Anovulatory Infertility.

The absence of ovulation makes a woman infertile, since fertilization and the birth of a new organism depend on this process. Anovulatory infertility is not uncommon and all women have at least once in their life had a menstrual cycle for one reason or another not accompanied by ovulation. The problem is a condition when the anovulatory cycles become permanent, which is associated with a violation in the human endocrine system. It is important to understand in time what caused the lack of ovulation.

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Content:
1 Definition;
2 reasons;
3 Symptoms;
4 Diagnostics;
5 treatment;
6 IVF;
7 Forecast.

In the language of gynecologists, anovulatory infertility is a hormonal state, while the number of eggs remains normal, but the process of their maturation and / or exit from the ovary does not occur.

Violation of the production of hormones of the hypothalamus, pituitary gland, thyroid gland, ovaries leads to the fact that ovulation does not occur (anovulation), as a result of which the conditions necessary for conception are not fulfilled. It is impossible to say that this infertility is permanent, because normalizing the amount of hormones leads to the restoration of ovulation, and therefore, fertility.

Causes
Anovulatory infertility can be caused by many factors. It is important to understand that the regulation of the menstrual cycle is associated with several levels of hormone-forming organs. The highest place in this hierarchy is occupied by such structures as:

  • cortex;
  • hippocampus;
  • limbic system.

Many people know that menstruation can stop from severe stress, that is, anovulatory infertility develops.

The next link in the regulation of the menstrual cycle in general and ovulation in particular is the hypothalamus. It is influenced by feedback hormones, neurotransmitters, neuropeptides and other substances, as a result of which the hypothalamus secretes gonadotropin releasing hormones, which apply not only to the sex glands, but also to other organs. Estradiol and endogenous opioid peptides – endorphins, enkephalins, dinorphins – have a powerful effect on the releasing factors of the hypothalamus.

The third level of regulation is the pituitary gland. Under the influence of gonadotropin releasing hormones are produced:

  • LH and FSH – luteinizing and follicle-stimulating factors;
  • adrenocorticotropic;
  • prolactin;
  • somatotropic;
  • thyroid-stimulating hormones.

Without proper release of substances, normal functioning of the ovaries and the occurrence of ovulation are impossible. Therefore, a violation in the amount of these hormones can cause anovulatory infertility.

The menstrual cycle has 2 phases: folliculin and luteal, between which ovulation occurs. The first phase depends to a greater extent on follicle-stimulating hormone, the second on luteinizing hormone. Ovulation as a process is stimulated by a sharp rise in LH.

The fourth level of regulation is the ovaries, adrenal glands, and thyroid gland. A key role belongs to the ovaries:

  • follicles mature in them;
  • ovulation occurs;
  • the formation of the corpus luteum;
  • production of steroid sex hormones.

The adrenal glands have a great influence on the reproductive system of women. Anovulatory menstrual cycles are characteristic of adrenogenital syndrome (AGS) of varying severity.

Polycystic ovary syndrome is a chronic disease characterized by anovulation and hyperandrogenism. Increased LH synthesis is accompanied by a decrease in progesterone, which is due to anovulatory infertility.

The development of anovulatory infertility is most often caused by the following reasons:

  • hormonal drugs that contribute to the absence of ovulation (contraceptives);
  • hormone-producing tumors of the breast and adrenal glands;
  • disruption of the hypothalamus, pituitary gland;
  • thyroid dysfunction (hypo- or hyperfunction);
  • a sharp decrease or weight gain;
  • polycystic ovary syndrome;
  • Ovarian exhaustion syndrome;
  • adrenogenital syndrome;
  • liver diseases (hepatitis, cirrhosis);
  • congenital pathologies, ovarian underdevelopment, lack of receptors or their lack;
  • the lack of protein, fatty foods, vitamins, trace elements in the diet;
  • physical overstrain;
  • chronic lack of sleep;
  • regular stress.

Symptoms

If without protection the couple’s pregnancy does not occur within a year and sexual intercourse is regular, then we can talk about infertility.

