Ovulatory dysfunction

Even if a woman gets a period every month, that does not necessarily mean she’s ovulating –  an ovulation disorder may still be the cause of infertility. The two most common causes of irregular ovulation are polycystic ovarian disease (PCO) and hypothalamic dysfunction.

Understanding PCO

PCO was originally thought to be a condition affecting overweight women with irregular menstrual cycles and excessive facial hair or acne. We now know the disease does not discriminate, as many affected women are thin and have no evidence of excessive facial hair.

PCO is diagnosed by clinical history, a physical exam, the appearance of the ovaries on ultrasound, and hormone measures. One common finding in women with PCO is dysfunction of their insulin and blood sugar metabolism, often requiring treatment with a drug called Metformin. There is some evidence that Metformin may improve egg quality in women with PCO.

Aside from insulin-related findings, women with classic PCO often have excessive follicle growth during ovarian stimulation, meaning many eggs are poor in quality. However, when good-quality eggs are found, the pregnancy rate in women with PCO is similar to that in women with normal ovarian function.

Treatment for women with PCO typically involves fertility medications to induce ovulation, such as Serophene, Letrazole, or gonadotropins. There are also surgical options in some cases. In overweight individuals, weight loss and exercise are important to successful treatment.

About Hypothalamic Dysfunction

Hypothalamic dysfunction is less common than PCO. Women with hypothalamic amenorrhea (lack of periods due to the condition) do not produce the necessary hormones to cause monthly ovulation. This condition is treated with medications that induce ovulation.