The absence of ovulation is one of the main causes of female infertility. After all, if there is no output of a full ovum from the ovary, then the fertilization process is impossible. So, it is necessary to seek medical help to identify and eliminate the causes that cause this condition in the female body.
What is ovulation
- What is ovulation
- What causes ovulation
- No ovulation: signs
- Absence of ovulation:
- diagnosis No ovulation:
- treatment How to determine ovulation day: video
What is ovulation
Before proceeding to violations in the process of ovulation, Concept and in how the mechanism functions in the norm.
Ovulation( from the Latin "Ovulla" - testicle) is the process of the emergence of a mature egg from the ovary when the follicle ruptures under the influence of hormonal factors. Occurs once during each menstrual cycle. The ripened follicle is a vial with liquid contents and an egg in this medium.
The maturation process s
Most often, ovulation occurs in the middle of the cycle. For example, if a woman's menstrual cycle is 28 days, then ovulation falls on the 14th day. However, deviation from this median value is considered normal.
After a mature egg has emerged from the ovarian follicle, it enters the fallopian tube. It is promoted by the motor activity of the villi of the uterine tube. Normally, it is in the fallopian tube that the fertilization of the mature female sex cell takes place. In the absence of fertilization, the egg will die after 12-36 hours, and a yellow body forms on the site of the burst follicle. It is a temporary gland that synthesizes the hormone progesterone. The formation of the yellow body is also regulated by the pituitary gland under the influence of luteinizing hormone.
Progesterone plays a dominant role in the preparation of the uterus for an anticipated pregnancy. And if fertilization has not occurred, and the egg has died, the yellow body regresses: it decreases in size and releases an ever smaller amount of progesterone. So begins menstruation, during which there is a rejection of the mucous layer of the uterus. From the first day of menstruation, the menstrual cycle is counted.
The reasons for the absence of ovulation
The absence of ovulation is termed anovulation( prefix "en" means negation).The reasons for it are quite diverse. In addition, one should distinguish between physiological and pathological anovulation.
To natural, or physiological anovulation are:
- puberty( usually within 2 years after the first menstruation);
- postpartum period;
- lactation period( breastfeeding);
- postmenopausal period( menopause);
- allowed the absence of ovulation with regular menstruation in a healthy woman during 1-2 menstrual cycles per year;
- the use of hormonal contraceptives( their action is aimed at suppressing ovulation, and even after the abolition of the drugs several subsequent cycles can go without ovulation).
The most common causes of abnormal ovulation are:
- Significant increase or decrease in weight. It is known that obesity changes the hormonal background of the woman's body, and this can lead to anovulation. However, not everyone knows that with a significant reduction in weight, ovulation also does not occur. The organism simply does not have enough resources to produce full-fledged sex cells. Endocrine pathology. Most often, anovulation leads to violations of the thyroid gland( hypo- or hyperthyroidism).The pathology of the adrenal gland can also cause the absence of ovulation.
- Pathology of the hypothalamic-pituitary system. This system is the central link in the regulation of the ovulation process. Violations in this system can result in:
- head injury;
- disorders of blood circulation of the brain;
- pituitary tumor;
- increased production of pituitary hormone prolactin;
- functional disorders of the hypothalamus.
- Gynecological diseases. The most common problem of the female genital area is polycystic ovary, which changes not only the function, but also the structure of the ovaries.
- Malformations of ovary development. Not the most common reason for the lack of ovulation, but also affect it is much more difficult. Diseases of inflammatory and infectious nature. The danger of this fairly common cause of anovulation is that with improper treatment, a transition from the acute course of the disease to the chronic one is possible. And with such a low-symptomatic sluggish process, it is much more difficult to fight. Often after inflammatory diseases, taking stimulant ovulation preparations is required. Excessive physical activity. More often it concerns professional sportswomen. Especially if low body weight is noted, as, for example, in athletics or ballerinas. This can cause suppression of the production of hormones responsible for the maturation of the follicle.
- Stress. This can be either an acute severe stressful situation( for example, loss of a loved one) and chronic stress. The answer of the female body does not take long to wait, and will be expressed by a violation of the menstrual cycle or complete cessation of ovulation. Stressful situation for the body can be even a change in climate or place of work.
- Taking some medications. To violate the processes of ovulation may long-term use of hormonal drugs or some antidepressants. To restore the ovulatory function, it may take some time after the drug has been withdrawn. And sometimes they resort to the medication stimulation of ovulation.
