Introduction to Treatment of Female Infertility

Ovulation and Menstruation Problems

What are the various ovulation problems

There are five main categories of ovulation problems:

Oligomenorrhoea (very erratic periods): There is a defect in the feedback of estrogen from the ovary to the brain. In spite of this, levels of F.S.H., L.H. and estrogen are normal, but there is usually a menstrual disorder with either oligomenorrhoea or secondary amenorrhoea.
Amenorrhoea (never have a period or periods have stopped): The pituitary gland fails to produce F.S.H. and L.H. This, in turn, affects the ovaries, which fail to produce estrogen. Amenorrhoea is usually the representing symptom.
Menopause-like condition: The ovaries fail to respond or may be resistant to F.S.H. As is the case in menopause, the F.S.H. levels are very high and the estrogen level very low.
Polycystic Ovary Disease: This is a condition where there are multiple tiny cysts in the ovaries. The L.H. level is characteristically high with normal F.S.H. and estrogen levels. There is often oligomenorrhoea or amenorrhoea.
Hyperprolactinaemia: The level of the hormone prolactin is very high while the levels of F.S.H. and estrogen are lowered. This condition is known as hyperprolactinaemia. There is either oligomenorrhoea or amenorrhoea. Discharge from the nipples is also a symptom of this condition as this is the hormone responsible for milk production.

If you have amenorrhoea, your specialist may recommend a test
called the Progesterone Challenge Test before the commencement of the "fertility drug" treatment. This involves taking progesterone tablets for five days. If the ovaries are producing estrogen, a withdrawal menstrual bleed should occur after progesterone tablets have been stopped.

Are ovulation problems reversible

With the exception of ovarian failure for which there is no treatment, all the other causes of ovulation disorders are treatable. If an ovulatory disorder lies at the root of your infertility, you can expect that with the appropriate treatment, the chances of your having a baby will be elevated almost to the levels enjoyed by the fertile population.

Is ovulatory disorder a major cause of infertility

At least 20% of the women attending an Infertility Clinic will have a problem relating to ovulation.

Your menstrual history may indicate the likelihood of an ovulatory disorder for example:

You may never have had a period, a condition called primary amenorrhoea;
Periods which were once present have now stopped altogether (known as secondary amenorrhoea);
Your cycle is so erratic. E.g. periods occurring every 1-4 months, that even if you are ovulating, ovulation is completely unpredictable (known as oligomenorrhoea).

Sometimes a woman's B.B.T. Chart, day-21 progesterone assay or endometrial biopsy may show that despite the fact that she has an apparently normal and regular cycle, definite problems exist. Either she is not ovulating (anovulatory cycles), or the luteal phase of the cycle is too short, perhaps combined with lowered progesterone levels from the corpus luteum after ovulation. (Inadequate luteal phase).

Which drugs are used for the treatment of infertility

Many drugs are used in the treatment of infertility. The main drugs discussed here are Clomiphene, Human Chorionic Gonadotrophin (H.C.G.), Bromocriptine, Human Menopausal Gonadotrophin (hMG), Urofollitrophin (Pure F.S.H.) and Gonadotrophin Releasing Hormone (GnRH or LHRH).

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