From the history that we take during the first patient visit, we will know if a patient's menstrual cycles are regular, approximately every 28 to 30 days, or irregular. If the cycles are irregular, an ovulation dysfunction may exist, meaning the hormones and ovulation are not working properly, or the patient may be anovulatory, which means no ovulation occurs at all. The treatment for this diagnosis is ovulation induction with Clomid or gonadotropins.
As women age, they become less fertile. Eventually, they go through menopause and can no longer conceive. Some women, however, find that they are unable to conceive at a much earlier age – often before the age of 40. Premature ovarian failure or a diminished ovarian reserve can cause infertility.
In premature ovarian failure (early menopause), the ovaries simply stop ovulating because there are no eggs left. In diminished ovarian reserve, the number of eggs left in the ovary is less than expected for her age. For a woman affected by premature ovarian failure to become pregnant, a donor egg with in vitro fertilization will be necessary. With diminished ovarian reserve, aggressive ovulation induction with or without IVF is the treatment.
All women are born with a certain number of eggs. No more eggs are created or made after birth. When a menstrual cycle starts each month, a group of eggs begins to grow. One egg, called the dominant follicle, develops ahead of the rest, which will shut off the other eggs that are growing. This dominant follicle will then ovulate. (http://www.fertilitylifelines.com/aboutyourfertility/femalebiology.jsp) Even though only one egg releases, this process causes many eggs to be used up every month. By the time a woman reaches menopause, around age 52, no more eggs are left. In some women, menopause occurs at a very early age, before the age of 40.
When menopause happens this early, it is termed premature ovarian failure and signifies that this woman’s eggs have been depleted earlier than expected. A milder version of this condition, called diminished ovarian reserve, suggests that a younger woman, say age 35, has fewer eggs left than she should for her age. With diminished ovarian reserve, a patient will ovulate like a 40-year-old and will become pregnant at the same rate as a 40-year-old, not a 35-year-old. Dr. Douglas can administer tests to check for ovarian reserve. The most popular are the day 3 FSH and estrogen. However, we may utilize other tests such as a sonogram for a basal follicle count, or a test called anti-Mullerian hormone, or AMH. With these screening tests, we can determine the status of the woman’s ovarian reserve. This information helps Dr. Douglas know what the chances of success are, and what doses of ovulation induction medication to use.