Anovulatory Infertility

Anovulatory Infertility is a condition of female infertility wherein a woman does not release an egg even when she’s having a menstrual cycle. This may be the culprit if you’ve had regular flow throughout and still have no luck conceiving. In this case, you’re only bleeding, but there’s no oocyte to fertilize, causing pregnancy to be out of reach.

Worry not, though, because this condition is curable through particular treatment regimens. Specifically, you could use either clomiphene citrate (Clomid), human menopausal gonadotropins (hMG), or follicle-stimulating hormone (FSH) with or without clomiphene. Note that while anovulation can be cured by medications, some common medications may cause it! These include treatments meant for other purposes, such as:

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

NSAIDs are one of the most accessible drugs you can find; they’re an over-the-counter remedy requiring no doctor’s prescription. It’s an effective remedy to fight off urinary incontinence. The drugs are widely used to relieve inflammation, pain, swelling, and fever. In fact, you may even have some of its variations stocked up in your medkit, like aspirin and mefenamic acid.

That’s right, these are medications you can freely access when you’re experiencing period pain. However, no matter how much they are blocking the discomfort, there are certain effects you should be aware of. NSAIDs can alter physiological processes, including those of your reproductive system.

Studies suggest that these drugs inhibit ovulation by directly affecting the dominant follicle. Instead of splitting open to release an egg, the follicle remains in its unruptured state. This condition won’t last for a lifetime, though. Withdrawal and avoidance of these drugs may lead to pregnancy.

Skin Creams and Other Topical Products With Hormones

Anovulation can also be due to skin creams and other topical products containing various hormones. For instance, there are brands that purposefully include progesterone and estrogenic chemicals in their formula. While these are effective in addressing wrinkles, dark spots, and melasma, they have an adverse effect on women’s fertility.

In particular, estrogens are a fool-proof way to increase collagen production and skin hydration. It’s a hormone known for decreasing skin aging, so they’re sought after in facial creams. However, in return, women gain an increase in estrogen exposure. These will have a great impact on hormone levels and can even affect ovum production in the long run.

On the other hand, progesterone is a handy addition to topical products as it can treat bloating, tenderness, and fatigue. There’s a lot to be gained from using creams made with this hormone, but there’s a certain disclaimer. You should only be using this if you’re done with ovulation and entering the luteal phase of your cycle. It’s because the body only produces progesterone for thickening the uterine lining for a possible pregnancy.

Steroids and Anovulatory Infertility

You could classify steroids into two: anabolic steroids, which are a charm for bodybuilders, and corticosteroids which reduce pain and stiffness. The latter is an effective medication against asthma, inflammation, and flare-ups. However, there’s one unpopular result it can bring with constant use – steroids affect fertility.

That’s right; if you’re planning on building a family, these drugs are a no-go. It’s a substance that can no doubt affect your menstrual cycle, making it irregular, heavier, and prolonged. It can even interfere with the body’s hormone production leading to anovulation.

On the chance that you get pregnant even while taking steroids, there are bound to be some congenital disabilities. Pregnancy complications may arise and may lead to failure in fetus development. The thing is, these types of drugs should not be in contact with your body if you’re keen on conceiving and giving birth.

Cortisone and Prednisone

Cortisone and Prednisone are types of corticosteroids meant to address various clinical problems. These include but are not limited to illnesses such as severe allergies, asthma, lupus, arthritis, and IBD. However, their downside is that they prevent the necessary hormone production for ovulation from occurring.

This is especially the case if you’ve taken both drugs in high doses as a regular routine. The organic chemicals in your body, namely follicle-stimulating hormone, and luteinizing hormone become blocked in production. For reference, FSH and LH are a pair of hormones known to stimulate egg maturation in the ovaries.

In general, corticosteroids are not recommended for those who are eager to conceive. Studies show that some women who took a single steroid shot had their menstruation cycles turn irregular. The fickleness of monthly periods is not a good sign, especially when it comes to reproductive health.

Herbs and Natural Remedies can Cause Anovulatory Infertility

If you believe you’re safe from anovulation because you’re all about the natural route, think again. Organic remedies may be eco-friendly and safer for your body, but they can also be the source of infertility. For instance, some herbs have hormone-like substances that can make your ovum production haywire.

For instance, some organic supplements contain ingredients that are high in estrogenic substances. Think of ginkgo, ginseng, clover, and other herbal plants effective in altering the sex-hormone concentration. In turn, egg production will be affected, and conception won’t occur.

This doesn’t mean you should completely stay away from herbs and natural remedies, though. They’re still a healthier, more sustainable alternative to chemically-processed substances. The best way to go is to schedule an appointment with your fertility doctor and take note of all the organic alternatives safe for use.

To Conclude

Anovulatory Infertility is a treatable condition that is experienced by thirty percent of women. It’s not as uncommon as you think and can be remedied by withdrawing from the substances causing it. You can also opt to get medications specifically addressing ovulatory irregularities.

