Female infertility, ovulatory disorders

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“The ovarian cycle is an extremely complex phenomenon, which depends on the integration of the effects of many and different hormones. Therefore, it is not surprising that a widespread cause of female infertility is there failure to ovulate or anovulation, in most cases due to hormonal deficiencies ”explains Professor Carlo Flamigni, gynecologist and member of the National Bioethics Committee.

A clear sign that there is something wrong with ovulation is the absence of menstruation (amenorrhea) or by the presence of irregular cycles, which may be less frequent than normal (oligomenorrea), but also more frequent. "In the phases preceding premature and early menopause, the frequency of menstrual cycles can increase as a consequence of the increase in the FSH hormone, followed by a decrease in the days necessary for the follicle to mature" explains gynecologist Carlo Flamigni. According to the World Health Organization, the causes ofovulatory failure - which are very complex - can be divided into three groups. We see:

name="group-1-hypothalamic-pituitary-insufficiency">Group 1: Hypothalamic-pituitary insufficiency

Women with this condition have no menstrual flow (amenorrhea) and have low levels of gonadotropins (hormones such as FHS or LH, produced by the pituitary) and di estrogen. The levels of prolactin are instead normal.

Anovulation, in Group 1, can be determined by:

  • pituitary insufficiency, for example genetic inability to produce LH or FSH;
  • hypothalamic insufficiency, due to severe weight loss, as can occur in cases of anorexia, anxiety, excessive exercise or genetic inability to produce gonadotropin-releasing hormone (GnRH).

Often, however, the causes of hypothalamic-pituitary insufficiency remain unknown.

Treatment may include gonadotropin administration, pulsatile GnRH infusion and lifestyle interventions, for example to normalize weight by adjusting diet and exercise levels.

name="group-2-hypothalamic-pituitary-dysfunction">Group 2: Hypothalamic-pituitary dysfunction

Women in this group may have various changes in their menstrual cycle, including amenorrhea, oligomenorrhea (rare and scanty menstruation) and insufficiency of the luteal phase. 85% of women with an ovulation disorder fall into this group, which includes polycystic ovary syndrome (a set of disorders that affects 5-10% of women of childbearing age) and hyperprolactinaemic amenorrhea.

Lhyperprolactinemia It is a condition characterized by the secretion of high quantities of prolactin, a hormone normally produced after childbirth and which stimulates the breasts to produce milk. Prolactin inhibits the intermittent release of GnRH, thus preventing gonadotropin secretion, follicular development and ovulation, leading to amenorrhea. Precisely for this reason, breastfeeding is associated with a strong reduction - but be careful: not the total absence - of fertility.

Read also: Contraception during breastfeeding: pros and cons of various methods

The causes of hyperprolactinemia can be both functional, due for example to very high stress, and connected with the presence of small tumors in the pituitary gland (pituitary adenomas) which lead to the secretion of prolactin. Generally, we intervene with drugs that counteract the production of the hormone.

L'insufficiency or deficit of the luteal phase it is due to a lack of progesterone, which leads to a shortening of the duration of the luteal phase of the cycle, the one that goes from ovulation to the next menstruation, or to an inadequate transformation of the endometrium. It intervenes with drugs that restore a valid ovulation and with progesterone for the post-ovulatory phase.

name="group-3-ovarian-failure">Group 3: Ovarian failure

It represents the rarest class of ovulatory disorders. In this group, the hypothalamus and pituitary gland normally secrete their hormones, but the ovary is unable to respond to their action and, therefore, does not secrete estrogen and does not produce mature follicles.

Is that what happens in early ovarian failure, or early menopause a situation that occurs when a woman's menstrual flows end before the age of 40, often without an apparent cause. The ovaries no longer respond to FSH and LH stimuli and, as in physiological menopause, the blood concentrations of these two hormones are very high.

Women with ovarian failure can only have a child through egg donation.

name="infertility-or-sterility">Infertility or sterility

Today we hear about infertility much more frequently than infertility, and the two terms are generally used interchangeably. To be precise, however, they indicate slightly different conditions.

Technically, for sterility means theinability to conceive, while for infertility means theinability to carry a pregnancy to term: in this case there may also be conception but, for example, there is no engraftment of the embryo or repeated abortions occur.

Consultation by Prof Carlo Flamigni, surgeon, freelance professor in the obstetrics and gynecology clinic, member of the National Bioethics Committee

(Revised by Valentina Murelli)

For a complete guide to fertility and conception go to the series of articles on Fertility and conception, from natural fertilization to assisted reproduction

Updated on 14.05.2022

  • fertility
  • ovulation
  • infertility
  • sterility
  • Infertility causes female
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