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Ovulation Disorders: Who Has Them and How To Treat Them

November 16, 2012

Ovulation disorders plague approximately 20% of couples trying to conceive. The most common ovulation disorder is polycystic ovarian syndrome (PCOS), which affects up to 10% of reproductive aged women. However, conditions like high prolactin, hypoactive or hyperactive thyroid conditions, or exercise and diet induced hypothalamic amenorrhea can also impact ovulation.

Women of childbearing age are most often diagnosed with an ovulation disorder due to absence of menses, however, young women may experience symptoms of an ovulation disorder from the onset of their menstrual cycle into their 20s. Women tracking ovulation with an over-the-counter ovulation prediction kit (OPK) may be confused by a positive result despite anovulation.

How do I know if I have an ovulation disorder?

Kenneth Gelman, M.D. of Infertility & Reproductive Medicine of South Broward, says, “Women might suspect an ovulation disorder if they are not getting a period. With PCOS, they might be confused about ovulation due to a false positive result on an ovulation prediction test due to a higher level of the Lutenizing Hormone (LH)." Often in PCOS, women will experience fertile cervical mucus and positive ovulation tests even if they are not ovulating.

When should I see a fertility doctor?

Women suspecting an ovulation disorder should have a fertility consultation sooner than later. Dr. Gelman advises women under 35, who are not getting a period or have other concerns about ovulation, to see a fertility doctor after 3 to 6 months of trying to conceive unsuccessfully. For patients over 35, as soon as 3 months is appropriate for a fertility workup.

A fertility workup for a patient with an ovulation disorder includes blood work and ultrasound. “We do a complete hormonal workup, endometrial biopsy during the luteal phase, and ultrasound, and coordinate with the blood progesterone levels to check for ovulation that month. All of this information is carefully scrutinized”, says Gelman. Once these results are obtained, a treatment protocol is developed. Dr. Gelman assures patients with ovulation disorders that once they have their fertility consultation and begin treatment, ovulation will be tracked by blood work and ultrasound monitoring. “We give the patient an ovulation induction drug, watch follicle growth through ultrasound, and trigger ovulation with a hormone injection”, he says.

How are ovulation disorders treated?

Treatments for restoring ovulation include Metformin or Pegnitude (an over-the-counter supplement), clomiphene citrate (Clomid), aromatase inhibitors like Femara, or gonadotropins like Follistim or Gonal-F. Additionally, women who are overweight or underweight and suspect an ovulation disorder should take the steps necessary to achieve a healthy balance.

Gelman affirms, “There is no substitute for a physician consultation to check for ovulation, tubal blockage and, of course, a semen analysis for the partner.”

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