GnRH agonists and antagonists: This is a group of medications that are used to control the release of luteinizing hormone (LH) by preventing the spontaneous release of an egg during the process of fertility treatment.
2. Surgical interventions:
Surgical interventions such as ovarian drilling and wedge resection may be considered in cases of anovulation caused by conditions such as Polycystic Ovaries Syndrome (PCOS) or ovarian cysts. However, these procedures are now less frequently performed due to the poor success rate.
3. Hormone Therapy:
Hormonal replacement therapy may be indicated in cases of anovulation caused by an imbalance of hormones, such as hypothyroidism or elevated prolactin levels (hyperprolactinemia).
4. Addressing Underlying Medical Conditions:
In certain circumstances, treating underlying medical conditions associated with anovulation, including thyroid disorders and hyperprolactinemia, may lead to restoring normal ovarian function.
5. Supplements and Alternative Therapies:
Some women may consider using supplements like myo-inositol or acupuncture, herbal medicines, and lifestyle changes in diet as alternative therapy for anovulatory infertility, but their efficacy is still being studied.
Conclusion
The treatment approach for anovulation infertility is tailored to individual needs and may involve a combination of lifestyle modifications, medication, monitoring, assisted reproductive techniques, and addressing underlying medical conditions.
When successful, these treatments can lead to consistent ovulation and a greater chance of pregnancy. Couples with anovulatory infertility should seek counseling and support to help them manage the emotional aspects of fertility treatment.