Fertility Solutions: Official Blog

Live, Online Seminar Q & A: Ovulation Disorders

Posted in Live Online Seminar: Q & A, Ovulation | Tagged Fertility Solutions, infertility questions, infertility seminar, ovulation, ovulation disorders September 15, 2011

Each month we host a live online seminar where patients can ask our physicians questions about infertility. The topic for each seminar changes monthly, whether it is IVF, tubal reversal, egg donation, or more. This month's topic was ovulation disorders (our last topic was decreased ovarian reserve). View the live Q & A chat about ovulation disorders:

(09/14/2011)

7:03

Fertility Solutions:

Welcome to our discussion on ovulation disorders

Wednesday September 14, 2011 7:03 Fertility Solutions

7:05

Fertility Solutions:

Ovulation disorders are quite common and are a cause of menstrual irregularity and infertility.

Wednesday September 14, 2011 7:05 Fertility Solutions

7:06

[Comment From jack jack : ]

why menstrual irregularity occurs and what causes it and how to cure?

Wednesday September 14, 2011 7:06 jack

7:07

Fertility Solutions:

There are many causes, most are caused by either irregular signaling between pituitary and ovaries or abnormalities in ovarian response.

Wednesday September 14, 2011 7:07 Fertility Solutions

7:08

Fertility Solutions:

Uterine abnormalities can cause menstrual irregularity as well. Testing is needed for anyone with menstrual irregularity to determine the source of the problem

Wednesday September 14, 2011 7:08 Fertility Solutions

7:08

[Comment From jack jack : ]

Even though ovaries are healthy why ovulation disorder occurs in younger age?

Wednesday September 14, 2011 7:08 jack

7:10

Fertility Solutions:

Sometimes ovaries no not receive the right signals from the pituitary that would cause the follicles to proceed through the normal maturation process and subsequently ovulation does not occur

Wednesday September 14, 2011 7:10 Fertility Solutions

7:11

[Comment From jack jack : ]

What is the correlation between pituitary and thyroid?

Wednesday September 14, 2011 7:11 jack

7:13

Fertility Solutions:

The pituitary gland is the gland that controls hormone production and secretion from other endocrine organs. It makes TSH which then instructs thyroid to make more thyroid hormone

Wednesday September 14, 2011 7:13 Fertility Solutions

7:13

[Comment From Danielle Danielle : ]

How likely is it to become pregnant with the help of IVF, and go to term with a diagnoses of PCOS?

Wednesday September 14, 2011 7:13 Danielle

7:14

Fertility Solutions:

PCOS often causes patients to respond more vigorously to the medication and makes stimulation a bit more tricky with IVF. In general patients with PCOS do well if IVF is needed

Wednesday September 14, 2011 7:14 Fertility Solutions

7:15

Fertility Solutions:

The risk of miscarriage is a bit higher in patients with PCOS, but the cause of this finding is still controversial. It likely has more to do with the overall endocrine environment and androgen levels than with egg quality

Wednesday September 14, 2011 7:15 Fertility Solutions

7:17

Fertility Solutions:

In patients with PCOS undergoing stimulation for IVF we have to adjust medications doses very carefully and sometimes use other medications such as metformin to help improve outcomes

Wednesday September 14, 2011 7:17 Fertility Solutions

7:18

Fertility Solutions:

Patients who have ovulation disorders do not necessarily need IVF treatment.

Wednesday September 14, 2011 7:18 Fertility Solutions

7:19

Fertility Solutions:

We can restore ovulation by either correcting the underlying endocrine problem or use medications to induce ovulation such as Clomid or Femara

Wednesday September 14, 2011 7:19 Fertility Solutions

7:19

[Comment From Stacey Stacey : ]

What is a luetal phase defect, and how can it be corrected.

Wednesday September 14, 2011 7:19 Stacey

7:20

Fertility Solutions:

Luteal phase is the second phase of the menstrual cycle after ovulation. Both estrogen and progesterone are produced at that time

Wednesday September 14, 2011 7:20 Fertility Solutions

7:21

Fertility Solutions:

If inadequate levels of progesterone are made, we say that the luteal phase is deficient.

Wednesday September 14, 2011 7:21 Fertility Solutions

7:21

Fertility Solutions:

Low progesterone levels can cause problems with development of the lining of the uterus, implantation problems or miscarriages.

Wednesday September 14, 2011 7:21 Fertility Solutions

7:21

[Comment From jack jack : ]

If IVF treatment is not necessary for ovulation disorder patients then what are the treatments that are effective other than IVF

Wednesday September 14, 2011 7:21 jack

7:23

Fertility Solutions:

IVF is one option, however using the ovulation stimulating medications along and adding intra-uterine insemination or timed intercourse is also a common option

Wednesday September 14, 2011 7:23 Fertility Solutions

7:23

[Comment From anon anon : ]

what can you recommend, instead of crinone, as support during the luteal phase?

Wednesday September 14, 2011 7:23 anon

7:25

Fertility Solutions:

We use a variety of progesteroen preparations, Crinone is one, there is also endometrin and compounded forms of progesterone that the pharmacy can make. Women who are going through IVF may also use intra-muscular form of progesterone

Wednesday September 14, 2011 7:25 Fertility Solutions

7:27

[Comment From anon anon : ]

regarding progesterone, would you be able to recommend any natural support?

