Ovulatory disorders are a common cause of infertility. Ovulation is controlled by complex interactions between numerous endocrine hormones including FSH, LH, estradiol, progesterone and others. Imbalances in these hormones, or alterations in the “feedback mechanism”, can prevent ovulation, or cause it to be irregular.

Clomid is often used to treat anovulation (lack of ovulation) and if it does not work, injectable drugs such as FSH are employed. Injectable fertility drugs are often combined with intrauterine insemination (IUI).

In the ovary, FSH and LH provide a signal for the development of eggs. As egg development occurs, the hormones estrogen and inhibin, produced by the ovary, provide negative feedback to the hypothalamus and pituitary.

This feedback causes the production of FSH and LH to decrease. In the failing ovary, (pre-menopausal) estrogen and inhibin levels are low; the negative feedback is inhibited; and FSH and LH levels may be high, signifying imminent ovarian failure.

The hypothalamus is an extremely sensitive part of the human brain, especially in females. Changes in diet, excessive weight gain or loss, stress, excessive exercise, emotional upheaval, and even alterations in the light/dark cycles may alter its function. These alterations affect the GnRH pulses and hence pituitary function with alteration in the secretion of the hormones FSH and LH.

These changes affect ovarian function with alterations in the production of estrogen, which prepares the uterus to accept an embryo, and progesterone, the hormone of the luteal phase, which is important in maintaining a pregnancy. Thyroid hormone balance is also extremely important to the overall functioning of this system.

Because of the hormonal changes discussed above, a female undergoes a monthly menstrual cycle. In the first half of the cycle, (proliferative phase), the lining of the uterus is developed so that an embryo can implant. This is the estrogenic phase. The second half of the cycle is characterized by the secretion of progesterone (secretory phase) to maintain the lining of the uterus.

Ovulation is the event that occurs between the proliferative and secretory phases, and is usually mid cycle. At the end of the secretory phase (which usually lasts fourteen days), menstruation (shedding of the lining of the uterus) occurs if there is no pregnancy.

The hormonal events in a normal menstrual cycle are complex. FSH is secreted from the pituitary gland causing the ovaries to produce estrogen. Just before ovulation, the hormone LH is released from the pituitary gland, triggering an ovulatory response in the ovary. (This is a hormone measured in ovulation prediction kits and is in the blood stream for a short time).

Many conditions can cause irregular ovulation including hyperprolactinemia. This condition is caused by a tumor (usually benign) located on the pituitary gland. Treatment with the drug Parlodel is often very effective.

In most cases, ovulation is effectively established using fertility medications unless there is ovarian failure due to age or other causes.

Uterine Factor

The uterus must be normally shaped and free of obstructions, such as polyps or fibroids. Large obstructions can interfere with embryo implantation and normal fetal development. The uterus can be damaged by pelvic inflammatory disease, previous surgery, endometriosis, or some women are born with a malformed uterus.

A skilled reproductive surgeon, like Dr. Kustin, can often surgically repair the uterus. If the damage is severe, a surrogate mother may be required. A surrogate is a woman who carries the couples child ,produced by an IVF cycle, to term an delivery.

The lining of the uterus is known as the endometrium and it is capable of rapid cell growth and division. During the menstrual cycle, progesterone and estrogen stimulate the endometrium to thicken and become more vascular. This development is necessary to support the developing fetus. Poor endometrial development can often be treated with additional progesterone.

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