Anovulation - a disorder in which a woman does not ovulate, then there is a way egg from the ovary. Approximately 30% of cases the cause of infertility is becoming anovulation. It is often accompanied by irregular menstruation (oligomenorrhea) or complete absence of menstruation for a predetermined time (amenorrhea). In many cases, anovulation can be cured by simple and effective way - using drugs that stimulate ovulation Ovulation - How to determine as accurately as possible? .

Specialists who treat infertility Infertility Treatment - What principles are priority They note that couples trying to have children, it is easier to maintain a warm, smooth relations when contacts with doctors limited than in cases when it is necessary to opt for in vitro fertilization, and patients and their partners have to spend a lot of time at the clinic. However, to use ovulation induction is not always possible. The choice of treatment depends on the cause of anovulation.

Causes of anovulation, where permissible ovulation induction

• Hypogonadotropic hypogonadism - a disorder in which the pituitary gland decreases production of luteinizing hormone and follicle-stimulating hormone. The most common causes of hypogonadotropic hypogonadism are excessive exercise, too little weight, or a combination of both.

Women with low body mass index (less than 18 units), as well as those who are regularly exposed to heavy wear - for example, gymnasts, runners on the marathon and dancers - anovulation may also develop as a result of the fact that the hypothalamus begins to produce less gonadotropin releasing hormone. If a woman with a small weight pregnancy occurs, there is a greater likelihood of giving birth, the weight of which will also be below normal. If low weight women associated with eating disorders, her newborn baby can be too slow to gain weight - sometimes in such cases require hospitalization.

Sheehan's syndrome, or postnatal myocardial pituitary (usually it is the result of severe postpartum hemorrhage or trauma), and Kallmann syndrome - amenorrhea combined with anosmia (loss of smell) due to congenital disorders produce gonadotropin-releasing hormone by the hypothalamus - a rare disorder, is also associated with anovulation.

Children who received treatment kraniofaringomy and some forms of leukemia, as hypogonadism can develop, due to which girls may subsequently suffer from anovulation.

• Hyperprolactinemia usually becomes the result of pituitary macroadenomas. This disorder leads to the fact that the pituitary gland starts to produce less luteinizing hormone and follicle-stimulating hormone. The most common consequences of this are anovulation and amenorrhea The absence of menstruation (amenorrhea) - ambiguous symptom But some patients also develop galactorrhea - the milk from the breast is the lactation period. Significantly less in patients with hyperprolactinemia are such symptoms as headaches and impaired vision - they can point to macroadenomas and need urgent treatment. In most cases, pituitary adenoma easily medication, and the result of therapy in women rather quickly recovers ovulation and fertility.
• Polycystic ovarian syndrome - one of the most common causes of anovulation and subfertility caused it - a condition in which fertility is significantly reduced .  In this disorder in the ovaries to produce excessive amounts of androgens, whereby ovarian follicles can not properly respond to the normal concentration of FSH .  Consequence is that ovulation occurs less frequently .  Women with polycystic ovary syndrome at the age of 30 years, there are such problems as hirsutism (excessive hair growth on the body), acne and irregular menstruation (cycle time is, on average, more than 35 days) .  Even when ovulation occurs, the probability of pregnancy is still below normal .  About a third of women diagnosed with polycystic ovary syndrome also suffer from obesity, and obesity significantly increases the probability of anovulation .

Causes of anovulation in which you can not use ovulation induction

• Premature ovarian failure (premature menopause). Unfortunately, this violation is irreversible. The only treatment that may result in pregnancy - is the use of donor eggs and conception in vitro. Patients need hormone replacement therapy to relieve symptoms of menopause, as well as to the fact that slow the process of reduction of bone density, resulting from changes in the balance of hormones.
• Genetic disorders. The most common genetic disorder that can lead to anovulation is Turner syndrome, in which due to undeveloped ovaries can develop premature ovarian failure. Certain disorders associated with the X chromosome, which are characteristic of Turner's syndrome, can also cause anovulation. With adequate use of replacement estrogen therapy uterus of a woman with Turner syndrome can grow large enough that she could carry out the procedure of artificial conception using donor eggs.
• Androgen insensitivity syndrome, testicular feminization syndrome, or - another genetic disorder that can cause anovulation. Due to the characteristics of patients with this syndrome have pregnancy impossible. Typically, such patients for a long time is required psychological support - it is essential that they understand the characteristics of your body, how they differ from the norm, and to adapt to them.

Diagnostics

To select the appropriate method of treatment of anovulation is very important, above all, correctly identify the cause.

• Hypogonadotropic hypogonadism

No matter what is the cause of hypogonadotropic hypogonadism, thus violating the concentration of luteinizing hormone, follicle-stimulating hormone and estradiol levels will be reduced. Besides the analysis on hormones, the important role played in the process of diagnosing learning history (of particular importance is whether the patient underwent surgery or radiotherapy, severe bleeding, whether it has eating disorders, loss of smell), and body mass index.