Wednesday September 14, 2011 7:27 anon

7:28

Fertility Solutions:

We can use hcg as a trigger for your body to make more of its own progesterone in the luteal phase

Wednesday September 14, 2011 7:28 Fertility Solutions

7:29

Fertility Solutions:

Progesterone suppositories can be compounded with bioidentical progesterone as well

Wednesday September 14, 2011 7:29 Fertility Solutions

7:29

[Comment From Guest Guest : ]

Is it ever necessary to supplement Estrogen during the luteal phase as well?

Wednesday September 14, 2011 7:29 Guest

7:30

Fertility Solutions:

Some patients after IVF when the corpus luteum is disrupted by the egg retrieval do not make sufficient estrogen as well. Estrogen support can be helpful under those circumstances.

Wednesday September 14, 2011 7:30 Fertility Solutions

7:30

[Comment From Stacey Stacey : ]

If all fertility testing shows no problems, and low progesterone is suspected for multiple miscarriages, do you recommend clomid as well as progesterone?

Wednesday September 14, 2011 7:30 Stacey

7:31

Fertility Solutions:

It is rare for patients who are not undergoing IVF to need luteal estrogen support. It may b necessary however if there is luteal phase bleeding which does not respond to progesterone treatment alone

Wednesday September 14, 2011 7:31 Fertility Solutions

7:32

Fertility Solutions:

Stacey, While in some cases progesterone alone may be effective, we will usually will prescribe both Clomid and progesterone together to help improve the luteal phase

Wednesday September 14, 2011 7:32 Fertility Solutions

7:33

Fertility Solutions:

Hcg trigger can also be used in addition to clomid to improve luteal progesterone production

Wednesday September 14, 2011 7:33 Fertility Solutions

7:35

[Comment From jack jack : ]

Is there a permanent solution for ovulation disorder and or menstrual irregularity?

Wednesday September 14, 2011 7:35 jack

7:36

Fertility Solutions:

It depends on the cause. If the ovulation problem stems from thyroid dysfunction or being overweight then treating the primary problem can permanently restore ovulation

Wednesday September 14, 2011 7:36 Fertility Solutions

7:37

Fertility Solutions:

If ovulation problem is caused by abnormal signaling between the hypothalamus-pituitary (glands that control ovarian function) then we do not understand how to restore this function to normal permanently.

Wednesday September 14, 2011 7:37 Fertility Solutions

7:38

Fertility Solutions:

We use medications which cause ovulation for those patients who are trying to conceive. For others we use hormone support to keep the menstrual cycle regular

Wednesday September 14, 2011 7:38 Fertility Solutions

7:38

[Comment From anon anon : ]

what would you recommend for a patient with sustained high follicular lh greater than 20 if blood work shows a surge at 50+ and ultrasound and blood work confirm ovulation?

Wednesday September 14, 2011 7:38 anon

7:40

Fertility Solutions:

If a surge can be documented the baseline level of LH is less critical

Wednesday September 14, 2011 7:40 Fertility Solutions

7:40

Fertility Solutions:

Patients with high baseline LH typically do not ovulate or have a higher chance to mimes interpret their surge

Wednesday September 14, 2011 7:40 Fertility Solutions

7:42

[Comment From Danielle Danielle : ]

Are there ways of identifying ovulation, other then blood work?

Wednesday September 14, 2011 7:42 Danielle

7:43

Fertility Solutions:

You can use ovulation prediction kits-they test for LH in the urine

Wednesday September 14, 2011 7:43 Fertility Solutions

7:44

Fertility Solutions:

Older methods such as temperature monitoring or even checking cervical mucous are less reliable but have been used by some with success

Wednesday September 14, 2011 7:44 Fertility Solutions

7:45

Fertility Solutions:

Blood work and detection of progesterone in the blood is the only incontrovertible evidence that ovulation occurred

Wednesday September 14, 2011 7:45 Fertility Solutions

7:48

Fertility Solutions:

An important consideration for women who experience irregular cycles an important blood test to have would be to confirm there is no early aging or diminished ovarian reserve. This can be detected by having a cycle day 3 FSH and estrogen level done

Wednesday September 14, 2011 7:48 Fertility Solutions

7:49

Fertility Solutions:

Thank you to all who joined our chat.

Wednesday September 14, 2011 7:49 Fertility Solutions

7:50

[Comment From anon anon : ]

if multiple follicles are released, will this influence the progesterone level?

Wednesday September 14, 2011 7:50 anon

7:50

Fertility Solutions:

We will take a couple of more questions before we sign off

Wednesday September 14, 2011 7:50 Fertility Solutions

7:51

Fertility Solutions:

Multiple follicles can increase the progesterone level in the luteal phase. This is one of the reasons that use of clomid is helpful for those patients who have a progesterone deficiency

Wednesday September 14, 2011 7:51 Fertility Solutions

7:51

[Comment From Caryn Caryn : ]

Would a consideration ever be made to use intra uterine insemination w/out first seeing if the tubes were blocked?

Wednesday September 14, 2011 7:51 Caryn

7:54

Fertility Solutions:

The test to check the tubes is usually one of the first steps to diagnose what the cause of a fertility problem may be. If someone does not ovulate and there is nothing in the history that would indicate a tubal problem then ovulation induction can be used without testing the tubes at least a few times.

Inseminations would be done without a tube test only for those patients who cannot have intercourse or do not have a heterosexual partner and are using donor sperm

Wednesday September 14, 2011 7:54 Fertility Solutions

7:56

Fertility Solutions:

Thank to everyone for participating and asking questions.

Wednesday September 14, 2011 7:56 Fertility Solutions

7:56

Fertility Solutions:

Join again in two weeks for a discussion regarding male infertility

Wednesday September 14, 2011 7:56 Fertility Solutions

7:56

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