Abnormal ovulation
Abnormalities of ovulation ( anovulation) may
appear in several ways. Menstrual cycles shorter than 21 days or longer than 35 days are often associated with anovulation. In addition, patients may skip menstrual periods for time intervals of three months or more and this is called oligomenorrhea (infrequent periods) .
If the periods stop entirely, this is called amenorrhea.
Many hormonal systems work together to
produce regular menstrual periods, and the blood levels of the hormones that make up these systems need to be tested in order to
determine the reason for the ovulatory
disorders.
The hormone blood tests, which are usually done on the third day of your cycle, test for the levels of the following key reproductive
hormones :
The FSH level: The FSH level gives a good idea of
the number of eggs remaining in the ovaries. A
high FSH level suggests that the ovary has
either failed or has started to fail. If the FSH
level is very high (in the menopausal range) then
the diagnosis is ovarian failure. If the level is
borderline, then some doctors will do a clomiphene stimulated FSH level, which allows for an earlier
diagnosis of failing ovaries. On the other hand, a
low FSH level suggests hypogonadotropic
hypogonadism. This seemingly verbose term simply means that the ovary in these patients is not working properly because of inadequate
production of FSH by the pituitary gland.
However, in most anovulatory patients, the FSH level will be in the normal range, and this can be reassuring.
The LH level: This is the other gonadotropin
hormone produced by the pituitary; and provides much the same information as the FSH level does.

Another useful test is the LH:FSH ratio which is normally 1:1.
If, however, the LH level is much higher than the FSH level,this suggests a diagnosis of polycystic ovarian disease.
Thyroxine and TSH: These tests for thyroid
function. The thyroxine level is high in patients
with overactive thyroid glands (hyperthyroidism).
In patients with decreased thyroid function
(hypothyroidism), the TSH level is increased.
Prolactin: Prolactin is a hormone produced by
the pituitary gland that induces lactation or milk formation, High prolactin levels
(hyperprolactinemia) can interfere with
ovulation . A milky discharge from the breast
nipple , not related to pregnancy or nursing , is
called galactorrhea, and this is a telltale symptom of high prolactin levels and needs to be investigated.
If the prolactin level is elevated, the doctor will need to recheck it to confirm it is persistently high. There are many reasons for
an elevated prolactin level, including certain drugs as well as stress.
In some women, the reason for a high prolactin level can be a small tumour in
the pituitary gland. This is called a prolactinoma or microadenoma, and the doctor may advise you have an X-ray of the skull ( or even a CT scan or
MRI scan) to rule out this possibility. However,
most infertile women with hyperprolactinemia
can be easily treated.l: The FSH level gives a good idea of
the number of eggs remaining in the ovaries. A
high FSH level suggests that the ovary has
either failed or has started to fail. If the FSH
level is very high (in the menopausal range) then
the diagnosis is ovarian failure. If the level is
borderline, then some doctors will do a clomiphene stimulated FSH level, which allows for an earlier
diagnosis of failing ovaries. On the other hand, a
low FSH level suggests hypogonadotropic
hypogonadism. This seemingly verbose term simply means that the ovary in these patients is not working properly because of inadequate
production of FSH by the pituitary gland.
However, in most anovulatory patients, the FSH level will be in the normal range, and this can be reassuring.
The LH level: This is the other gonadotropin
hormone produced by the pituitary; and provides much the same information as the FSH level does.

Another useful test is the LH:FSH ratio which is normally 1:1.
If, however, the LH level is much higher than the FSH level,this suggests a diagnosis of polycystic ovarian disease.
Thyroxine and TSH: These tests for thyroid
function. The thyroxine level is high in patients
with overactive thyroid glands (hyperthyroidism).
In patients with decreased thyroid function
(hypothyroidism), the TSH level is increased.
Prolactin: Prolactin is a hormone produced by
the pituitary gland that induces lactation or milk formation, High prolactin levels
(hyperprolactinemia) can interfere with
ovulation . A milky discharge from the breast
nipple , not related to pregnancy or nursing , is
called galactorrhea, and this is a telltale symptom of high prolactin levels and needs to be investigated.
If the prolactin level is elevated, the doctor will need to recheck it to confirm it is persistently high. There are many reasons for
an elevated prolactin level, including certain drugs as well as stress.
In some women, the reason for a high prolactin level can be a small tumour in
the pituitary gland. This is called a prolactinoma or microadenoma, and the doctor may advise you have an X-ray of the skull ( or even a CT scan or
MRI scan) to rule out this possibility. However,
most infertile women with hyperprolactinemia
can be easily treated.

