It is a wonder that all it takes is one sperm to fertilise an egg and yet even 15 million sperm are considered a low sperm count and not sufficient to fertilise a female egg. A man should have a sperm count of at least 20 million sperm per millilitre of semen. The most astounding elements that even with so many sperm, none are able to do the required job, ending up with infertility. This has to do more with the fact that most of the sperm have some shortcoming in them and a very small percentage are actually capable of reaching the fallopian tube and fertilising the egg. Given the small percentage, a minimum of 20 million gives the couple a better chance of conceiving.
While there is so much talk going on about the sperm, what about the female egg? Every cycle a woman has just one egg available for fertilisation, which in most cases the sperm are not able to find or fertilise. Female fertility is always calculated against the menstrual cycle. The menstrual cycle is the most integral part of a woman’s fertility. It defines whether a woman is fertile or not. Any encumbrance with the menstrual cycles denotes that there is a possible disorder in the woman’s fertility.
Women who have been trying to get pregnant may look at each forthcoming cycle with trepidation. Stress and anxiety are common when you feel pressured to get pregnant but seem unable to. Ovulation disorder is not uncommon today, and many young women suffer from it.
WHAT IS OVULATION?
Ovulation is one of the most important aspects of a woman’s fertility. This represents the readiness of the female egg to be fertilised by the male sperm. The female eggs are stored in the ovaries. Every cycle the ovary is stimulated to mature an egg. Once the egg is mature, it enters the fallopian tubes. The fallopian tubes are fine structures which run from the ovaries to the uterus, connecting the two. The uterus is the areas where the foetus grows and develops into a baby. The uterus is more commonly referred to as the womb. The process of the egg maturing and entering into the fallopian tubes is known as ovulation.
While the egg is in the fallopian tube, it waits for the sperm to fertilise it. In most cases, the sperm are already in the fallopian tube and waiting for the egg to arrive. It takes the sperm up to 12 hours to travel from the cervix to the fallopian tubes. Some fast swimmer may be able to reach the fallopian tubes in 45 minutes. The sperm can survive inside the female body for up to 7 days in a favourable environment. The egg remains in the fallopian tube for a period between 12 to 48 hours. This period known as the fertility window is when fertilisation takes place. If there are no sperm available to fertilise the egg, it begins to disintegrate and is absorbed by the body to be expelled with the upcoming menstrual cycle.
The menstrual cycle takes place when fertilisation of the egg does not take place. It is the shedding of the endometrial lining which formed in anticipation of receiving the embryo. Usually, the menstrual cycle begins 14 days after ovulation. The first day of the menstrual cycle also marks the beginning of a new fertility cycle.
Ovulation defines a woman’s fertility. A woman with a healthy reproductive system ovulates regularly and can conceive easily. For women who want to get pregnant, it is mandatory to have sex in time for the sperm to meet the egg. It can take a sperm sometimes to reach the fallopian tubes, which means that one needs to know exactly when during their fertility cycle, they will ovulate. This helps to plan intercourse accordingly.
Doctors advise having sex at least every alternate day in the week leading up to ovulation. This ensures that some sperm are present in the fallopian tube to meet the egg. There are a number of ways to track ovulation. Many women use an ovulation calendar. Women may not always ovulate on the same day. Fortunately, there are symptoms that can help you to know exactly when you are ovulating. A slight cramping sensation is a good way to recognise that you are ovulating. Other symptoms are clear and watery cervical mucus. Women who are keen to get pregnant become more conscious of their bodies and the changes that take place during the cycle.
Ovulation usually takes place 14 days prior to the start of your menstrual cycle. If you have a 28-day cycle, you will most probably ovulate on the 14 days. However, if your cycle is different, the ovulation date will vary and hence counting backwards from your menstrual cycle is a better way to calculate your ovulation date.
There are many factors that go into pregnancy, and even if you’ve had sex on the right days, there is a probability that you might not conceive. Women who have regular unprotected sex do not conceive on every cycle. But do not get discouraged and continue trying. The probability of getting successfully pregnant increases with each consequent menstrual cycle.
Anovulatory disorder describes a condition when ovulation does not take place. Sometimes the body doesn’t function as it is supposed to and things don’t turn out exactly as we expect. Though the process of ovulation may sound quite simple, there are a lot of factors that have to be perfectly aligned for a new life to come into existence, not to rule out the divine intervention and the creator of new life.
Ovulation is induced by the release of hormones in our body. When there is a disruption in the hormones, and the balance is out of proportion, women may have irregular periods and consequently a disruption in ovulation.
