How Can I Start Ovulating Again

I NTRODUCTION

Some women may have difficulty getting pregnant because their ovaries do not release (ovulate) eggs. Fertility specialists may use medications that piece of work on ovulation to help these women get pregnant. There are two common ways these medicines are used: i) to cause ovulation in a woman who does not ovulate regularly, and 2) to cause multiple eggs to develop and be released at one time.

About 25% of infertile women accept bug with ovulation. These women may ovulate less oftentimes or not at all (anovulation). Ovulation inducation medications can assist a woman to ovulate more regularly, increasing her take chances of getting pregnant. These medicines, sometimes chosen "fertility drugs," may also improve the lining of the womb or uterus (endometrium).

In some situations, these medicines may exist used to crusade multiple eggs to develop at once. This is unremarkably desired when women undergo treatment known equally superovulation with intrauterine insemination (IUI), in vitro fertilization (IVF), donate their eggs, or freeze their eggs (either as eggs or fertilized eggs [embryos]).

This booklet explains the basics of normal ovulation and the diagnosis and treatment of ovulatory bug. The specific uses for several types of ovulation medicines are outlined, forth with the intended results and possible side effects of each drug.

Normal Reproductive Anatomy

The ovaries are two small organs, each about i½ inches long and 3/4 of an inch wide, located in a woman's pelvis (Figure 1). The ovaries are attached to both sides of the uterus (womb), usually below the fallopian tubes. At nativity, a female has about 1-2 million pre-formed eggs in her two ovaries. Unlike men, who brand sperm throughout their life, women are born with all the eggs they will ever accept. Near of the eggs die off naturally (but every bit hair and peel cells die off) with normal aging. By the time a daughter reaches puberty (around age ten-13, on boilerplate), she has almost 400,000 eggs remaining. Every bit a girl begins to have regular menstrual periods, approximately once a month, an egg matures within a follicle (a fluid-filled cyst in the ovary that contains the egg). When hormone levels attain the right level, the egg is released from the follicle (ovulated). The fimbriae (finger-like projections) of the fallopian tubes sweep over the ovary and move the released egg into the tube. If sperm are present, the egg is normally fertilized in the tube. The fertilized egg (at present chosen an embryo) begins to divide and travels through the tube and into the uterus where it implants in the endometrium (uterine lining).

THE MENSTRUAL CYCLE

The menstrual bicycle is divided into three phases: the follicular phase, the ovulatory phase, and the luteal phase (Figure two).

The Follicular Phase

The follicular phase lasts about 10 to 14 days, beginning with the first day of menstruation and lasting until the luteinizing hormone (LH) surge. During the follicular phase, the hypothalamus (an organ located just in a higher place the pituitary gland in the brain) releases gonadotropin-releasing hormone (GnRH). This hormone tells the pituitary gland to release follicle-stimulating hormone (FSH), which travels through the blood to the ovary. Each month, the encephalon causes the release of FSH to stimulate the evolution of a number of follicles in the ovaries, each containing a unmarried egg. Normally, but one will become the dominant follicle with its egg reaching total maturity; the rest of the follicles volition end developing and their eggs will die off (called atresia). The dominant follicle increases in size and releases a hormone called estradiol into the bloodstream. The rising levels of estradiol cause the pituitary to tiresome downward the production of FSH. Estradiol also begins to prepare the uterine lining (endometrium) for the possibility of pregnancy.

The Ovulatory Phase

The ovulatory phase begins with the LH surge and ends with ovulation (release of the egg from the dominant ovarian follicle). Every bit ovulation approaches, estrodiol levels rise and trigger the pituitary gland to release a surge of LH. About 32 to forty hours after the onset of this LH surge, ovulation occurs.

The Luteal Phase

The luteal phase begins later ovulation and generally lasts near 12 to 16 days. After the egg is released, the at present-empty follicle that had contained the ovulated egg becomes known every bit the corpus luteum. The corpus luteum produces a hormone chosen progesterone that helps prepare the uterine lining for implantation of the embryo and pregnancy. Later the egg is released it is picked up past the fallopian tube where fertilization occurs. If the egg is fertilized past a sperm, the embryo is transported within the tube and reaches

Figure two.

