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Ovulation Disorders

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Ovulation disorders refer to conditions where the normal release of an egg (ovulation) either doesn’t occur or happens irregularly. These disruptions fall under menstrual disorders and are major contributors to infertility

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Ovulation Disorders

What is Ovulation Disorders ?

Ovulation disorders refer to conditions where the normal release of an egg (ovulation) either doesn’t occur or happens irregularly. These disruptions fall under menstrual disorders and are major contributors to infertility

  • Anovulation: Complete absence of ovulation, no egg release when expected. Menstrual cycles are irregular, absent, or have unpredictable bleeding.
  • Oligo-ovulation: Infrequent or irregular ovulation, fewer than 8 cycles per year or cycles longer than 36 days.
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When it is Considered ?

Ovulation disorders are typically suspected when:

  • A woman has irregular or absent menstrual periods (e.g., fewer than 8 per year).
  • Fertility evaluation reveals no signs of ovulation despite regular cycles.
  • Other causes like PCOS, hormonal imbalances, or stress-related amenorrhea are present.

Types of Ovulation Disorders

The World Health Organization (WHO) classifies ovulation disorders into four groups:

  • WHO Group I: Hypothalamic-pituitary-gonadal axis failure (e.g., low GnRH/FSH/LH production).
  • WHO Group II: Dysfunction of the HPG axis (most common), includes PCOS.
  • WHO Group III: Ovarian failure (e.g., primary ovarian insufficiency before age 40).
  • WHO Group IV: Hyperprolactinemia (elevated prolactin suppressing GnRH).

More on specific causes:

  • PCOS: The leading cause; defined by ovulation issues, high androgens, and often polycystic ovaries
  • Hypogonadotropic hypogonadism: Includes Functional Hypothalamic Amenorrhea (FHA), due to stress, weight loss, or excessive exercise, suppressing GnRH.
  • Primary Ovarian Insufficiency (POI): Early loss of ovarian function before age 40.
  • Hyperprolactinemia: Elevated prolactin levels hinder GnRH release.

Procedure ( Diagnosis & Management )

Diagnosis:

  • Track menstrual cycles for patterns of regularity.
  • Blood tests for hormones like FSH, LH, estradiol, prolactin, and thyroid
  • Rule out pregnancy, anatomical issues, or pituitary/hypothalamic disease.

Treatment Approaches:

  • Lifestyle modifications – especially for FHA (restore stress and nutrition balance).
  • Ovulation induction – using medications such as:
    Clomiphene citrate or letrozole (anti-estrogens/aromatase inhibitor) to stimulate ovulation.
    If these fail, FSH injections may be used.
  • Underlying condition treatment – e.g., metformin for PCOS, dopamine agonists for hyperprolactinemia, hormone replacement for POI.

Results

  • Lifestyle fix (FHA): Often restores ovulation and menses if triggers (stress, weight) are addressed.
  • PCOS (Group II): Ovulation induction has a good success rate; medications like clomiphene/letrozole are effective.
  • Group III (POI): Reduced ovarian reserve limits response; donor eggs may be considered.
  • Group IV (Hyperprolactinemia): Treating prolactin restores ovulation in many cases.
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