• Hyperprolactinemia

In patients with hyperprolactinemia prolactin level in the blood is greater than 1000 IU / L (international units per liter) - usually it indicates a pituitary adenoma. Also noted a reduced level of luteinizing hormone, follicle-stimulating hormone and estradiol. To confirm the diagnosis is necessary to conduct computerized tomography or magnetic resonance imaging. Patients with pituitary macroadenomas Pituitary macroadenomas - treatment options   It is also advised to check peripheral vision.

• Polycystic Ovary Syndrome

For the diagnosis of polycystic ovary syndrome is usually used transvaginal ultrasound. About 80% of women with this syndrome are higher than normal levels of testosterone (2.4 nmol / l), so the analysis of testosterone can also be used in diagnosis. The level of luteinizing hormone in the blood is elevated in 45-70% of women with polycystic ovary syndrome.

Infertility treatment is a complex task, which requires couples to gain strength and patience. The positive effect of the onset of the long-awaited pregnancy may not be short-term, and sometimes it takes a few years. When choosing a treatment strategy is necessary to adhere to the principle of sequential treatment measures. The success of treatment depends directly on the early establishment of the causes of infertility, so it is important to promptly contact the couple to the profile expert.

The choice of tactics of therapy

Following a comprehensive survey of submitting couples and establishing the causes that led to sterility, the physician must determine the necessary treatment tactics. On her choice affects the following important points:

• the fundamental point is the shape and duration of infertility
• Age
• which were taken before treatment, what was their efficiency, and what period of time has passed after the completion of remedial measures

The time factor is important for achieving positive results in the treatment of infertility. If since the traditional conservative treatment has been more than two years, with no results from such treatment, and for patients aged 35 years and over this period is reduced to one year, it is necessary to radically change the chosen tactics. The effectiveness of therapy affects the presence of concomitant extragenital and gynecological pathology, both partners age, duration of disease, so it is very difficult to make any predictions about a possible pregnancy after completing the course of treatment.

According to statistics, more than half of women who were treated in connection with infertility are tubal and peritoneal factors. If the patient's doctor implies adhesions, then evaluate its presence and extent of possible during diagnostic endoscopic surgery (diagnostic laparoscopy). According to most experts to carry out a long conservative treatment tuboperitoneal infertility using anti-inflammatory therapy, drug protivospaechnogo treatment, physiotherapy and spa treatment is a futile exercise. The only method that allows you to restore patency of tubes, ie reproduction, is surgery. The method of choice is laparoscopic microsurgery. Depending on the severity of adhesive disease Adhesive disease: almost inevitable after surgery   surgical treatment efficiency is from 10% to 45%.

For all women with infertility is a mandatory assessment of the state of the uterus, the endometrium. This is due to the presence of high frequency pathology within the cavity of the uterus, which leads to infertility. For this purpose, appointed a diagnostic procedure - hysteroscopy with diagnostic curettage. In identifying the pathology of histological findings that specifically establishes the form of hyperplasia Hyperplasia - do not be afraid   or endometrial polyps, a woman held a course of hormone therapy. This course should be appointed for a period of at least four months, depending on the specific clinical situation. The criteria for cure is the lack of pathological changes in the control biopsy of the uterine cavity. In the future such patients is carried out successively several courses of ovulation induction Ovulation - How to determine as accurately as possible?   to achieve the hormonal regulation of relationships and pregnancy.

When reasonably apply hormonal preparations

Primarily therapy hormonal drug prescribed to patients with endocrine problems of nature that led to infertility .  Success is possible to apply a specific type of hormone therapy in order to restore the disturbed balance hormones .  For this purpose, use birth control pills (or COCs), progestin, drugs bromocriptine, cabergoline, glucocorticoids .  As an additional method of treatment can be made persistent infertility stimulation of ovulation .  If a patient in the background adequately selected hormone therapy remains infertile for one year, it is recommended to exclude the presence of her tubal factor .  In this situation, the absence of pregnancy is the result of a combination of hormonal disorders and tubal infertility .  Schemes of ovulation induction or stimulation can be used as an independent type of therapy in the event that a woman with infertility there is only a violation of ovulation, but the cause of their occurrence can not be determined .

Hormone therapy as a conservative treatment is also used for the treatment of male infertility. Androgenic drugs used (as monotherapy), antiestrogens, preparations of human chorionic gonadotropin (or hCG), prolactin secretion inhibitors, anti-oxidants Antioxidants: the truth about the notorious benefits , Angioprotectors and enzyme preparations (Wobenzym). In the appointment of androgens should be aware of the risk of side effects, so be sure to follow the general condition of the patient and control it. Absolute contraindication for administration to a patient of testosterone and its preparations is a tumor of the prostate, testis or breast cancer, which is hormonally active. Before the start of the course of treatment is necessary to eliminate the above-mentioned diseases. The criterion of effectiveness of the treatment is considered to be the normalization of indicators, which are measured at spermogramme (restoring fertility of sperm), as well as pregnancy. A common scheme is conservative treatment of male infertility, within three months. At the present stage, many experts dispute the appropriateness of its use.