~PUNCH Nigeria. WEDNESDAY, NOVEMBER 21, 2018.
|Dr Oladapo Ashiru|
Fortunately, approximately 70 per cent of these cases can be successfully treated by using drugs that support ovulation. Many pharmaceutical industries continue to produce or import many of such drugs regularly. The drugs include clomid, gonadotropins, such as menogon, follitrope, folligraft and gonal F, as well as several other FSH (follicle stimulating hormone) containing hormone injections. Anovulation (inability to ovulate) can be due to four major factors categorised as follows:
These are the most common causes of anovulation. As explained in my doctoral dissertation, the ovulatory mechanism is controlled by a complex balance of hormones and like an orchestra in a symphony, any disruption in this process can hinder ovulation. The hormones are released by the endocrine glands in the body, starting from the brain, hypothalamus, pituitary, thyroid, pancreatic islets cells, adrenal glands and the gonads. There are three main sources causing this problem:
a) Failure to produce mature eggs
In approximately 50 per cent of the cases of anovulation, the ovaries do not produce normal follicles in which the eggs can mature. Ovulation is rare if the eggs are immature and the chance of fertilisation becomes almost non-existent. Even when we give a substantial amount of ovulatory support to hormones like FSH, we may obtain as many as 12 eggs, for instance, and only seven will be fully mature, while five of them will be immature eggs that cannot be fertilised by using "brute force" with Intra cytoplasmic sperm injection.
Polycystic ovary syndrome is the most common disorder responsible for this problem. It includes symptoms, such as amenorrhoea, hirsutism, anovulation and infertility.
This syndrome is characterised by a reduced production of FSH and normal or increased levels of LH, estrogen and testosterone. The current hypothesis is that the suppression of FSH associated with this condition causes only partial development of the ovarian follicles and follicular cysts, which can be detected in an ultrasound scan.
The affected ovary often becomes surrounded with a smooth white capsule and it is double its normal size. The increased level of oestrogen raises the risk of breast cancer. This condition has also been linked with inadequate carbohydrate metabolism, especially with resistance to Insulin. Insulin is the hormone produced in the body to help us to manage our sugar intake. This has been successfully managed by the dietary regulation, detoxification and the use of anti-diabetic drugs like metformin. The thyroid gland and the adrenal gland also play a significant role in the manifestations of some of the infertility problems at the level.
b) Malfunction of the hypothalamus
The hypothalamus is the portion of the brain responsible for sending signals to the pituitary gland, which, in turn, sends hormonal stimuli to the ovaries in the form of FSH and LH to initiate egg maturation. It can be regarded as the director of music for the symphony orchestra for ovulation. If the hypothalamus fails to trigger and control this process, immature eggs will result. This is the cause of ovarian failure in 20 per cent of cases. We now know that some of the malfunctions of the hypothalamus can be due to poor diet as in malnutrition, bad eating habits, stress and some environmental and occupational toxins.
c) Malfunction of the pituitary gland
The pituitary gland's responsibility lies in producing and secreting FSH and LH. It is easily termed the musical conductor. The ovaries will be unable to ovulate properly if either too much or too little of these substances is produced. This can occur due to physical injury, a tumuor or if there is a chemical imbalance in the pituitary gland. One classical hormone produced in an abnormal form is the Prolactin hormone. Excess production of this hormone is a major cause of infertility. In good hands, it can be easily corrected with medications.
Physical damage to the ovaries may result in failed ovulation. For example, extensive, invasive, or multiple surgeries, for repeated ovarian cysts may cause the capsule of the ovary to become damaged or scarred, such that follicles cannot mature properly and ovulation does not occur. Infection may also have this impact.
This is a rare and unexplainable cause of anovulation. Some women cease menstruation and begin menopause before the normal age. It is hypothesised that their natural supply of eggs has been depleted or that the majority of cases occur in extremely athletic women with a long history of low body weight and extensive exercise.
In Nigeria, many women have suffered premature ovarian failure because they attempted to terminate a pregnancy. A termination of pregnancy through D&C (dilatation and curettage) by unskilled hand with excess bleeding may lead to ovarian shut-down and scarring. There is also a genetic possibility for this condition.
Although currently unexplained, the "unruptured follicle syndrome" occurs in women who produce a normal follicle, with an egg inside of it, every month yet the follicle fails to rupture. The egg, therefore, remains inside the ovary and proper ovulation does not occur.
The management of Anovulation can be very easy and successful in the hand of competent reproductive endocrinologist just as it can be elusive in the hand of non-expert.
In general, the management of infertility requires a complete evaluation of the various hormonal panel in the body. Once it is corrected, it can enhance the fertility of the individual substantially.