Ovulatory dysfunction can be defined as the absence or disruption of normal ovulation which can be caused by problems either in the ovaries or problems with the hypothalamus and pathways regulating reproductive hormones necessary for ovulation.Ovulation disorders can cause irregular ovulation, or sometime absence of ovulation.ovulation disorders in women can be deducted by assessment of her periods, Hormonal levels(FSH and AMH levels) and by evaluating the ovaries through ultrasound techniques. World Health Organization(WHO) has postulated that ovulation disorders are the cause for about 25 percent of the couples with infertility.

 

Common ovulation disorders:

Hypothalamic dysfunction.

Hormonal imbalances

Luteal phase defect.

Hyperprolactinemia

Primary ovarian insufficiency.

 

Ovulation tests for ovulation disorders

Women with ovulation disorders should consult with their gynaecologist to set up an ovulation test. Blood testing can be done to evaluate the level of hormonessuch as AMH, FSH, LH, prolactin, estradiol, testosterone, and GnRH. An ultrasound scan may be performed to evaluate the ovaries.

 

Hypothalamic dysfunction

            Hypothalamic dysfunction is nothing but thedefective function of the hypothalamuswhichregulates various body functions. The most common symptoms include irregular or absent periods. Hypothalamic dysfunction canprimarily occurbecause of surgeries, brain injury, tumors, radiation, andsome rare genetic conditions. Secondary causes may include sudden weight loss or gain, excess physical and emotional stress, and nutritional deficiencies. Primary causes for Hypothalamic dysfunction are treatable, from simple lifestyle changes to medications that can regulate or replace hormones to surgery to remove a tumor in the brain. Other Secondary causes can be addressed by lifestyle changes such as weight loss and stress reduction techniques.

 

Hormonal imbalance 

Proper balance of hormones is necessary for ovulation. The most common hormonal imbalances affecting ovulation are PCOS and thyroid dysfunction. PCOS affects 6-12 percent of reproductive age women as it prevents the release of mature eggs are and turns it into cysts.Anovulation makes it difficult or impossible for a woman to conceive. This is frequently caused by a hormonal imbalance.

Hyperprolactinemia

Over production of the prolactin hormone can lead to a condition called Hyperprolactinemiawhichcan disrupt ovulation. Increased levels of prolactin levels can decrease estrogen production causing infertility.A blood test can usually detect elevated levels of prolactin, and if hyperprolactinemia is detected Medications can used to reduce prolactin levels.

Luteal phase defect

This type of ovulationdefect can occur during the luteal phase of the menstrual cyclebecause of the insufficient progesterone being produced by the ovaries or because of the endometrium which responds to the progesterone. They can cause spotting of blood between periods, more frequent periods, and miscarriage. This condition is bit difficult to diagnose, but blood tests can evaluate levels of LH, FSH and progesterone. At times the thickness of the endometrium can be evaluated using Pelvic ultrasound which can indicate luteal phase defect.

Primary ovarian insufficiency

Primary ovarian insufficiency (POI) is when a woman’s ovaries stop working by the time, she reaches her menopause. The cause is thought to be related to the ovary follicles, which is where eggs grow and mature before ovulation. Causes of the anovulation may also be related to genetic disorders, autoimmune disease, radiation or chemotherapy, and toxins such as cigarette smoke and exposure to pesticides. Women between the ages of 35 and 40 are at higher risk of premature ovarian insufficiency. POI can be usually diagnosed by reviewing the woman’s medical history, pelvic exam, blood tests and ultrasound. Till date there is no proven treatment to restore normal ovarian function for women with POI.