Hormonal cycle in women with normal ovulation. The follicular phase is the phase in which the follicle is growing and secreting estrogen. The ovulatory stage is the 48-60 minutes menstruation characterized past the LH surge and the release of the egg (ovulation). The luteal phase is characterized by secretion of big amounts of progesterone and estrogen.

the uterus 4-5 days after ovulation. Once in the uterus, it begins to attach to the endometrium (lining of the uterus), a process that is called implantation. About 11-13 days afterward ovulation, if there is no implantation, ovarian production of progesterone and estradiol starts to autumn off. This causes the endometrium to pause downwards and start to shed, resulting in menses, also known as the menstrual period. As menstruation starts, a new ovarian cycle starts with now increasing levels of FSH from the pituitary stimulating the growth of another group of ovarian follicles.

DIAGNOSIS

A woman who has regular periods every month is probably too ovulating each month with ovulation occurring about 14 days earlier the kickoff solar day of each menstrual period. Notwithstanding, it is important to recall that a woman can have uterine bleeding even though she never ovulates. There are several means to detect ovulation, including home ovulation prediction kits that measure the LH surge earlier ovulation actually occurs. Basal body temperature (BBT) charts can track the rise in temperature that follows ovulation. Other tests include measuring luteal-phase claret progesterone levels, ultrasound monitoring of ovarian follicles.

TREATMENT: OVULATION MEDICATION

Who Needs Ovulation Medication?

Women with irregular menstrual (oligo-ovulatory) cycles or no menstrual periods (amenorrhea or anovulation) are likely to have ovulatory dysfunction. In these women, medications can be used to cause regular ovulation. Before medicines are given, the dr. should effort to determine the crusade of the problem with ovulation. Some possible reasons for ovulation problems include polycystic ovary syndrome (PCOS), low production of LH and FSH by the pituitary, ovaries that do not respond to normal levels of LH and FSH, thyroid illness, increased levels of the hormone prolactin (hyperprolactinemia), obesity, eating disorders, or extreme weight loss and/or do. Sometimes the cause cannot be identified for sure. Women with ovulatory dysfunction typically benefit from ovulation induction with fertility drugs.

Ovulation induction with fertility drugs is as well used in patients without ovulatory dysfunction. The goal is to stimulate the ovaries to produce more than i follicle per cycle leading to the release of multiple eggs in the hope that at to the lowest degree one egg will be fertilized and consequence in a pregnancy. This is called controlled ovarian stimulation (COS), or superovulation, and may be achieved with medicines taken by mouth or by injection. COS combined with either timed intercourse or intrauterine insemination (IUI) is commonly used as an initial treatment for several types of infertility when the woman has open fallopian tubes. COS is also an important office of near IVF treatment.

Before using fertility drugs for COS, information technology is recommended to brand sure the fallopian tubes are unblocked and open up. This tin be confirmed by injecting dye into the fallopian tubes hysterosalpingogram [HSG]) or using a lighted telescope to wait inside the lower belly (laparoscopy). For more information on HSG and laparoscopy, delight come across the ASRM fact sheets titled, Hysterosalpingogram and the booklet titled, Laparoscopy and hysteroscopy. Patients with blocked fallopian tubes volition non become pregnant with fertility drugs or may be at risk for an ectopic pregnancy (pregnancy outside the uterus). Patients with blocked fallopian tubes should non undergo ovulation consecration unless the purpose of the ovulation consecration is to collect the eggs in grooming for IVF.

Before starting ovulation induction, the male person partner should have a semen assay to aid make up one's mind whether ovulation consecration should be combined with timed intercourse, IUI, or IVF. For more information on IVF, consult the ASRM patient information booklet titled, Assisted Reproductive Technologies.

Unremarkably PRESCRIBED MEDICATIONS

The most commonly prescribed ovulation drugs are clomiphene citrate (CC), aromatase inhibitors (such as letrozole), and gonadotropins (FSH, LH, man menopausal gonadotropin (hMG), chorionic gonadotropin (hCG)). Other medicines used in ovulation consecration include bromocriptine, cabergoline, GnRH, GnRH analogs, and insulin-sensitizing agents, which take very specialized applications which are described beneath. Table ane provides a summary of common ovulation drugs and their side furnishings (adjacent page).

Clomiphene Citrate (CC)

Clomiphene is the almost commonly prescribed ovulation-induction drug used to stimulate ovulation in women with infrequent ovulation or amenorrhea. It besides is used to induce more than ane follicle to develop in conjunction with IUI equally a treatment for unexplained infertility and for those who are unable or unwilling to pursue more ambitious therapies.