Anovulation ( not ovulating) is one of the common reasons of infertility. Normally, one of the ovaries releases a single mature egg every
month, and this is called ovulation.
Egg maturation and ovulation is stimulated by two hormones secreted by the pituitary - follicle stimulating hormone (FSH) and luteinizing hormone (LH) .
These two hormones must be produced in appropriate amounts throughout the monthly cycle for normal ovulation to occur.
Every month, at the start of the menstrual cycle, in response to the FSH produced by the pituitary gland, about 30-40 primordial follicles start to grow. Of these, only one matures to form a large fluid-filled structure, called a Graafian follicle which contains a mature egg, while the others die ( a process called atresia). The mature egg is released from the follicle when the follicle ruptures in response to a surge of LH produced by the pituitary.After ovulation has occured, the follicle from which the egg has been released forms a cystic structure called the corpus luteum. This is responsible for progesterone production in the second half of the cycle.
Most women who have regular periods have
ovulatory cycles. Women who fail to ovulate or
who have abnormal ovulation usually have a
disturbance of their menstrual pattern. This may take the form of complete lack of periods
(amenorrhoea), irregular or delayed periods
(oligomenorrhoea) or occasionally a shortened
cycle due to a defect in the second part (luteal phase) of the cycle.

In Vitro Fertilization:
If 3 cycles of IUI have failed, then In Vitro
Fertilization is the best treatment option for
patients with PCOD. However, many IVF clinics
have little experience in superovulating these
women, and they often mess up their
superovulation. Because these women grow so
many eggs in response to the HMG injections
used for superovulation, and because doctors
are very worried about the risk of ovarian
hyperstimulation, they often end up triggering
egg collection with HCG when the eggs are
immature. They consequently get lots of eggs,
but since most of these are immature,
fertilization rates and pregnancy rates are very poor.
But from extensive experience in dealing with women with PCOD( which is much commoner any ways), one can do  a much better job at getting these women to grow many mature eggs.
Also, if your FS carefully and meticulously flush each and every follicle at the time of egg collection, the risk of PCOD patients developing ovarian hyperstimulation Will reduce,

We have now learned that many patients with
PCOD also have insulin resistance - a condition
similar to that found in diabetics, in that they
have raised levels of insulin in their blood
( hyperinsulinemia) , and their response to insulin is blunted. This is why some patients with PCOD
who do not respond to clomiphene are treated
with antidiabetic drugs, such as metformin.
Studies have shown that these drugs can help
to improve their fertility by reversing their
endocrine abnormality and thus improving their
ovulatory response

Polycystic Ovarian Disease,
We don't really understand what causes PCOD.
However, we do know that the characteristic
polycystic ovary emerges when a state of
anovulation persists for a length of time.
Patients with PCO have persistently elevated
levels of androgens and estrogens, which set up a vicious cycle.
Obesity can aggravate PCOD
because fatty tissues are hormonally active and they produce estrogen which disrupts ovulation.
Overactive adrenal glands can also produce
excess androgens, and these may also
contribute to PCOD.
Treatment of PCOD for the infertile patient will usually focus on inducing ovulation to help them conceive.

Diagnosis ,
PCOD can be easy to diagnose in some patients.
The typical medical history is that of irregular
menstrual cycles, which are unpredictable and
can be very heavy, and the need to take
hormonal tablets (progestins) to induce a period.
Patients suffering from PCOD are often obese
and may have hirsutism, (excessive facial and
body hair) as a result of the high androgen levels.
However, remember the "sin of diagnostic greed " ! Not all patients with PCOD will have all or any of these symptoms. I see many patients who have what I call "occult PCOD". They have regular cycles, but when they are superovulated, they grow lots of eggs, which is typical of patients who have PCOD.
Most gynecologists ( and even infertility specialists !) often overlook this
diagnosis, because they do not think of it.

mogbomoya:

Dear Dr. Haastrup,

From my user name, am sure you know who I am.  

Been TTC for 11 months, my BMI is 29. I know am overweight, but there are far more obese people who take in easily.

Would my being overweight affect my chances of conception?  

Numerous studies have demonstrated that women who are obese (body mass index
over 30) are more likely to have ovulation problems that result in irregular or
infrequent menstrual cycles and infertility.
Women who are obese are also at increased riskfor miscarriage though the reasons for this are as yet unclear. I
n the treatment of infertility, they are less successful. For example, in vitro fertilization (IVF) pregnancy rates are lower in
obese women compared to those of normal
weight. This may be due in part to the fact
that obese women do not respond to fertility
medications as well and have a higher percentage of immature eggs.
Fertility surgery is also riskier in obese women compared to normal weight women.
And I note that just as our genetic composition are different so also will our body's response or otherwise to what's 'normal',
And the above inferences are made barring that the women presents with any other issue.e of immature eggs.
Fertility surgery is also riskier in obese women compared to normal weight women.
And I note that just as our genetic composition are different so also will our body's response or otherwise to what's 'normal',
And the above inferences are made barring that the women presents with any other issue.