Anovulatory infertility can be suspected by the following symptoms:

  • the absence of pain in the lower abdomen previously characteristic of ovulation in the middle of the cycle, malaise;
  • the development of bleeding, regardless of the menstrual cycle;
  • change in the nature of menstrual flow, duration;
  • loss of body weight.

But there are indirect symptoms that will help to suspect a violation of hormonal regulation:

  • male type hair;
  • various degrees of obesity, adipose tissue is mainly concentrated in the upper half of the body;
  • Underdevelopment of the external genitalia;
  • the presence of a male voice timbre;
  • late onset of menstruation (15-16 years);
  • striae on the chest, abdomen, hips.

Diagnostics

Basal temperature measurement. In the morning before getting out of bed, you need to perform thermometry in the rectum, and this manipulation is carried out throughout the menstrual cycle. If all values ​​are noted on the temperature curve, then a peak after ovulation by 0.4-0.8 degrees will be visible on it. One day before menstruation, the temperature drops by 1 degree. There is no rise in the second phase of the cycle – anovulation.
To find out if an egg has exited the ovary or not, you can use a simple ovulation test. This method will determine the burst of luteinizing hormone, which indicates completed ovulation. This way you can detect the rise of the hormone in the urine and saliva, but the second option will be much more expensive. But we can talk about a more reliable definition of anovulation.
When examining the cervix in the mirrors, a symptom of the “pupil” is revealed on the eve of ovulation. This phenomenon is based on the expansion of the outer opening of the neck and the accumulation of transparent mucus in it.
The phenomenon of “fern” is the crystallization of cervical mucus when dried on a glass slide. This phenomenon is most pronounced during ovulation.
Stretching of cervical mucus. The cervical mucus is maximally stretched during the release of the egg.
Lack of ovulation can be detected by ultrasound. The specialist will not detect a follicular cyst at the site of development of the egg.
A smear from the vaginal wall shows the cellular composition of the discharge, which varies significantly depending on the phase of the menstrual cycle, which are regulated by hormones.
But what if ovulation occurred, but the egg could not reach its destination? This occurs when the patency of the fallopian tubes is impaired. This violation can be detected using x-ray tracing, diagnostic laparoscopy, chromohydrotubation.
So, it became clear that there is still no ovulation, now it is important to find out why it does not occur. In this case, you need to take tests for the amount of hormones in the blood. The following indicators are important:

  • FSH;
  • LH;
  • progesterone;
  • prolactin;
  • adrenocorticotropic hormone;
  • androgens;
  • insulin and glucose in PCOS;
  • estrogens;
  • cortisol;
  • thyroid hormones.

Treatment

The treatment of anovulatory infertility implies an impact on the root cause of the disease: if it is associated with an obstacle to the mature egg, then it is eliminated through surgical procedures. If infertility is associated with a change in hormonal levels, then replacement therapy is first prescribed or secretion is suppressed.

The appointment of an inhibitor of endogenous opioid peptides – naloxone – leads to increased production of releasing hormones, thus allowing normal ovulation to occur.

In polycystic ovary syndrome, gonadotropin is prescribed in the form of drugs, Clomid helps normalize the hypothalamic-pituitary connection, which returns ovulation in 30-40% of cases of infertility in PCOS.

Self-medication in case of anovulatory infertility can only cause harm! Constantly observed by a doctor and not make decisions about the cancellation or dose adjustment of drugs on their own!

It should be remembered that hormone replacement often requires not one, but many treatment cycles. Often, replacement therapy lasts a lifetime.

ECO
One way to get pregnant in the absence of ovulation is artificial insemination. There are indications and contraindications for this method. It is important to identify them and outline a clear plan of action, develop preparation for this responsible process and choose the appropriate IVF protocol.

Forecast
Anovulatory infertility is not a sentence and can be completely treated if you pay attention to the symptoms earlier and begin to deal with the causes of the pathology. With proper treatment, replacement of lost hormonal functions, you can become pregnant, have a healthy baby and enjoy motherhood.