Irregular menstrual cycles in an infertility patient can signal a patient who is not ovulating. Usually, the egg gets released mid-cycle (around day 14) during a normal ovulatory cycle, and if there is no pregnancy, then a menstrual cycle will occur two weeks later ( completing a 28 day cycle that month. ie: the ‘norm’) If the cycle is short (for example only 21 days), or long (more than 35 days), it can mean the patient is having trouble with ovulation. This will affect the pregnancy rate because an egg needs to ovulate in order to fertilize with a sperm, and be implanted into a receptive uterus. About 40% of infertility in the female is related to cycles that do not ovulate, and a common syndrome with anovulation is polycystic ovarian syndrome.
In a young patient, a hormonal imbalance can usually explain the reason for a cycle to not ovulate. The female hormones, estrogen and progesterone, are uniquely coordinated in the ovary to produce an egg for ovulation. A synchrony exists between the brain and the ovary that allows the egg to develop normally and the uterus to be receptive to the fertilized egg for implantation. Hormones like Clomid or FSH can be given to the patient to help her ovulate and produce a pregnancy. These hormones need to be monitored by an infertility specialist who is familiar with the medications to help ovulation, and can control the dosage so multiple births are minimal. Ovulation monitoring consists of frequent blood estrogen levels and ultrasounds to evaluate how the patient is responding, with adjustments made accordingly. Very high success levels are achieved with these medications as long as other reasons for infertility are ruled out.
In an older patient, over 40, the reason for not ovulating may be related to the fact that she is undergoing an early menopause and the eggs that remain are few. A day 3 hormone level (FSH and Estradiol) can determine whether the patient has a good ovarian reserve for ovulation. Ovulation medications like FSH can be given to maximize the pregnancy rate as well.
A patient who is under age 35, and unable to achieve a pregnancy for 1 year, should seek treatment with an infertility specialist. If the woman is over age 35 she should only try for 6 months before seeking an evaluation by the specialist. Anyone over the age of 40 should not wait – she should see a specialist as soon as she has decided to conceive as time is critical in terms of the success rate for pregnancy.
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