ITSURS:

Thank you DR for your assistance, lecture and analysis. I'll keep u posted as soon as i get HORMONAL test result. Just a question for you; what is the success rate of IUI in Nigeria

Basically the chances of IUI is 50% anywhere but these criteria depends on a lot of factors eg like what the patient is presenting with and the method used. But anywhere its not less than 50%.

Did you guys hear that there's a new Law in Lagos that any guy who impregnates a woman and refuse to take responsibility risk been jailed?
God help us, why would anyone want to start what he can't finish.
If we dey cry we dey see road now.

Obesity and Fertility,

Obesity results in an increased production of
estrogen; this hormonal imbalance in turn
interferes with ovulation, which of course, is
the basis of successful conception.
Ovulatory disorders are the leading cause of
female infertility, resulting in the disruption of
hormones, menstrual cycles, and conception.
Approximately 15% of such disorders are linked
to weight disorders, mainly being overweight and obese.
High estrogen levels associated with obesity can also result in pre-cancerous transformations (usually reversible) in the uterus.
According to several studies, women whose
obesity could be traced back to their childhood
(childhood obesity) had a greater risk of
amenorrhea, a condition in which menstrual
cycles are absent.
Women who are overweight or obese are less
likely to respond to fertility drugs, because
excess weight interferes with the proper
absorption of a variety of drugs used in
infertility treatment.
So ladies please watch it.
infertility treatment.
So ladies please watch it.

What's these spam bot wahala that makes it difficult for me to post and answer people question and enlighten them.
Dominique please do something please, www.nairaland.com/nigeria/topic-731911.0.html,

IUI
Sometimes nature needs help to start a
pregnancy - and the doctor can do this by giving the sperm a piggy back ride through a fine tube into the body. This procedure is called
intrauterine insemination ( IUI) or artificial
insemination with husband’s sperm (AIH) - and
effectively, the doctor is giving nature a helping hand by increasing the chances of the egg and sperm meeting.
IUI is useful when:
The woman has a cervical mucus problem - for
example, it maybe scanty or maybe hostile to the sperm. With an intrauterine insemination (IUI) the sperm bypass her cervix and enter the uterine cavity directly.
The man has antibodies to his own sperm. The "
good" sperm which have not been affected by
the antibodies are separated in the laboratory
and used for IUI.
If the man cannot ejaculate into his partner's
vagina. This is usually because of psychologic
problems such as impotence (inability to get and
maintain an erection) and vaginismus ( an
involuntary spasm of the vaginal muscles so that vaginal penetration is not possible); or anatomic problems of the penis, such as uncorrected hypospadias; or if he is paraplegic.
The man suffers from retrograde ejaculation in
which the semen goes backward into the
bladder instead of coming out of the penis.
For unexplained infertility, since the technique of IUI increases the chances of the eggs and sperm meeting.
If the husband is away from the wife for long
stretches of time (for example, husbands who
work on ships or work abroad), his sperm can befrozen and stored in a sperm bank and used to inseminate his wife even in his absence.

Stress, Sex and Infertility
We are now seeing many couples who are
having difficulty conceiving because they are
too stressed or too busy to have sex ! This is
the price couples often pay for living in a huge
metropolis !
Having a sexual problem is bad enough - and the
added stress of the involunatary " infertility "
makes it even worse. This often becomes a
negative vicious cycle, which is hard to break.
The demand to have intercourse at the proper
times can provoke frustration when one
partner has a business trip, is working late, or
just cannot get in the mood for sex. Couples
who go through cycles of sex on demand often find that lovemaking loses its spontaneity and playfulness.
Sex becomes a chore to be performed at mid-cycle only. Sometimes the pressure to perform at mid-cycle is so great that a man has trouble with erection or is unable to ejaculate.
Both men and women with fertility problems
also suffer from anxiety and stress over their
sex life, and this often become a chicken-and-
egg problem. In a study of men and women
about to undergo infertility treatment,
researchers found that both anxiety and
stress over sex were fairly common problems.
This means that these men sometimes have
problems producing a semen sample on demand
( either when timing baby making sex at home
or when producing a sample in the clinic) .

