Which is the leading reason of female infertility?

More than 25% of cases of infertility fall in the category of  ovulatory disorders.  Ovulatory disorders, like irregular ovulation or a complete lack of ovulation (anovulation), are usually due to a hormonal imbalance.  Too much prolactin, a milk-producing hormone that suppresses ovulation, or too many androgens (produced mostly by the ovaries and adrenal glands), are considered major reasons behind ovarian dysfunction.  The imbalance of any of these types of hormone may lead to ovulatory dysfunction such that eggs do not develop properly or are not released from the follicles of the ovaries.

Signs of ovulatory disorders:  Women who are suffering from these disorders may not menstruate for several months.  Others may have vaginal bleeding even though they are not ovulating.

Some causes other than hormonal imbalances may involve:

• Eating disorders,
• Other medical disorders,
• Oligo-ovulation is a disorder in which ovulation doesn’t occur on a regular basis, and the menstrual cycle may differ from the normal cycle of 21 to 35 days.
• Exercising or dieting excessively may also stop ovulation.

How is Ovulatory Dysfunction diagnosed?

Medical history is helpful in diagnosing ovulatory dysfunction.

There are some tests that may be required to confirm the dysfunction.  One or more of the following tests will be a diagnostic tool to manage the problem further.

1.  FSH blood level: This is a blood test which is used to evaluate the amount of follicle stimulating hormone (FSH).  It is mostly used to test if a woman is approaching menopause.

2.  Progesterone blood level: A blood test that measures the amount of progesterone in blood to diagnose if ovulation has occurred.

3.  Endometrial biopsy: A sample of endometrial tissue is examined to evaluate if it is developed enough to support a pregnancy.  The endometrial tissue may support the diagnosis of ovarian dysfunction in a woman.

4.  Ultrasound:  A scan may see if the follicles are developing normally.  High frequency sound waves are used to evaluate the follicular size.  Small ovaries with a few small follicles may be a sign of various medical conditions that may affect ovarian function.

Ovulatory dysfunction must be considered when a woman has had a tubal reversal and is attempting pregnancy. Although the chances of conceiving after a tubal reversal are good, even secondary to tubal ligation, disorders of ovulation must be considered.  With a tubal reversal and proper treatment of ovulatory dysorders, most women are able to get pregnant again.

What are glandular problems?

Primary glands are involved in producing reproductive hormones in women.  Hormonal imbalances are sometimes traced back to glandular problems rather than a surgical procedure such as a tubal ligation or tubal reversal.

Primary glands include the hypothalamus, thyroid and pituitary glands.  These glands are constantly sending signals in order to maintain the balance of hormones in the body.  Having a problem with any one of these primary glands in a woman’s body could upset the natural balance of the reproductive hormones estrogen and progesterone.

Primary glands

• Hypothalamus:  The hypothalamus is a small region at the bottom of the brain.  The hypothalamus is responsible for two major jobs.  The first are metabolic processes like controlling body temperature, hunger, thirst, fatigue, and circadian cycles. The second is control of the Autonomic Nervous System.  Hypothalamic-releasing hormones are also responsible for stimulating or inhibiting the secretion of pituitary hormones.  These Hypothalamic-releasing hormones can be affected by birth control pills, stress, and some disease or medications.

• Thyroid:  The thyroid, one of the largest endocrine glands, is found in the neck inferior to the thyroid cartilage, i.e. just below the “Adam’s apple.” Hypothyroidism, in which an underactive thyroid gland can cause excessive levels of the hormone prolactin, can inhibit ovulation.

• Pituitary:  The pituitary gland, or hypophysis, is about the size of a pea and weighs 0.5 g.  Its location is at the bottom of the hypothalamus at the base of the brain.  The pituitary fossa, in which the pituitary gland resides, is located in the sphenoid bone in the middle cranial fossa at the base of the brain.  The pituitary gland secretes hormones for homeostasis, including tropic hormones that stimulate other endocrine glands.  It is functionally connected to the hypothalamus by the median eminence, and rests in a small, bony cavity (sella turcica) covered by a dural fold (diaphragma sellae).  Microscopic tumors or prolactinomas on the pituitary gland can release the hormone prolactin, which may cause infertility by interfering with ovulation.

In some cases hypothyroidism is observed as a postoperative symptom of a surgical procedure on the brain, but not with minor procedures like a tubal ligation or a tubal reversal.  Tubal reversal (tubal reanastomosis) is a surgical procedure that restores the function of the fallopian tubes after a tubal ligation.