women s health issues
Infertility Problems With Ovulation
Treatment of Ovulation Problems
Treatment of the cause, if identified A medication to stimulate ovulation Underlying disorders (such as Treatment or A medication, such asclomiphene,letrozole, or human gonadotropins, can usually stimulate ovulation. The particular medication is selected based on the specific problem. If the cause of infertility is early menopause, neitherclomiphenenor human gonadotropins can stimulate ovulation. If ovulation has not occurred for a long time,clomipheneis usually preferred. A few days after menstrual bleeding begins, the woman takesclomipheneby mouth for 5 days. Before the medication is started, the woman usually needs to be given hormones to induce menstrual bleeding. Usually, she ovulates 5 to 10 days afterclomipheneis stopped, and she has a menstrual period 14 to 16 days after ovulation.Clomipheneis not effective for all causes of ovulation problems. It is most effective when the cause is polycystic ovary syndrome. involve Multiple Births , usually twins. Side effectsofclomipheneinclude hot flashes, abdominal bloating, breast tenderness, nausea, vision problems, and headaches. Ovarian hyperstimulation syndromeoccurs in fewer than 1% of women treated withclomiphene. In this syndrome, the ovaries enlarge greatly and a large amount of fluid moves out the bloodstream into the abdomen. This syndrome may be life threatening. To try to prevent it, doctors prescribe the lowest effective dose ofclomiphene, and if the ovaries enlarge, they stop the medication. Clomipheneis used only after pregnancy has been ruled out because birth defects may result when it is used early in pregnancy. Letrozoleis an aromatase inhibitor. Aromatase inhibitors block the production ofestrogen. They are usually used to treat breast cancer in women who have gone through menopause.Letrozolemay be used instead ofclomipheneto stimulate ovulation. In women with polycystic ovary syndrome and obesity,letrozolemay be more likely to stimulate ovulation thanclomiphene. No evidence suggests thatletrozoleis more effective thanclomiphenein women without polycystic ovary syndrome. Likeclomiphene,letrozoleis started a few days after menstrual bleeding begins, and women take it by mouth for 5 days. If ovulation does not occur, a higher dose is used in each cycle until ovulation occurs or the maximum dose is reached. Letrozolehas fewer side effects thanclomiphene. The most common side effects ofletrozoleare fatigue and dizziness. Letrozoleis used only after pregnancy has been ruled out because birth defects may result when it is used early in pregnancy. , hormone therapy with human gonadotropins, injected into a muscle or under the skin, can be tried. Human gonadotropins contain follicle-stimulating hormone and sometimes luteinizing hormone. These hormones stimulate the follicles of the ovaries to mature and thus make ovulation possible. Fallopian tubes are fluid-filled cavities, each of which contains an egg. Ultrasonography can detect when the follicles are mature. When the follicles are mature, the woman is given an injection of a different hormone, human chorionic gonadotropin, to stimulate ovulation. Human chorionic gonadotropin is produced during pregnancy and is similar to luteinizing hormone, which is normally released in the middle of the menstrual cycle. Or, a gonadotropin-releasing hormone (GnRH) agonist can be used to stimulate ovulation, especially in women at high risk of ovarian hyperstimulation syndrome. GnRH agonists are synthetic forms of a hormone produced by the body (GnRH). When human gonadotropins are used appropriately, more than 95% of women treated with them ovulate, but only 50 to 75% of those who ovulate become pregnant. About 10 to 30% of pregnancies in women treated with human gonadotropins involve Multiple Births , primarily twins. Human gonadotropins are expensive and can have severe side effects, so doctors closely monitor the woman during treatment. About 10 to 20% of women treated with human gonadotropins develop moderate to severe ovarian hyperstimulation syndrome. If a woman has a high risk of having more than one fetus or of developing ovarian hyperstimulation syndrome, it is safer not to use a medication to stimulate ovulation. However, if it is necessary to stimulate ovulation, using a GnRH agonist is safer than using human chorionic gonadotropin. (a medication used to treat people with diabetes) is sometimes used to stimulate ovulation. These women include those who are significantly overweight (with a body mass index of more than 35) and those who have polycystic ovary syndrome and Diabetes Mellitus (DM) or prediabetes (blood sugar levels that are high but not high enough to be labeled diabetes). However, even in these women, If the hypothalamus does not secrete gonadotropin-releasing hormone, a synthetic version of this hormone (called gonadorelin acetate), given intravenously, may be useful. This medication, like the natural hormone, stimulates the pituitary gland to produce the hormones that stimulate ovulation. The risk of ovarian hyperstimulation is low with this treatment, so close monitoring is not needed. However, this medication is not available in the United States. When the cause of infertility is high levels of the hormone prolactin, the best medication to use is one that acts likedopamine, called adopamineagonist, such asbromocriptineorcabergoline. (Dopamineis a chemical messenger that generally inhibits the production of prolactin.) 