Medical Contribution By Dr. Eugene Katz
The words “infertility treatment” can conjure up tremendous anxiety in people having trouble getting pregnant. Many people immediately worry that seeing a fertility specialist will equal having to use high-tech assisted reproductive therapies like IVF, and all that means in terms of time, money, and effort.
The reality is that most people who seek fertility treatment don’t have to use IVF to get pregnant. In fact, the most common reason for female infertility — ovulation disorders — is very often resolved with the lowest tech treatments available.
Bumps in the Road
If you think of ovulation as a series of events, instead of as a single occurrence in which an egg is dispersed from the ovary, it becomes clear that there are several points in the cycle where something can go wrong.
Dr. Eugene Katz, at the Shady Grove Fertility Center at GBMC in Baltimore, explains how the common diagnosis we call “ovulation disorders” is really a spectrum of infertility causes.
“There are different reasons that cause ovulatory disorders,” Dr. Katz says, “and also different levels of severity.”
Many compartments in the female body need to be working in sync for healthy ovulation to occur.
At the highest level is the hypothalamus in the brain. It sends a signal to start the ovulation cycle rolling. Disorders of the hypothalamus can result in amenorrhea, complete lack of ovulation and menstrual periods. Very serious levels of psychological stress, such as living in constant danger, can cause hypothalamic dysfunction.
Exercise-induced stress and related amenorrhea can also happen to women who are under-weight. A certain percentage of body fat is necessary to promote proper functioning of the brain and endocrine glands. Women with eating disorders may have their fertility disrupted in this way.
In the same region of the brain, the pituitary gland sometimes produces excess prolactin; when this occurs, the brains stops making substances to command the ovaries to work. A common symptom of prolactin disorders is the production of breast milk in a woman who is not pregnant or nursing.
Jumping to the end of ovulatory disorder spectrum, we find ovarian failure and poor ovarian reserve. These are diagnoses given when a woman isn’t yet menopausal, but the ovaries are no longer producing eggs.
“This is the most difficult group of patients to treat,” Dr. Katz says, “because we can’t go back in time. If the ovaries have failed, that’s it. Before her body gets to that point, however, we can try more aggressive treatments.”
Patients with ovulatory disorders fall into a spectrum that ranges from irregular cycles and occasional ovulation to complete absence of ovulation and menses, including some suffering from Polycystic Ovarian Disease (PCOD) or Syndrome (PCOS).
Women with PCOD have:
- Abnormal menses and
- Excess male hormones
Using the criteria listed above, the diagnosis of PCOD is relatively easy to make with an expert professional eye. Dr. Katz explains, “The severity of presentation is very variable. Some people simply don’t ovulate regularly, but they have no signs of excess male hormone. Other groups will have many visible signs of male hormone excess, like hirsutism, acne, and over-weight issues.”
The Issue of Timing in Treatment
Except for cases of ovarian failure, women with ovulation disorders are easily treatable with a high degree of success.
Typical treatments are medications that will induce ovulation. Conception may result following timed intercourse, so long as no male factor infertility is present in the couple. In fact, any couple pursuing fertility therapy should also be sure that the male partner undergoes a semen analysis before the female begins using fertility medications.
It may be more efficient in some cases to also use intrauterine insemination (IUI). If a patient is older than mid 30’s, or if timing is otherwise an issue (say, for a schoolteacher who wants to schedule her treatment around summer break,) IUI may be recommended.
“Not all patients will require sophisticated fertility therapies,” Dr. Katz ventures. “Age is very important — in fact, once you have this diagnosis of ovulatory disorder, age is key to success, the most important factor. We start seeing a minimal decline in fertility at 30, more significant decline at 35, and a dramatic drop in ability to conceive at 38.”
Unfortunately, fertility specialists often see patients who have already spent a lot of time at a primary care practice in fruitless pursuit of pregnancy.
“Most women taking medication to induce ovulation will succeed within two to four months,” Katz says, “After that point, if pregnancy has not occurred, it’s time to see a specialist and explore other possible causes of infertility.”
Examples of other factors that impact fertility include male factor issues and fallopian tube blockages, both of which can be treated, but that need more than just ovulation medication and IUI.
A fertility specialist should be consulted if a woman has :
- Experienced irregular or absent menstrual periods;
- Already tried fertility medication prescribed by a gynecologist and not been successful with getting pregnant;
- Been unable to conceive after three months and is 37 years or older.
People who are having trouble conceiving need not fear the higher-end assisted reproductive technologies, but many no doubt breathe a sigh of relief upon learning that most patients need only low-tech treatment for a successful pregnancy.