Absence of ovulation: signs
Of course, the main reason will be the symptomatology of the main cause, which caused a violation or absence of ovulation. But there are general manifestations:
- irregular menstrual cycle of a permanent nature( the exception is a regular cycle during anovulation caused by physiological causes);
- absence of menstruation, or amenorrhea - this phenomenon can lead to chronic absence of ovulation;
- is a very irregular menstrual cycle - oligomenorrhea;
- long and profuse menstruation. Due to hormonal imbalance during anovulation, the mucous layer of the endometrium of the uterus is overgrown. Therefore, at the onset of menstruation, its uneven rejection occurs. Possible uterine bleeding, which is not associated with the menstrual cycle;
- if the cause of anovulation is polycystic ovary or adrenal insufficiency, there may be a hirsutism( excess facial hair and limbs in a male type), acne and obesity;
- with increased content of the hormone prolactin in the blood( hyperprolactinemia), there will be changes in the mammary glands( mastopathy);
- changes in the manifestations of premenstrual syndrome;
- impossibility of conception - in case pregnancy does occur, there is a problem of bearing the fetus;
- change in basal temperature.
Diagnosis If you notice symptoms of ovulation disorder, you should not hesitate to seek medical help. A gynecologist will conduct compulsory diagnostics.
- A thorough questioning about the menstrual cycle: its regularity, subjective sensations that accompany menstruation, bleeding profuse. Also information on the transferred diseases, operative interventions and traumas, gynecological manipulations will be important.
- General and gynecological examination. It will allow to judge about the correctness of the development of the female sexual sphere and to recognize the clinical manifestations of anovulation.
- Baseline temperature measurement. This simple diagnostic method the woman will carry out independently at home during several menstrual cycles( usually not less than 3).It is in the daily measurement of temperature in the rectum. The technique is based on the property of the hormone progesterone( which is produced by the yellow body) to raise the temperature. In this simple manipulation there are several features:
- need to be convinced of the absence of inflammatory and infectious diseases, as well as diseases of the genitourinary system;
- can be used with a mercury or digital thermometer;
- should be started from the first day of menstruation( ie, the beginning of the cycle);
- basal temperature measurement is performed strictly in the morning hours( preferably at the same time);
- total sleep time should be at least 6 hours;The
- thermometer is inserted into the rectum approximately 3-4 cm right after waking, without changing the position of the body( so it's best to put it next to you in the evening);
- measuring time 3 minutes;
- it is forbidden to use on the eve of a liquid containing alcohol;
- should not have sex during the time that precedes the measurement of temperature;
- is not measured when taking hormonal drugs.
The obtained results are recorded in the graph: on the horizontal axis, the cycle days are marked, and the vertical data are reflected in the temperature data.
In the 1st phase of the menstrual cycle( before the onset of ovulation) the basal temperature will be within 370C.The day before the onset of ovulation, it is usually somewhat reduced. And when ovulation occurs, the basal temperature increases to 37.2-37.40C.Thus, a temperature "splash" appears on the graph. Its absence indicates a monophasic cycle, which means that the absence of ovulation is most likely. However, you should not rush with self-diagnosis: provide the data of the graphs to your doctor.
- Additionally, you may need to test for ovulation. The test is purchased at the pharmacy and is conducted similarly to the pregnancy test. The level of luteinizing hormone in the urine is determined. You need to start the test a few days before the date of expected ovulation. For an approximate calculation use the formula: the number of days of the menstrual cycle minus 17. Then the test is performed daily before ovulation or the onset of menstruation. Interpreting the test, it should be borne in mind that, for example, in polycystic ovaries, the concentration of luteinizing hormone is increased.
- Further blood tests are performed to determine the level of hormones in the blood: prolactin, follicle stimulating( FSH), luteinizing( LH), cortisol, progesterone and thyroid hormones( to determine the function of the thyroid gland).In women with polycystic ovaries and external signs, such as hirsutism, the level of testosterone is further investigated.
- If the doctor suspects that the reason for the violation of the central link in the regulation of the ovulation process is a malfunction in the hypothalamic-pituitary system, craniography may be prescribed. This is an X-ray study of the skull to detect a pituitary tumor. For a more detailed study of brain structures, magnetic resonance imaging( MRI) can be used.
- ultrasound will help to identify structural changes in the ovaries( for example, in polycystosis, tumors), inflammatory manifestations and determine the presence or absence of ovulation signs( number of follicles and their size, thickness of the endometrium, etc.).Especially important is the detection of the dominant follicle. Its absence indicates anovulation. Ultrasound for reliability is performed repeatedly during several menstrual cycles.
- Diagnostic scraping of the endometrium is possible. This procedure is performed to visualize structural changes in the endometrium that occur under the influence of hormones that are directly involved in the process of ovulation.
Absence of ovulation: treatment of
Given that the absence of ovulation is not a separate disease, then treatment, first of all, should be aimed at eliminating the cause that caused this pathological condition.