The standard dosage of CC is 50-100 milligrams (mg) of clomiphene per day for five consecutive days. Treatment begins early on in the cycle, usually starting on the second to fifth twenty-four hours after catamenia begins although it can as well be started without a period if the adult female is anovulatory. If a adult female does not have periods, a period can be induced by taking an oral progestin for v-12 days.

Table 1. Ovulation drugs and their almost common side event

Clomiphene works by causing the pituitary gland to make more FSH. The higher level of FSH stimulates one or more follicles to develop (each containing a single egg). As the follicles grow, they secrete estradiol into the bloodstream. About a week after the last dose of CC is taken, the college levels of estradiol cause the pituitary to release an LH surge. The LH surge causes the egg(south) in the ascendant follicle(s) to be released. It is important to determine whether the dose of CC given results in ovulation. This can be done using the menstrual pattern, ovulation prediction kits, measurement of blood progesterone levels, or the basal trunk temperature chart to monitor a patient's response to the given dose of clomiphene.

If ovulation does not occur at the 50-mg dose, CC is increased by 50-mg increments in immediate or subsequent cycles until ovulation happens. More than than 200 mg each 24-hour interval for v days is usually not helpful, and women who do not ovulate on a clomiphene dosage of 200 mg tend to respond meliorate to a unlike treatment, such as injections of gonadotropins. Your doctor will determine the appropriate dose for you. Occasionally, the doc may choose to add other medicines to a CC regimen if the drug does not induce ovulation. For more information about detecting when ovulation has happened, refer to the ASRM Patient Fact Canvass titled, Ovulation Detection.

Depending on the timing of the menstrual bicycle compared with the fourth dimension of ovulation, the cervical mucus tin can either help sperm enter the uterus or act every bit a barrier. Under the influence of estrogen before ovulation, the mucus is sparse and stretchy which helps sperm. In the days following ovulation, when progesterone levels rising, the mucus becomes thick and tenacious. In some women, CC tin change cervical mucus, making information technology thicker. IUI tin be used along with CC to aid overcome this. CC sometimes tin alter thickness of the uterine lining, making it thin and less receptive to implantation. For this reason, the lowest dose of CC that causes ovulation in anovulatory women is usually prescribed. CC volition induce ovulation in about 80% of properly selected patients. Once the CC dose that induces ovulation is established, three ovulatory CC cycles are an adequate trial for nearly patients and may be continued for upwards to six cycles. However, studies show that CC should not exist given for more than six cycles, because the chance of pregnancy is very low and alternative treatments should be considered.

CC is generally not constructive for women who have irregular or absent-minded ovulation due to disorders of the hypothalamus (such equally those associated with severe weight loss) or very low estrogen levels (such as those with non-functioning ovaries). In improver, women who are obese may have amend success later weight loss. CC is by and large tolerated well. Side furnishings are relatively mutual, but generally mild. Hot flashes occur in about 10% of women taking clomiphene, and typically disappear shortly after the final pill is taken. Mood swings, chest tenderness, and nausea as well are mutual. Severe headaches or visual problems (such equally blurred or double vision) are uncommon and virtually always reversible. In the event that these severe side effects occur, handling should be stopped immediately and the patient should inform her physician. It is not advisable to reattempt whatever farther exposure to CC in these cases.

Women who conceive using CC have approximately a 5-8% chance of having twins. Triplet and college-order pregnancies are rare (<1%), but may occur. Ovarian cysts, which tin can cause discomfort, may form but typically resolve with time. A pelvic exam or ultrasound may be washed if indicated to look for ovarian cysts before get-go another CC treatment cycle. Side effects are more frequent with higher doses.

Aromatase Inhibitors

Aromatase inhibitors are medicines that temporarily decrease estradiol levels, which cause the pituitary gland to make more than FSH. 2 medicines, letrozole and anastrozole, are currently FDA-approved to treat breast cancer that occurs subsequently menopause, but have also been used to induce ovulation in women with ovulatory issues. Treatment begins early in the cycle, unremarkably starting on the second to 5th 24-hour interval after menstruation begins although it also can be started without a period if the adult female is anovulatory. The typical dose is 2.5–5 mg daily for five days. Studies show that pregnancy rates with aromatase inhibitors are similar to CC rates, and may exist improve in sure ovulation disorders such every bit polycystic ovary syndrome (PCOS). Similar to CC, information technology can exist used to crusade more than one follicle to develop for fertility treatments with superovulation-IUI, with similar success rates with CC combined with IUI. Recent enquiry has not shown whatsoever increased risk for nascence defects in children whose mothers took letrozole for fertility treatment.