Irregular periods are common in infertile women.
However, many women are very confused about the relation between irregular periods and their infertility. They naively assume that once their periods become regular, they will conceive.
While it's easy to make the periods regular by
putting a woman on birth control pills, this will
obviously not help her to get pregnant.
You need to remember that just like infertility is only a symptom, and not a diagnosis, irregular
periods are also just a symptom of an underlying problem called anovulation, or not ovulating. It is the underlying anovulation which causes both the irregular periods and the infertility, and this is what needs to be treated.
Infertile women with irregular periods need the
following medical tests: blood test for measuring the level of the reproductive hormones, FSH,LH,PRL and TSH on Day 3 of their cycle, so we can find out what the reason for the anovulation is.
Once we know what the problem is, then we
can treat it by inducing ovulation !need the
following medical tests: blood test for measuring the level of the reproductive hormones, FSH,LH,PRL and TSH on Day 3 of their cycle, so we can find out what the reason for the anovulation is.
Once we know what the problem is, then we
can treat it by inducing ovulation !

Tacoma:

Thank you very much for your quick response. I did the 2 IVF cycles in the US. When my RE told me I had a high FSH (which funny enough was normal before I started the 2 IVF cycles) added with the poor quality of eggs retrieved during the 2 failed cycles, I know not to do further tests because honestly I am tired. So, DH and I discussed with my RE that we would like to move up to DE IVF.

We have decided to do the procedure in Nigeria because there are more "black donors' like me in Nigeria and also it is way cheaper . I would like a reputable clinic that screens the egg donors VERY well!.

Thank you very much for your time

Nordica Fertility centre has a dry good egg donor centre.
Let me know when you are ready and I will call Dr Ajayi to review you and book you for donor egg IVF and screening.

Prolactin is a hormone that is secreted by your
pituitary gland, a pea-sized gland found below
the brain. Prolactin is found in both men and
women and is released at various times
throughout the day and night. As the name
suggests, the role of prolactin is to stimulate
milk production in pregnant women. It also
enlarges a woman's mammary glands in order to
allow her to prepare for breastfeeding .
Prolactin and Infertility
Prolactin doesn't just cause your body to
increase milk production - it also affects your
ovulation and menstrual cycles. ( This is why
women who are breastfeeding rarely get
pregnant). Prolactin inhibit two hormones
necessary for ovulation: follicle stimulating
hormone (FSH) and gonadotropin releasing
hormone (GnRH). When you have high levels of
prolactin in your blood ( a condition called
hyperprolactinemia) , you will not ovulate and this will result in infertility. This anovulation can also cause you to have irregular cycles.

In the past, infertility was blamed wholly and
solely on the woman. This may have been to
protect the fragile male ego, was because the
male psyche equates fertility with virility, and
views failure to father a child with shame.
Studies today however show that 40% of
infertility is because of a medical problem with
the man.
The vast majority of men have simply no way of
judging their fertility before getting married
(unless, of course, they have had a premarital
affair and fathered a pregnancy - the ultimate
proof of male fertility ! Rarely, however, some
men may know they have a fertility problem -
for example, a sexual problem of impotence,
which prevents consummation of the marriage;
or one of hypospadias (in which the urethra is
located at the base of the penis and the semen cannot be put in the vagina); or undescended testes (in which both the testes are not in the scrotum).
When testing a couple for infertility, the man
must always be tested first. Tests for the
woman are far more complicated, invasive and
expensive - it is much simpler to find out if the
man has a problem.

Tacoma:

HI Dr.

Please can you recommend a good donor egg IVF program in Lagos?

STATS

Me - 29 yrs never being pregnant.
DH - 32yrs
TTC - 3 years
Diagnosis - Endo (caused permanent scarring to tubes) and high FSH (possibly ovarian failure)
2 failed fresh IVFs 6 eggs retrieved both cycles with only two fertilized.
DH Fluid count/morphology optimal.

P.S. I have also done a lap to take out the endo and some fibroids in 2007 (I think the endo is back cos I am cramping again)

I would be grateful for any suggestions thanks.

Yea there very good Donor egg IVF centre in Lagos.
You dint mention the ones you've been to so we can eliminate them but I have a very particular one in mind. I've worked with them for a couple of years and still do. So talk to me online.
Endometriosis ( "endo" is a common disorder that affects women of reproductive age. It occurs when normal endometrial tissue (the lining of the uterus) grows outside the uterus. This misplaced tissue may implant itself and grow anywhere within the abdominal cavity.
Many specialists feel that severe endometriosis
is more likely to be found in infertile women who have delayed pregnancy and for this reason, the condition is sometimes labeled a "career woman's disease".
The symptoms are usually progressively severe menstrual cramp, pain during intercourse. While some people does not have any of the above symptoms.
Treatment can be surgical or medical.
Though very expensive but easy to manage.
There's a new medical treatment of Endo.
You did not tell me if your Doctor checked your AMH ( a measure of your ovarian reserve) and FSH level.
Talk to me online kenny_haastrup@yahoo.com