Ovulatory factor


Basically, it means a defect in the growth and maturation of the egg. This again can range from the total absence of eggs (a genetic disorder) to subtle upsets at genetic levels. As the entire process of the ovulation is under the control of the brain and the pituitary gland, disorders of these areas can cause anovulation. The diagnosis of ovulation can be done by many ways of which the serial transvaginal ultrasound gives an accurate picture. The serum progesterone test in the second half of the cycle can also aid in the diagnosis of ovulation. The estimation of the hormones FSH and LH within 5 days of menses can help in finding the type of anovulation.


The hormone production from the pituitary gland (FSH & LH) is low. This should be treated by replacing the FSH & LH as injections. Drugs like Clomiphene Citrate does not have a role. The ovaries can be absent as a part of the genetic disorder. Such women do not reach menarche. However, they may have a small uterus and pregnancy is possible in them by assisted reproduction with donor eggs.


On the other hand, the brain and the pituitary may be totally normal, but the hormonal proportions for follicular growth and release may not be appropriate. The example of this disorder is Polycystic Ovarian Disease (PCOD) which is a common Ovulatory disorder. Anovulation, obesity, excessive male hormone expression (eg. Growth of hair as in the male) and ovaries with multiple small follicles are the hallmarks of this disease. Again there is a great variation in the extent and combination of the above features. Glucose and insulin metabolism is also disturbed with respect to the ovarian environment. Excessive amounts of Luteinising hormone and the male hormones are involved in causing this disorder. The end result of these often women are labeled to have the polycystic ovarian disease after a single ultrasound scan without clinical or biochemical evidence. This finding may be encountered in normally ovulating women and is not a cause of concern if all other factors are normal. The diagnosis is based on the Rotterdam criteria

The treatment of PCOD begins with weight reduction in obese patients and stepwise induction of ovulation with simple drugs such as clomiphene citrate which often leads to successful ovulation and pregnancy in mild and moderate disease. Severe cases may require gonadotrophin injections and when these fail the choice of treatment available is two-fold-medical corrections with controlled ovarian hyperstimulation with ART or micro ovariotomy with the aid of a laparoscope. This surgical procedure has to be done with utmost caution as excessive cautery on the ovary may defeat the very purpose of treatment. Surgeries on the ovary (e.g. Wedge resection) are not relevant in the present day context of treatment.

Ideal body weight as calculated by the Body Mass Index (BMI) ensures better success with ovulation and pregnancy rates especially in women with PCOS. Regulation of carbohydrates and fat intake along with exercise forms the basis of sustainable weight reduction. Fancy diet and crash dieting should be avoided. BMI = Body mass index is one of the ways to measure if a person is overweight or not. It is determined by – Weight (kg) / Height (m2) Degree of obesity is determined by BMI. If a person is 10% more than this optimum weight then she/he is called overweight. If it is more than 20% then she/hr. is OBESE. Abnormal insulin and blood glucose levels can also cause anovulation and can be a part of PCOD scene, so much so that oral antidiabetic drugs are used in selected cases for making ovulation successful.

Pituitary, thyroid, and adrenal disorders also cause upsets in ovulation. Appropriate hormonal testing will reveal their involvement. Excessive stress and too much exercise can also upset the delicate axis of ovulation acting via the brain. Thus athletes on training can become anovulatory and can even stop menstruating. Teenage girls who go on a fancy weight reduction to resemble models also suffer from anovulation. This condition is known as anorexia nervosa. However such anovulation is reversible totally.


Ovarian failure is a cause for concern especially when it occurs in women below 40. The exact reason for this pre-mature ovarian failure is not known. The FSH and LH levels are very high in such cases. When it sets in, the only answer may be Assisted Reproduction with donated eggs. A woman’s best reproductive years are in her 20s. Fertility gradually declines in the 30s, particularly after age 35. Each month that she tries, a healthy, fertile 30-year-old woman has a 20% chance of getting pregnant. By age 40, a woman’s chance is less than 5% per cycle, so fewer than 5 out of every 100 women are expected to be successful each month.

Women do not remain fertile until menopause. The average age for menopause is 51, but most women become unable to have a successful pregnancy sometime in their mid-40s. These percentages are true for natural conception as well as conception using fertility treatment, including in vitro fertilization (IVF). Although stories in the news media may lead women and their partners to believe that they will be to able use fertility treatments such as IVF to get pregnant, a woman’s age affects the success rates of infertility treatments. The age-related loss of female fertility happens because both the quality and the quantity of eggs gradually decline.


An important change in egg quality is the frequency of genetic abnormalities called aneuploidy (too many or too few chromosomes in the egg). At fertilization, a normal egg should have 23 chromosomes, so that when it is fertilized by a sperm also has 23 chromosomes, the resulting embryo will have a normal total of 46 chromosomes. As a woman gets older, more and more of her eggs have either too few or too many chromosomes. If fertilization occurs, the embryo also will have too many or too few chromosomes. Down syndrome is one such condition that results when the embryo has an extra chromosome 21. Most embryos with too many or too few chromosomes do not result in pregnancy at all or result in miscarriage. This helps explain the lower chance of pregnancy and a higher chance of miscarriage in older women.

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