TYPES OF OVULATION DISORDER
Many women today suffer from problems that prevent them from ovulating. The two common types of ovulatory disorders are:
Anovulation describes a condition where a woman does not ovulate. She may or may not have her menstrual cycle. The failure to ovulate could be due to the lack of proper maturation of the follicles, which results in the egg not being released. Several reasons have been presumed to cause anovulation such as poor eating habits, a variety of medical illnesses, too much exercise, hormonal imbalance, and various other causes. Some women who are into physically strenuous sports may suffer from ovulation irregularities. Sometimes a woman may not even be aware that she is not ovulating until she is not able to conceive.
Some women have longer cycles which may be with a gap of more than 35 days, which means they have their menstrual cycle about 8 times a year. These women have a condition called oligo-ovulation. These women do not ovulate at all, even though they have a menstrual cycle.
DIAGNOSING OVULATION DISORDERS
Before prescribing any tests, the doctor may want to know about your medical history any other illness or medical conditions, lifestyle habits and medications that you may be taking. These are all factors that could disrupt ovulation and will enable the doctor to make a proper diagnosis of what the problem is.
Some of the popular tests used to diagnose the cause of anovulation disorder are:
FSH (Follicle Stimulating Hormone) test: One of the first tests the doctor may recommend is a blood test to check the level of the FSH in the blood. This test is usually conducted on a particular day of the menstrual cycle. This test is used to check if the patient is nearing menopause. The level of FSH in the blood reduces when a person is closer to menopause.
Progesterone blood level: The progesterone level in the blood is also checked to see if ovulation has taken place. The corpus luteum is the follicle that has released the egg. Once the egg is released the corpus luteum begins releasing the progesterone hormone to prepare the uterus for implantation. Progesterone is only produced after the egg has been released and ovulation takes place. This is a good indication to check if ovulation has occurred.
Ultrasound: An ultrasound of the ovaries checks to see if the follicles are maturing. A reduced quantity of follicles in the ovaries helps to identify if the patient is approaching menopause. The depleted ovarian reserve is an indication that menopause is nearing.
Endometrial biopsy: An endometrial biopsy is not a regular test and conducted in very rare cases where the doctor may have some suspicions regarding the endometrium. A section of tissue is taken from the endometrial lining to check if the endometrium is thick enough to support a pregnancy. Some women have a thin endometrial lining, which is one of the reasons implantation does not take place.
Doctors need to be sure about the onset of menopause as well as the development stage of follicles in the ovaries based on the level of hormones in the blood. Through these tests, the doctors can determine if there is an ovulatory disorder.
CAUSES OF OVULATION DISORDERS
Women face a number of different kinds of problems which result in ovulation disorders. There are various conditions due to which a woman may not ovulate regularly. Some of these conditions are:
Premature Ovarian Failure
The ovarian reserve diminishes with age, and when the eggs in the ovaries are exhausted, the ovaries stop ovulating. Premature ovarian failure is a condition in which the eggs in the ovaries are depleting at a faster pace. Usually, many eggs are lost during each ovulation cycle while only one matures. Those women who have premature ovarian failure lose a greater number of eggs during each ovulation cycle causing the reserve to diminish even faster. Due to this condition, they come into menopause earlier than they would have in normal conditions. Premature ovarian failure is a genetic condition and is passed down through the genes.
Women who are older have a lower ovarian reserve. As a woman get older, better eggs are used up, and the eggs that remain in the ovaries may not be of optimal quality. When a woman advances in age, she is closer to menopause and hence has a lesser quantity of eggs in the ovaries. Older women are more prone to ovulation disorders and may not ovulate regularly. Anovulation disorder, which is related to advanced age, usually begins to show up a little before a woman enters menopause.
Women who have a problem with their thyroid glands tend to face an ovulation disorder also. This is mainly because the hormone balance gets disrupted with hypothyroidism and hyperthyroidism. Hypothyroidism is a condition where not enough of the thyroid hormone is produced and in the case of hyperthyroidism too much of the thyroid hormone is produced by the body. Women with a thyroid problem tend to produce higher amounts of oestrogen. The excessive oestrogen interferes with the FSH and the LH hormones release, and the result is disrupted ovulation.
Polycystic Ovarian Syndrome (PCOS)
The PCOS is a condition where a woman has multiple cysts in her ovaries. This inhibits the proper functioning of the ovaries and leads to high production of the androgen hormone and reduced insulin sensitivity. The excess amounts of androgen cause irregular ovulation or may prevent ovulation altogether.
The prolactin hormone helps in the production of breast milk. This hormone also reduces the level of the FSH and the LH hormone. Too much of the prolactin hormone in the body, especially when a woman is not pregnant, can disrupt ovulation by preventing the follicles from maturing.
The adrenal glands produce androgens. When the adrenal glands are not functioning correctly, there is a higher level of androgen in the body, which in turn leads to oligo-ovulation. A woman who has an elevated level of androgens in her body is more susceptible to an increased level of prolactin as well as tumours or growths on the ovaries, pituitary glands and adrenal glands.