Insulin Sensitizing Drugs

Insulin resistance and the associated high levels of insulin in the blood (hyperinsulinemia) are seen commonly in women with polycystic ovary syndrome (PCOS). Although most women with PCOS volition ovulate with clomiphene, some will not ("clomiphene resistant") and ultimately require an alternate or additional treatment. When used by themselves for 4–6 months, insulin-sensitizing agents such as metformin tin can cause regular menstrual periods and ovulation in some women with PCOS. Insulin-sensitizing agents are not currently approved by the FDA for this purpose; they are canonical to care for blazon two diabetes by improving the body's sensitivity to insulin. 11

Some PCOS patients do non ovulate in response to either CC or metformin alone only may respond when the two drugs are used together. In a large study sponsored past the National Institute of Child Health and Human being Development (NICHD), metformin alone helped fewer couples excogitate than CC by itself, or metformin and CC combined. This is in contrast to an Italian study which showed metformin to be more effective. Still, CC is typically considered the first-line medication in the United States. The most common side furnishings are gastrointestinal, and include nausea, vomiting, and diarrhea. Metformin therapy is uncommonly associated with liver dysfunction in infertile women, and, in very rare cases, a astringent condition called lactic acidosis. Blood tests to check liver and kidney function should be washed periodically. Other drugs used for diabetics that amend insulin sensitivity, such as rosiglitazone and pioglitazone, also accept been used for this purpose. For more information, delight run into the ASRM Fact Canvas titled Insulin Sensitizing Agents and PCOS.

Gonadotropins

Gonadotropins are fertility medications that incorporate FSH or LH alone or together. Dissimilar CC, aromatase inhibitors, and insulin-sensitizing agents that are taken by oral fissure, gonadotropins are delivered by injection. There are a variety of gonadotropin preparations, and others are in various stages of inquiry and evolution. Because of rapid changes in the international marketplace, the medicines named in the sections below may non include all those available in the United States and worldwide.

Gonadotropins might be prescribed for anovulatory women who have tried CC without conceiving. They likewise are used to help women whose pituitary gland does not produce enough FSH and LH. Gonadotropins are used to cause multiple follicles to develop simultaneously for fertility treatments with superovulation-IUI and IVF. Information technology is important to note that using gonadotropins does not "apply upwardly" more eggs than a nonmedicated menstrual cycle. Gonadotropin therapy can rescue the eggs that would normally die off assuasive those eggs to besides mature and exist available for retrieval or conception.

For non-IVF superovulation cycles, the gonadotropin treatment normally begins on day two or three of the menstrual cycle and the usual starting dose is 75 to 150 IU injected daily. Typically, seven to 12 days of stimulation is enough simply this may exist extended if the ovaries are slow to respond. The size of the follicles is monitored with ultrasound, and the claret estradiol level also may be measured often, both during the stimulation phase of treatment. If claret estradiol levels do not ascent and ultrasound shows that the ovaries are not responding to gonadotropins, the dose may be increased, or, less unremarkably, the bicycle may be cancelled. The goal is to attain one or more mature follicles 12

and an advisable estradiol level so that ovulation can be triggered by hCG to mimic the natural LH surge. If likewise many follicles develop, or if the estradiol level is too high, the md may decide to withhold the hCG injection rather than take a chance the development of ovarian hyperstimulation syndrome (OHSS) or a loftier-order (more than than twins) multiple pregnancy.

Human Chorionic Gonadotropin (hCG)

hCG is like in chemical structure and part to LH. An injection of hCG mimics the natural LH surge and causes the dominant follicle to release its egg and ovulate. The doctor may apply ultrasound and blood estradiol levels to determine when to give hCG. Ovulation volition unremarkably occur about 36 hours after hCG is administered. hCG is typically used to trigger ovulation with gonadotropins, and may be used when CC or aromatase inhibitors are used to induce ovulation. It is important to call back that a pregnancy test works past detecting hCG; in a pregnant woman, hCG is produced by the implanting embryo and developing placenta. Pregnancy tests (either blood or urine) may be falsely positive if done less than 10 days after an hCG is given to trigger ovulation since the residue hCG is still present.