- In some cases, it is enough for a woman to change her rhythm of life and normalize her diet. Sometimes ovulation with such changes can appear already in the next cycle. It was noted that weight loss with obesity of only 10% of the available body weight can restore ovulation.
- If the cause of anovulation is the pathology of the thyroid gland, then hormone replacement therapy( thyroid hormones) is prescribed.
- When hyperprolactinaemia, the doctor prescribes drugs that help reduce the level of prolactin in the blood( for example, Bromocriptine, Parlodel).Do not take these drugs if the increase in prolactin in the blood is single. Only with a significant excess of the norm of this hormone must be prescribed medication. And the result was confirmed three times in a laboratory study.
- It is important to eliminate psychoemotional disorders in women.
If it was not possible to restore ovulation by eliminating the causes that contributed to its occurrence, then medicament preparations are used. Their action is aimed at artificial stimulation of ovulation.
- Clostilbedite( clomiphene).Its use enhances the synthesis of gonadotropic hormones: FSH, LH and prolactin, as a result of which the process of ovulation is stimulated:
- if a woman's menstrual cycle is maintained, then the reception starts on the 5th day of the cycle;
- is taken once for 50 mg( 1 tablet);
- is obligatory to control the growth of follicles with the use of ultrasound;
- with the positive effect of ovulation occurs on the 11-15th day of the menstrual cycle;
- in the absence of ovulation treatment is continued in the next cycle with an increase in the dose to 100 mg( 2 tablets);
- with a negative result of repeated stimulation, repeat treatment again at a dose of 100 mg;
- in case of ineffectiveness of all attempts the repeated stimulation of ovulation can be carried out only after 3 months;
- the course dose should not exceed 750 mg;
- is contraindicated in ovarian cysts, severe liver disease, uterine bleeding in the past, visual impairment and oncological processes;
- uncontrolled intake and excess of recommended doses may lead to early depletion of ovarian function;
- preparation should not be used at the initially low level of estrogen, otherwise on the background of taking the drug their level may decrease even more.
- Menogon. Applied in the injection form. Contains FSH and LH at 75 IU.Strengthens the growth of the ovaries and stimulates their development. The treatment regimen is selected individually by the attending physician. Contraindications to use are the same as in Klostilbegit.
- Puregon. Contains FSH, which is obtained by genetic engineering methods. Stimulates the growth and maturation of follicles, as well as normalizes the synthesis of steroid hormones of the female reproductive system. It is used in the form of injections. After the treatment with Purigon, the administration of human chorionic gonadotropin( hCG) is recommended in order to induce the final stage of follicular maturation.
- DUFASTON.This synthetic progesterone is often used in the absence of ovulation. Produced in tablets of 10 mg. Its advantage over other analogs is that it does not have adverse side effects for each woman( male-type hair, voice timbre, etc.).Moreover, the synthetic analogue far surpasses the strength of the action of the natural hormone progesterone.
However, it is necessary to know that the drug Dufaston in the 1st phase of the menstrual cycle( ie before ovulation) can not be taken: it can inhibit ovulation. Therefore, Dufaston is used in the 2 nd phase of the cycle( usually from the 14th to the 25th day of the menstrual cycle, 1 tablet per day).Many doctors are reinsured, and in order not to knock down the process of ovulation, at first they are certain that ovulation has occurred, and only then they start treatment with Dufaston. And if the conception occurred against the background of taking the drug, then the treatment is continued during the first trimester of pregnancy, without lowering the dosage. This prevents spontaneous miscarriage. But this approach to treatment is justified when the progesterone is produced by the body at a low level. Otherwise, when obtaining synthetic progesterone from the outside, you can achieve that your own yellow body will stop producing this hormone.
- Utrozestan. Unlike Dufaston, contains not synthetic, but natural micronized progesterone. Produced in capsules of 100 and 200 mg.
It should always be remembered that hormone therapy is a serious intervention in the body, and one should not be light-minded about such treatment. Before proceeding to it, it is necessary to be convinced that all available methods are used in the treatment of anovulation, and all necessary examinations have been completed to determine the reasons for the absence of ovulation.
Of the side effects of hormonal stimulation are possible:
- problems with the gastrointestinal tract;
- problems with the central nervous system;
- formation of cysts;
- aggravation of hormonal disorders;
- early menopause( depletion of the functional capacity of the ovaries);
- increase in body weight;
- development of multiple pregnancies.
In no case can hormone drugs be used alone! Stimulation is mandatory under the supervision of doctors and ultrasound monitoring. This is the only way to see how a woman reacts to a given drug and to detect negative effects in time. Otherwise, uncontrolled intake of hormonal drugs can contribute not only to deterioration of health, but also to create a threat to life.