Irregular Ovulation: A Silent Cause of Infertility

Chronic anovulation is a disorder of ovarian function that disrupts normal egg development, resulting in irregular or absent menstrual cycles and representing a major cause of infertility.

For further information or Booking..

A Major Cause of Female Infertility

Studies have shown that approximately 10% of adolescent girls experience underlying ovulatory disorders. Clinical presentations vary widely among individuals. Some women have regular menstrual cycles, while others experience irregular cycles or frequent missed periods.

Common associated symptoms may include persistent acne, oily skin, excessive weight gain in some cases, increased body hair (hirsutism), or male-pattern hair thinning. However, some individuals may have no obvious symptoms other than difficulty conceiving and are ultimately diagnosed with infertility due to ovulatory dysfunction.

Challenges in Diagnosing Ovulatory Disorders

Diagnosing ovulatory disorders can be challenging. Physical examinations may appear normal, although signs such as acne, oily skin, or obesity may be present in some cases. Hormonal testing may reveal imbalances in reproductive hormones, indicating impaired ovarian function.

Transvaginal ultrasound can provide valuable diagnostic information by identifying characteristic ovarian features, such as the presence of multiple small, immature follicles arranged in a “string of pearls” pattern. This ultrasound finding is considered one of the most reliable indicators of ovulatory disorders.

Treatment Approaches for Chronic Anovulation

Treatment strategies for chronic anovulation differ from those for occasional or irregular ovulation. The primary treatment goal is to induce ovulation while minimizing treatment-related complications.

Women with chronic anovulation often show limited response to oral ovulation-inducing medications, but may respond better to injectable therapies. However, achieving controlled ovulation can be difficult, as stimulating the development of only one or two follicles using conservative methods is often challenging.

Conversely, injectable ovulation-inducing medications may overstimulate the ovaries, leading to the development of an excessive number of eggs. This can increase the risk of multiple pregnancies and complications such as fluid retention, severe nausea, and vomiting during ovarian stimulation and early pregnancy.

Treatment Options for Persistent Anovulation-Related Infertility

Several treatment approaches may be considered for infertility caused by persistent anovulation:

• Oral ovulation-inducing medications may be combined with additional agents to improve responsiveness. For example, metformin, commonly used to treat diabetes, may be added in selected cases when oral ovulation-inducing drugs alone are ineffective.

• Low-dose injectable ovulation-inducing medications may be used to stimulate the growth of a limited number of follicles (typically fewer than three). If ovulation is achieved, natural intercourse may be attempted when sperm parameters are normal, or intrauterine insemination (IUI) may be performed when sperm quality is suboptimal. If unsuccessful, further treatment options can be explored.

• Low-dose injectable medications combined with in vitro fertilization (IVF) may be used to stimulate multiple follicles under controlled conditions. The resulting embryos are cryopreserved, and embryo transfer is postponed to a subsequent natural cycle. This approach helps reduce excessive hormone exposure, improves cycle control, and lowers the risk of complications.

• In vitro maturation (IVM) involves retrieving immature eggs without full ovarian stimulation. These eggs are matured in the laboratory and fertilized using intracytoplasmic sperm injection (ICSI). The resulting embryos are transferred into the uterus in a manner similar to conventional IVF. This method reduces the risk of ovarian hyperstimulation syndrome, although pregnancy rates may be lower compared with standard IVF.

Conclusion

With appropriate treatment selection and careful monitoring, pregnancy rates can be significantly improved while minimizing complications. Among the available options, conventional in vitro fertilization (IVF) offers the highest pregnancy success rates while allowing effective control of potential risks.

Additionally, frozen embryo transfer (FET) enables flexible timing of embryo transfer and helps reduce the risk of ovarian hyperstimulation syndrome, which typically resolves within approximately seven days after egg retrieval. When choosing a treatment approach, both the likelihood of achieving pregnancy and the potential risks associated with treatment should be carefully considered.

For further information or Booking..