Side effects of gonadotropins

As with all medicines, at that place are potential risks and complications associated with the use of gonadotropins. Side effects should be discussed before taking these (and any other) drugs. Ane of the most common risks is condign pregnant with more than than one fetus (multiple pregnancy). Upwards to 30% of gonadotropin-stimulated pregnancies are multiple. Of these multiple pregnancies, about two-thirds are twins and one-third are triplets or more than. Multiple pregnancy holds wellness concerns for the mother and babies. Preterm delivery is more mutual in multiple pregnancies; the greater the number of fetuses in the uterus, the greater the chance. Preterm delivery can exist associated with serious wellness consequences for the newborn such equally severe animate issues, haemorrhage within the brain, cerebral palsy, infections, and even death. For women who are pregnant with more than than twins (such as triplets, quadruplets or a higher number of fetuses), a procedure known as multifetal pregnancy reduction is an option that tin help reduce the risk of problems resulting from a high-club multiple pregnancy.

In addition to problems associated with high-order multiple pregnancy, some other serious possible side consequence of gonadotropin therapy is ovarian hyperstimulation syndrome (OHSS). In OHSS, ovaries get swollen and painful. In astringent cases, excessive fluid collects in the abdominal cavity (ascites) and occasionally in the breast. In upwardly to 2% of gonadotropin cycles,

hyperstimulation may be severe enough to require hospitalization. Careful monitoring with ultrasound, measurement of serum estradiol levels, and adjustment of gonadotropin dosage will help the doctor to place risk factors and decrease the run a risk of severe OHSS. When serum estradiol levels are rising quickly, are too high, or an excessive number of ovarian follicles develop, ane of several strategies can exist used to decrease the chance or severity of OHSS. Gonadotropin stimulation can be stopped and hCG administration delayed until estradiol levels plateau or refuse ("benumbed"). Alternately, hCG can be completely withheld so that ovulation fails to occur. Another strategy in women not on leuprolide acetateis to substitute a GnRH agonist for hCG to trigger ovulation, thereby dramatically decreasing hyperstimulation risks.

Other potential side effects of gonadotropin treatment include breast tenderness, swelling or rash at the injection site, abdominal bloating, mood swings, and mild abdominal pain. Some women experience mood swings during gonadotropin therapy, although usually less severe than those that occur with CC. It is difficult to dissever the emotional changes due to the hormone levels seen during gonadotropin therapy from the stress associated with fertility treatment. Regardless of the cause, a change in mood is not uncommon during gonadotropin therapy.

Bromocriptine and Cabergoline

Some women ovulate irregularly or not at all because their pituitary gland secretes also much prolactin. Higher-than-normal blood levels of prolactin (hyperprolactinemia) inhibit the release of FSH and LH, leading to disruption of evolution of a dominant follicle and ovulation. In some women, high prolactin levels can result from a benign tumor that is composed of prolactin secreting cells, called an adenoma. High prolactin levels also can issue from the apply of certain drugs such as tranquilizers, hallucinogens, painkillers, alcohol, and, in rare cases, oral contraceptives. Diseases of the kidney or thyroid may also enhance prolactin levels.

Hyperprolactinemia often is treated with bromocriptine or cabergoline which act by reducing the corporeality of prolactin released past the pituitary gland. Blood prolactin levels return to normal in 90% of patients who take these medications. Bromocriptine is typically taken daily. Cabergoline is taken twice weekly. Of the women treated, approximately 85% will ovulate and can become pregnant if no other causes of infertility are present. Treatment is usually discontinued once pregnancy is achieved. Women who exercise non ovulate afterwards their prolactin levels are normal may likewise exist started on CC or gonadotropins.

Possible side effects of bromocriptine and cabergoline include nasal congestion, fatigue, drowsiness, headaches, nausea, and vomiting, fainting, dizziness and decreased blood pressure. For most patients, adjusting the dosage tin minimize or eliminate these side furnishings. Some doctors start their patients on a very low dose and increase it gradually in an attempt to prevent side effects. The risk of multiple pregnancies is not increased as a outcome of bromocriptine or cabergoline therapy when taken without other fertility medications.

Gonadotropin-releasing Hormone (GnRH)

GnRH is released from the hypothalamus in small amounts about once every 90 minutes. This pulsatile (rhythmic) release of GnRH from the hypothalamus into the claret stream stimulates the pituitary gland to secrete FSH and LH. If GnRH is not being released properly, it can be given as a serial by a special drug-delivery organization that includes a belt holding a lightweight pump. The pump delivers a small corporeality of GnRH every 60 to xc minutes through a needle placed beneath the skin (usually in the belly) or into a blood vessel. The run a risk of multiple births and OHSS, are quite small. At present, GnRH is not bachelor for this utilise in the U.s..

