Pregnancy And Functioning Ovaries
Women need functioning ovaries, fallopian tubes, and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility. Some of these conditions are listed below and can be evaluated using several different tests.
Meaning of ovulation
Regular predictable periods that occur every 24 to 32 days likely reflect ovulation. Ovulation can be predicted by using an ovulation predictor kit and can be confirmed by a blood test to see the woman’s progesterone level. A woman’s menstrual cycle is, on average, 28 days long.
Day one is defined as the first day of ‘full flow.’ A woman with irregular periods is likely not ovulating. This may be due to several conditions, warranting an evaluation by a doctor. Potential causes of anovulation include the following:
Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is a hormone imbalance problem that can interfere with normal ovulation. PCOS is the most common cause of female infertility.
Functional hypothalamic amenorrhea
Functional hypothalamic amenorrhea (FHA) relates to excessive physical or emotional stress that results in amenorrhea (absent periods).
Diminished ovarian reserve (DOR)
This occurs when the ability of the ovary to produce eggs is reduced because of congenital, medical, surgical, or unexplained causes. Ovarian reserves naturally decline with age.
Premature ovarian insufficiency (POI)
POI occurs when a woman’s ovaries fail before she is 40 years of age. It is similar to premature (early) menopause.
Menopause
Menopause is an age-appropriate decline in ovarian function that usually occurs around age 50. It is often associated with hot flashes and irregular periods.
Ovarian function
Several tests exist to evaluate a woman’s ovarian function.
No single test is a perfect predictor of fertility.
The most commonly used markers of ovarian function include follicle-stimulating hormone (FSH) value on day three to five of the menstrual cycle, anti-mullerian hormone value (AMH), and antral follicle count (AFC) using a transvaginal ultrasound.
Tubal patency
Tubal Patency determines whether the fallopian tubes are open, blocked, or swollen.
Risk factors for blocked fallopian tubes (tubal occlusion) can include a history of pelvic infection, history of ruptured appendicitis, history of gonorrhea or chlamydia, known endometriosis, or a history of abdominal surgery.
Tubal evaluation may be performed using an X-ray, which is called a hysterosalpingogram (HSG), or by chromopertubation (CP) in the operating room at the time of laparoscopy, a surgical procedure in which a small incision is made and a viewing tube called a laparoscope is inserted.
Uterine contour, physical characteristics of the uterus
Depending on a woman’s symptoms, the uterus may be evaluated by transvaginal ultrasound to look for fibroids or other anatomic abnormalities. If suspicion exists that the fibroids may be entering the endometrial cavity, a sonohystogram (SHG) or hysteroscopy (HSC) may be performed to further evaluate the uterine environment.
Surrogacy
Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man’s sperm and her egg. The child will be genetically related to the surrogate and the male partner.
Gestational Carrier
Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who should not become pregnant because of a serious health problem. In this case, a woman uses her egg. It is fertilised by her partner’s sperm, and the embryo is placed inside the carrier’s uterus.