Ovulation Disorders

Testing for Ovulation Disorders

 

WHAT CONTROLS OVULATION?

In the female reproductive system there are specific mechanisms that are responsible for the changes that occur during the menstrual cycle. The hormone interaction is coordinated between the pituitary gland and ovaries, which allows for proper functioning of the ovarian and uterine cycles. The pituitary is responsible for luteinizing hormone (LH) and follicle-stimulating hormone (FSH) production. When the FSH is secreted, the ovaries are stimulated to develop new ‘primordial’ follicles each month. Each month numerous primordial follicles go through a process of recruitment, selection and dominance. Recruitment is when a large group of follicles begin to grow and estrogen begins to increase. Some of these follicles grow and are selected whereas others become atretic (degenerative). In nature, a single "dominant" follicle produces more estrogen than other follicles, thus stimulating the preovulatory surge of LH. These high levels of LH (surge) then cause the dominant follicle to burst and release the mature and fertilizable egg (ovulation).

The trigger of LH release and the resulting ovulation of the egg marks the beginning of the luteal phase. The levels of progesterone increase at this time due to the rupturing of the follicle and formation of a corpus luteum. The sustained release of progesterone during the luteal phase is preparing the uterine lining for pregnancy. The highest blood levels of progesterone occur 6-7 days after ovulation, which corresponds to the time a potential fertilized egg (embryo) will be reaching the uterus and trying to implant after traveling through the Fallopian tube.

CONFIRMATION OF NORMAL OVULATION

Normal ovulation occurs when 1) an egg is released, but then 2) a proper amount of progesterone is also produced by the resulting corpus luteum cyst, generally a serum level over 15. This progesterone level will usually properly prepare the uterine lining to be receptive to implantation of an embryo.

A careful medical history by the clinical staff regarding weight changes / exercise / stress issues can often uncover ovulation problems.

Most often the doctor can tell whether there is likely to be an ovulation disorder just from discussing the details regarding the patient’s menstrual cycles:

  • Regular cycles (26 - 32 days) - Generally ovulating; progesterone often adequate
  • Irregular cycles (2-6 months) - Rarely ovulating

OVULATION PREDICTOR KIT (OPK)

Use of a simple or digital Ovulation Predictor Kit (OPK) at home to test the urine for the ‘LH surge’ is relatively inexpensive and easy to do. This helps to identify the best timing for ovulation & intercourse and also allows for measurement of the serum progesterone level approximately 7days later when the hormone should be at its highest level.

Serum progesterone 7 days post ovulation:

  • If less than 3 - No ovulation.
  • If 3-10 - Ovulation, but poor prognosis; increased miscarriage risk.
  • If greater than 15 - Ovulation; good prognosis.
 

ENDOCRINE (HORMONAL) TESTING

If anovulation (absence of ovulation) or ovulatory dysfunction (low progesterone) is confirmed, a thorough assessment of several hormones should be performed to try to determine the underlying cause.

COMPREHENSIVE ENDOCRINE EVALUATION:

  • Thyroid (T4; TSH)
  • Pituitary (PRL; LH; FSH)
  • Adrenal (Cortisol; 17 OH Progesterone)
  • Androgens (Testosterone; Androsteindione; DHEAS)
  • Insulin and Glucose (Fasting)

The comprehensive endocrine evaluation can help diagnose many pathological conditions that will contribute to ovulation disorders:

  • Hypothalamus (GnRH): Stress, exercise, anorexia, medications.
  • Pituitary (PRL, LH): Adenoma, medications.
  • Thyroid (T4, TSH): Hypothyroid, Hyperthyroid.
  • Adrenal (Cortisol, 17-OHP Testosterone DHEAS): CAH, Cushing's
  • Insulin, Glucose: Insulin resistance, obesity.
  • PCOS: The most common ovulation disorder of pre-menopausal women
 

POLYCYSTIC OVARIAN SYNDROME (PCOS)

PCOS can have many variable and subtle symptoms and there is no single test to definitively diagnose PCOS.

SYMPTOMS MAY INCLUDE:

  • Oligo-amenorrhea (irregular or absent periods)
  • Oligo-anovulation (infrequent or no ovulation)
  • Infertility
  • Hirsutism (excessive hair growth) of face, chest or abdomen
  • Acne
  • Weight gain

DIAGNOSTIC TESTING TO CONFIRM PCOS:

Many experts agree that in order to diagnose PCOS, you must first rule out other endocrine conditions, such as thyroid and adrenal disease and the woman must have two out of three of the following diagnostic criteria (from the Rotterdamn Conference):

  • History of irregular or absent menstrual cycles and/or no ovulation
  • Hirsutism and/or high blood levels of male hormones (Androgens)
  • Ultrasound evidence of ‘polycystic ovaries’

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PCO: 12 or more follicles in periphery.

SCHEDULE A PCOS SCREENING WITH DR. LAURENCE JACOBS

To schedule an appointment for a PCOS Screening, please follow these steps:

  • Obtain a PCOS Screening requisition form from your doctor. You can print the form provided here.
  • If you are a patient of Fertility Centers of Illinois (FCI), you will be given an order form with instructions to call FCI to schedule an appointment.
  • If you are using a physician outside of FCI, your doctor can print a copy of the order form by printing the form on this link or call our office and ask for the Office Manager by calling 847-215-8899.
  • Your doctor does not need to send in the requisition form prior to your arrival. You may bring this form with you to your scheduled appointment. Photo identification is required at the time of specimen drop off.

Dr. Laurence Jacobs is the Director of the Fertility Center of Illinois PCOS "Center of Excellence. In cooperation with Fertility Centers of Illinois, Dr. Jacobs has developed thePCOS Awareness Screening Program.

This inexpensive program consists of an appointment (done on the second, third, or fourth day of your menstrual period), at which time a brief questionnaire, a vaginal ultrasound and comprehensive endocrine blood work will be done. Within approximately one week, we will have the results to share with you, along with Dr. Jacobs' impression and advice. Should any abnormalities be found, we will advise you to schedule an appointment with the physician for consultation, physical exam, and discussion of additional testing.