Ovulation problems lead to problems in fertility and irregular periods. As part of our clinical practice at Delhi, we have identified ovulation disturbance in a sizeable number of couples, which when treated adequately have given fruitful results for couples seeking fertility treatment.
What causes ovulation problem ?
Dr. Sahu emphasizes that it is of utmost importance that every gynecologist tries to find the cause of ovulation disturbances, as each cause can be specifically treated with different specific approaches.
Some of the cause of ovulation problem that she routinely diagnoses are:
- Polycystic ovarian syndrome. Ovary cysts or cysts in the ovary
- Hypogonadotropic hypogonadal anovulation, which can be caused by hypothalamus , pituitary problems
- Hyperprolactinemia. Increased prolactin, due to pituitary adenoma, prolactinoma
- Primary ovarian insufficiency, premature ovarian failure
How is ovulation problem treated ?
The treatment of ovulation disorder, in other words inducing ovulation , also called as ovulation induction treatment depends on the cause of problem. In general, at Delhi Gyne, we have some basic principles of treatment:
- First, we try to use the least invasive and the most simple treatment options – and yes – though hard to believe , but so many ladies actually get treated with simple approaches - if used scientifically, and using the right dose at the right time.
- Secondly, if conventional therapy is used appropriately for ovulation fails, it is only then that we think about assisted reproductive techniques.
How is ovulation induction done for PCOD ?
For PCOD, PCOS , polycystic ovarian syndrome, patients – the essence of treatment is metabolic correction using conventional weight loss therapy, with diet and exercise. We also use where appropriate agents such as clomiphine citrate, metformin, and in some aromatase inhibitors. Sometimes gonadotropin injections are also used, and in rare instances only we resort to laparoscopic surgery for ovarian stimulation, in which a very minimal part of ovary is resected, drilled or ablated.
How are hormones used for ovulation induction ?
One of a good approach is using GnRH (Gonadotropic Releasing Hormones) in a pulsatile fashion, where the hormone is given by intravenous route at intervals of every 60 to 90 minutes. This hormone in turn stimulates LH and FSH hormone which can then stimulate ovary to produce eggs. This approach mimics that of what happens in normal human body. However using IV treatment and sending bolus of injection via pump can be cumbersome for few. Because of the distinct hot weather at India, coupled with the cost and unavailability, we generally do not advocate using pumps during summers at India even for the fortunate few who can afford it.
As part of Fertility Gynecology practice at Delhi, Dr. Sahu uses Gonadotropin therapy for ovulation induction. Gondotropins are Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). She typically starts hormone injections after a spontaneous or progesterone induced periods. Dose that Dr. Meenakshi chooses for fertility treatment of her patients depends on variety of factors such as first time IVF, past history of failed IVF, past stimulation protocols used, age, AMH levels, history of PCOD, any previous history of hyperstimulation etc. In summary, FSH is used to develop and mature a follicle containing the egg. The response to treatment is monitored by ultrasound to measure follice size , follice diameter. The criteria for assessing follicle maturity are follicle diameter of 18 mm or/and a serum estradiol concentration of 200 pg/mL per dominant follicle. hCG , Human Chorionic Gonadotropin is then used for triggering the ovulation.
What are the risks of ovulation induction?
There are certain risks of ovulation induction that depends on treatment choice. The typical risks are related to multiple follicular development that can lead to some undesired situation such as:
Ovarian hyperstimulation syndrome.
This is one of the potential situation that needs to be monitored for very meticulously, because in this situation there is development of of multiple follicle that are of big size , multiple cysts in ovary, ovary size enlargement, fluid accumulation in the abdomen etc.
What oral medicines can be used for ovulation induction ?
Oral medicines (which means not using injections) that are used by Fertility experts at Delhi, for ovulation induction are :
- Clomiphene Citrate
- Aromatase inhibitors (Letrozole)
- Bromocriptine(Used if there are endocrinology issues with prolactin causing infertility)