GnRH Analogs (Agonists and Antagonists)

GnRH analogs are synthetic hormones similar to natural GnRH, but are chemically modified to change their role (typically making them final longer). Leuprolide acetate, nafarelin acetate, and goserelin acetate are GnRH agonists. The normal pulsatile rhythmic release of GnRH from the hypothalamus stimulates the pituitary gland to secrete FSH and LH. However, when a woman takes a GnRH agonist, her pituitary gland is exposed to a abiding, rather than a pulsatile, pattern of synthetic GnRH. This steady exposure causes an initial rising in FSH and LH product followed by a refuse in further release and thereby prevents spontaneous ovulation.

Ganirelix and cetrorelix acetate are GnRH antagonists, which immediately suppress the production of FSH and LH without the initial rise in product that is seen with agonists.

Both agonists and antagonists are ineffective when taken orally. Both GnRH agonists and antagonists tin prevent ovulation from occurring spontaneously which allows eggs to exist retrieved from developing follicles and used with virtually all IVF cycles.

The woman taking a GnRH antagonist or agonist long-term may take temporary side furnishings of menopause, including hot flashes, mood swings, and xv

vaginal dryness. In addition, headaches, insomnia, decreased breast size, hurting during intercourse, and bone loss may occur with long-term employ. These side effects are temporary as the effects on the pituitary are reversed after GnRH analogs are discontinued.

LONG-TERM RISKS OF OVULATION DRUGS

After years of clinical use, doctors can advise patients confidently that CC and gonadotropins are not associated with an increased risk of nativity defects. Information technology is besides clear, after years of report, that women taking ovulation-inducing drugs such every bit CC and gonadotropin may not be at increased run a risk for ovarian cancer. Long-term data nearly the use of aromatase inhibitors is growing and, is likewise reassuring.

Decision

Infertility due to disorders with ovulation can often be corrected with diverse medications and treatments that lead to the growth and development of a mature egg that volition ovulate.

Many of the medications used to induce ovulation can also be used to abound multiple eggs at once (superovulation) in conjunction with additional treatments, such as IUI and IVF to treat other types of infertility.

GLOSSARY

Amenorrhea. Absenteeism of menstrual periods.

Anovulation. A state of failure to ovulate; this can exist transient or chronic.

Biopsy. A tissue sample taken for microscopic test.

Controlled ovarian stimulation (COS). Administration of fertility medications in order to reach the evolution of 2 or more mature follicles. Also chosen superovulation

Corpus luteum. A mature follicle that has collapsed later on releasing its egg at ovulation. The corpus luteum secretes progesterone and estrogen during the 2nd half of a normal menstrual cycle. The secreted progesterone prepares the lining of the uterus (endometrium) to support a pregnancy.

Embryo. The earliest stage of homo development after a sperm fertilizes an egg.

Endometrium. Uterine lining that sheds monthly to produce a menstrual period.

Estradiol. The main type of iii types of estrogen that is produced by the ovaries.

Estrogen. The female sexual practice hormone produced by the ovaries that is responsible for the development of female sex activity characteristics. Estrogen is largely responsible for stimulating the uterine lining to thicken during the first one-half of the menstrual cycle in preparation for ovulation and possible pregnancy. It also is important for healthy basic and overall health. A small corporeality of this hormone as well is made in the male person testes.

Fallopian tubes . A pair of hollow tubes attached one on each side of the uterus. The egg travels from the ovary to the uterus through narrow passageways within these tubes.

Fimbriae. The finger-similar projections of the fallopian tubes that sweep over the ovary and move the egg into the tube.

Follicle. A fluid-filled cyst located just beneath the surface of the ovary, containing an egg (oocyte) that is surrounded by hormone producing cells (granulosa cells). The sac increases in size and book during the showtime half of the menstrual cycle, and at ovulation, the follicle matures and ruptures, releasing the egg. As the follicle matures, it tin be visualized by ultrasound.

Follicle Stimulating Hormone (FSH). Produced by the pituitary gland, FSH is the hormone responsible in women for stimulating ovarian follicles to grow, stimulating egg development and the production of estrogen. In men, FSH travels through the bloodstream to the testes and helps stimulate them to produce sperm. FSH can too be given as a medication.

