women s health issues
Infertility Problems With Ovulation
Causes of Ovulation Problems
The Overview of the Female Reproductive System is controlled by areas of the brain, including the hypothalamus (an area of the brain) and the pituitary gland and by the ovaries and other glands, such as the adrenal glands and thyroid gland. Problems with ovulation (release of an egg) result when one part of this system malfunctions. For example, The hypothalamus may not secrete enough gonadotropin-releasing hormone (GnRH). GnRH is necessary to stimulate the pituitary gland to produce luteinizing hormone and follicle-stimulating hormone, the hormones that stimulate the ovaries and ovulation. The pituitary gland may produce too little luteinizing hormone or follicle-stimulating hormone. The ovaries may produce too littleestrogen. The pituitary gland may produce too much prolactin, a hormone that stimulates breast milk production. High levels of prolactin (hyperprolactinemia) may result in low levels of the hormones that stimulate ovulation. Prolactin levels may be high because of a pituitary gland tumor ( Prolactinoma ), which is almost always noncancerous. Other glands may malfunction. For example, the adrenal glands may overproduce male hormones (such astestosterone), or the thyroid glands can overproduce or underproduce thyroid hormones. These hormones help keep the pituitary gland and ovaries in balance. Problems with ovulation may be due to many disorders. The most common cause of chronic ovulation problems is Polycystic Ovary Syndrome (PCOS) , which is usually characterized by irregular periods, excess weight gain, acne, and excess body hair (due to excess production of male hormones by the ovaries) Other causes of ovulation problems include Diabetes Mellitus (DM) None Obesity None Excessive exercise Certain medications (includingestrogensand progestins and certain antidepressants) Excessive weight loss Psychologic stress Rarely, the cause is Premature Menopause —when the supply of eggs runs out early. An ovulation problem is often the cause of infertility in women who have irregular periods or no periods ( Absence of Menstrual Periods ). Infrequently, an ovulation problem is the cause of infertility in women who have regular menstrual periods but do not have premenstrual symptoms, such as breast tenderness, lower abdominal swelling, and mood changes. The Menstrual Cycle is regulated by the complex interaction of hormones: luteinizing hormone, follicle-stimulating hormone, and the female sex hormones The menstrual cycle has three phases: Follicular (before release of the egg) Ovulatory (egg release) Luteal (after egg release) The menstrual cycle begins with menstrual bleeding (menstruation), which marks the first day of the follicular phase. When thefollicular phasebegins, levels ofestrogenandprogesteroneare low. As a result, the top layers of the thickened lining of the uterus (endometrium) break down and are shed, and menstrual bleeding occurs. About this time, the follicle-stimulating hormone level increases slightly, stimulating the development of several follicles in the ovaries. Each follicle contains an egg. Later in this phase, as the follicle-stimulating hormone level decreases, only one follicle continues to develop. This follicle producesestrogen. As the follicular phase continues, the increasing levels of estrogen cause the lining of the uterus to thicken. Theovulatory phasebegins with a surge in luteinizing hormone and follicle-stimulating hormone levels. Luteinizing hormone stimulates egg release (ovulation), which usually occurs 32 to 36 hours after the surge begins. Theestrogenlevel peaks during the surge, and theprogesteronelevel starts to increase. During theluteal phase,luteinizing hormone and follicle-stimulating hormone levels decrease. The ruptured follicle closes after releasing the egg and forms a corpus luteum, which producesprogesterone. During most of this phase, theestrogenlevel is high.Progesteroneandestrogencause the lining of the uterus to thicken more and thus prepare for possible fertilization. If the egg is not fertilized, the corpus luteum degenerates and no longer producesprogesterone, theestrogenlevel decreases, the top layers of the lining break down and are shed, and menstrual bleeding occurs (the start of a new menstrual cycle). 