Ovulation refers to the process of releasing 1 egg each month which happens about 2 weeks prior to the start of a period. Many women have irregular or non-existent menstrual cycles where the egg is not regularly released each month. Others may release an egg but do not have the normal hormonal balance to maintain development of an embryo.

Testing: Hormone testing, transvaginal ultrasound

Treatment: Depending on the cause, different medications may be used for ovulation induction

PCOS is a complex hormonal disorder that is the most common cause of irregular menstrual cycles and anovulation. Other associated symptoms include acne, oily skin, excessive hair growth (hirsutism). Obesity and metabolic syndrome are also seen in some women with PCOS. Ovaries of women with PCOS usually have a distinctive appearance on ultrasound.

Testing: Hormone testing, transvaginal ultrasound

Treatment: Diet modification, exercise, and weight loss may eventually restore regular menstrual cycles and ovulation. Occasionally, metformin, a drug that is used to treat diabetes, can also help women with PCOS. The most common medications used to induce ovulation are Clomiphene citrate and Letrozole. Gonadotropins can be another alternative. Laparoscopic ovarian drilling is a surgical option that can be used.

Age is the most common reason for infertility. Women are most fertile in their 20’s and early 30’s. After 35, the rate of infertility rises quickly. By the age of 40, 50% of women are infertile, and by the age of 45, the rate is >95%.

Testing: Ovarian reserve testing (Day 3 FSH & estradiol, AMH, antral follicle count). There is no test for egg quality.

Treatment: Superovulation, IVF, egg donorIVF