Follicular phase. The beginning half of the menstrual cycle (start on day 1 of bleeding) during which the ascendant follicle secretes increasing amounts of estrogen.

Gonadotropin-releasing Hormone (GnRH). The natural hormone secreted past the hypothalamus that prompts the pituitary gland to release FSH and LH into the bloodstream, which in plough stimulate the ovaries to produce estrogen and progesterone (FSH), and to ovulate (LH).

Human being chorionic gonadotropin (hCG). A hormone produced by the placenta during pregnancy that mimics the LH surge. It is ofttimes used with clomiphene or hMG to cause ovulation.

Hyperprolactinemia. High levels of prolactin in the bloodstream.

Hypothalamus. A thumb-sized area in the brain that controls many functions of the body, regulates the pituitary gland, and releases GnRH.

Hysterosalpingogram. An X-ray performed after dye is injected into the uterus and fallopian tubes to determine if both fallopian tubes are open and if the shape of the uterine cavity is normal.

In vitro fertilization (IVF). A method of assisted reproduction that involves surgically removing an egg from the woman'due south ovary and combining it with sperm in a laboratory dish. If the egg is fertilized, resulting in an embryo, the embryo is transferred to the woman's uterus.

Insemination. The deposit of semen through a syringe inside the uterine cavity or cervix to facilitate fertilization of the egg.

Laparoscopy. A surgery performed in which a thin camera is inserted into the belly through a small incision to audit the condition of the pelvic organs.

LH surge. The secretion, or surge, of large amounts of luteinizing hormone (LH) by the pituitary gland. This surge is the stimulus for ovulation to occur.

Luteal phase. The 2d half of the menstrual cycle after ovulation when the corpus luteum secretes big amounts of progesterone as well as estrogen.

Luteal phase defect. A shorter than normal luteal phase or one with lesser progesterone secretion despite a normal elapsing.

Luteinizing hormone (LH). The hormone that triggers ovulation and stimulates the corpus luteum to secrete progesterone.

Multifetal pregnancy reduction. Also known as selective reduction. A procedure to reduce the number of fetuses in the uterus. This process may be considered for women who are significant with multiple (more than than two) fetuses. As the adventure of extreme premature commitment, miscarriage (spontaneous abortion), and other problems increases with the number of fetuses nowadays, this process may be performed in an endeavor to prevent the entire pregnancy from miscarrying (aborting).

Ovarian hyperstimulation syndrome (OHSS). A possible side-effect of controlled ovarian stimulation treatment with fertility medications, particularly injectable hormones, in which the ovaries become enlarged due to evolution of many follicles, are painful and swollen, and fluid may accrue in the abdomen and chest.

Ovarian reserve. Quantity of eggs available at whatsoever age and reflects a woman'due south fertility potential. Diminished ovarian reserve is associated with depletion in the number of eggs and also may be associated with worsening of egg quality.

Ovulation. The expulsion of a mature egg from its follicle in the outer layer of the ovary. Information technology usually occurs on approximately day 14 of a 28-day wheel.

Pituitary gland. A small gland just beneath the hypothalamus that secretes follicle stimulating hormone and luteinizing hormone, which stimulate egg maturation and hormone production past the ovary.

Polycystic ovary syndrome (PCOS). A status characterized by chronic anovulation, excessive ovarian production of testosterone and/or ovaries with many small cystic follicles. Symptoms may include irregular or absent menstrual periods, obesity, infertility, excessive pilus growth, and/or acne.

Progesterone. A female person hormone secreted past the corpus luteum after ovulation during the second half of the menstrual cycle (luteal phase). It prepares the lining of the uterus (endometrium) for implantation of a fertilized egg and allows for complete shedding of the endometrium at the fourth dimension of period. In the event of pregnancy, the progesterone level remains stable beginning a week or so later on conception.

Progestin. A constructed hormone that acts like to progesterone.

Prolactin. A pituitary hormone that stimulates milk production and interferes with ovulation by inhibiting FSH and LH release.

Superovulation. Administration of fertility medications in order to attain the evolution of two or more than mature follicles. Also called controlled ovarian stimulation.

Ultrasound. Loftier frequency sound waves that produce an image of internal organs on a monitor screen.

Uterus (womb). The muscular organ in the pelvis in which an embryo implants and grows during pregnancy. The lining of the uterus, called the endometrium, produces the monthly menstrual blood menstruation when at that place is no pregnancy.

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