Other causes of ovulation disorder are factors such as anorexia, obesity, stress, or too much exercise — women who have any of these conditions and are unable to conceive need to get a medical check-up.
Asha suffered from a thyroid problem and consequently was overweight. The doctor’s advice to lose weight fell on deaf ears. Asha was not inclined to exercising and even taking a walk was too much effort. Two years after getting married, her in-law began hinting at having a baby. Even Asha felt it was time to get pregnant, and she was keen to be a mother. During the first two years of marriage Ajay and she had not used any protection. However, Asha now made a conscious effort to calculate her ovulation date to get pregnant. Her periods were sometimes early and sometimes delayed, but she had them almost every month. After one year of trying to get pregnant, she was still not pregnant. They visited a doctor and after some tests learnt that due to Asha’s thyroid problem, she was not ovulating regularly. IVF treatment was the only choice for them to have a baby.
TREATMENT FOR OVULATORY DISORDER
If a woman is not ovulating the first procedure is for the doctor to prescribe oral medication, which will induce ovulation. In the event that the oral medication is not effective, the doctor will prescribe injectable fertility drugs, also known as gonadotropins. The ovulation is monitored through a blood test and by taking an ultrasound.This medication will stimulate the ovaries to mature the follicles.
In cases where some other condition is responsible for the ovulation disorder like thyroid, etc., the condition due to which the regular ovulation process is interrupted needs to be treated alongside the ovulation medication.
POSSIBLE RISK FACTORS FOR OVULATION IRREGULARITIES
It is always advisable to know what can put you at risk for ovulation problems
- Living under very high stress
- Hormonal disorders
- Thyroid problem
- Being underweight
- Harmful drugs and alcohol
- Cysts, tumours and other unusual growths in the reproductive organs
FERTILITY OPTIONS FOR WOMEN WITH OVULATION PROBLEMS
Women who have a problem with their ovulation are invariable also not able to conceive. This diagnosis can be very heart-wrenching. In most cases, doctors advise couples to have fertility treatment, which is the most effective way to start a family. The most common and successful fertility treatment options recommended for ovulation problems are:
Intra Uterine Insemination (IUI): This treatment is recommended in cases where a woman is on oral medicines like clomiphene to induce ovulation. A sample of the male partner’s semen is taken and washed in the lab. Following this, it is injected into the uterus. The IUI procedure is performed just before ovulation. It follows the process of natural conception after the semen insemination.
In Vitro Fertilisation (IVF): IVF is the most successful treatment for helping couples with ovulation disorders to conceive. involves an out of body fertilisation of the embryo. The female egg and the male sperm are fertilised in the lab. The embryo that forms from this fertilisation process is then placed in the mother’s uterus to develop naturally.
“I have a thyroid problem, and I am highly diabetic and insulin-dependent. Getting pregnant was a huge issue, and my gynaecologist advised me to forget about having a baby as I would have a very complicated pregnancy. A friend of mine had an IVF baby at Medicover. I could not resist myself and booked an appointment with my supportive husband in tow. There were risks involved, but the doctor was hopeful, so we went ahead. It was a high-risk pregnancy, and I spent a lot of time at the hospital during my pregnancy to have my vital signs monitored. My blood pressure shot through the roof, and even after my delivery, I was advised not to breastfeed my baby for a week. In a few weeks, my health regulated. When I look at my baby I feel that it was worth the risk. The medical team at Medicover played an important role in keeping me alive and making our dream child a reality. He is truly a miracle child.”
LATEST TECHNOLOGY TREATMENT AT MEDICOVER FERTILITY
Medicover Fertility is a part of a European health care group. Medicover is an IVF clinic which offers fertility treatment to childless couples using the latest technology treatment option for the best fertility success rates. Medicover fertility maintains international standards at all their clinics and believes in the principle that each patient is different and has unique needs. Individualised patient care is the hallmark of Medicover Fertility world over.
Q: I was diagnosed with an ovulation disorder when my periods started becoming irregular, but my doctor said that I would not have any problem getting pregnant.
A: Anovulation disorder means that you are not ovulating regularly or not ovulating at all. Without ovulation, it is impossible to conceive.
Q: Can thyroid cause infertility?
A: Women who suffer from thyroid problem have irregular hormone balance, which affects their fertility.
Q: Can I have an ovulation disorder because of diabetes?
A: Diabetes is an autoimmune disorder hampers your fertility in numerous ways. Women who have diabetes have reduced fertility, which means you will find it increasingly difficult to conceive. Diabetes can also lead to other complication such as hormonal imbalance and ovulation disorders.