Advancements in the medical world are growing rapidly, so you have access to various treatments in your hands. On the chance that you’re considering IVF, ask if they manage the patient journey with ART Compass. It’s a lab management software that can assist you with your conception goals through artificial intelligence.

Being pregnant during Covid-19 may be stressful and induce anxiety in many soon-to-be moms. However, that doesn’t mean that it’s impossible to get through! We outlined some of the guidance the CDC has released for pregnant women during Covid-19 because the sharing of useful information during a time like this is CRUCIAL.

Are COVID-19 vaccines safe in pregnancy?

A. Probably yes.

B. Pregnancy and the COVID19 vaccine itself very much isn’t. It is very dangerous to pregnant women.

The impact of covid-19 on pregnant women has been a concern for many people. unfortunately, there isn’t too much data available because we’re still learning about the virus. THE CDC however suggests that pregnant individuals may be at a higher risk.

The CDC also states that the pregnant population could possibly suffer from adverse pregnancy outcomes, such as preterm birth. It is advised that pregnant individuals take the utmost caution during these stressful times and do not skip their prenatal care appointments.

Here is some data released by the CDC:

4,954 Pregnant women have been Hospitalized since January 22nd.

21,573 pregnant women have been diagnosed with covid in the U.S.A and there have been 48 deaths.
Hispanic or Latino pregnant women seem to be heavily impacted

Being pregnant during the pandemic is unimaginably stressful. shout out to all those new moms out there! If you’re having a difficult time coping with the pandemic and the risks it imposes, you don’t have to go through this alone! Approach your physician with any questions.

And of course-keep, yourself occupied! staying at home doesn’t mean you can’t have fun! Video call some of your pals or start picking out that wallpaper for the nursery! and most important-stay safe. Wear a mask and wash your hands regularly for twenty seconds.

References:

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/special-populations/pregnancy-data-on-covid-19.html

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html

Image by Sarah Pflug

Biochemical pregnancy is one that occurs within just a few weeks of implantation. It is believed that biochemical pregnancies account for up to 75% of all miscarriages. Even at such an early stage, the embryo produces enough of the hormone human chorionic gonadotropin (hCG) to be detected by a pregnancy test. Sadly, however, the embryo does not develop into a healthy pregnancy. Biochemical pregnancy can be devastating for couples who are trying to start a family.⁠

Women who experience repeated IVF failures need to be evaluated thoroughly for both embryo competency and implantation dysfunction before and/or in the course of their next IVF attempt. Implantation problems should be evaluated before proceeding to the next IVF cycle. ⁠

Unexplained Infertility

Unexplained infertility can only truly be diagnosed after a full and complete fertility evaluation of both the male and female partner.

An unexplained infertility diagnosis may be justified if it has been shown that…

You are ovulating regularly.

Your ovarian reserves are good. (Evaluated with blood work and/or an antral follicle count.)

Your fallopian tubes are open and healthy. (Evaluated with an HSG.)

Your partner’s semen analysis is normal (including total count, sperm movement, and sperm shape.)

There are no serious uterine fertility issues. (Evaluated with a hysteroscopy.)

If any of the above has not been evaluated, a diagnosis of unexplained infertility may be premature.

Some may also argue a laparoscopy is also needed to rule out endometriosis. Endometriosis cannot be diagnosed with blood work or ultrasound.

Other reasons for What is a biochemical pregnancy??:

The interaction between the vaginal environment and sperm: After ejaculation, sperm must make their way out of the semen and into the cervical mucus. Then, they must swim up from the vagina, into the cervical opening, and eventually into the uterus.

Sometimes, there may be problems during that transition period, from the semen, into the cervical mucus, and up the cervix. For example, there may be antibodies in the cervical mucus or even the semen that attack the sperm.

This is known as hostile cervical mucus. How to effectively diagnose this problem isn’t clear, leaving cases like these frequently unexplained.

Poor egg quality: We have tests to determine if you’re ovulating, and testing to get a general idea of whether there is a relatively good quantity of eggs in the ovaries.

But there is no test to determine whether the eggs are good quality. Poor quality eggs may be caused by age, an underlying medical condition, or some yet unknown cause.

One study published in 2016 found that a newly discovered virus is more commonly found in the endometrial tissue of women with infertility than in women with proven fertility. But how to diagnose and treat this problem isn’t known.

Problems with a fertilized egg developing to a healthy embryo: Let’s say we get a healthy looking egg and sperm, and they become an embryo. Next, the cells inside the embryo divide and grow to eventually form a fetus.

Sometimes, this goes wrong. This is another problem that may be diagnosed during IVF treatment since embryos are monitored for normal cell division.

Primary Ovarian Insufficiency

Primary ovarian insufficiency — also called premature ovarian failure — occurs when the ovaries stop functioning normally before age 40. When this happens, your ovaries don’t produce normal amounts of the hormone estrogen or release eggs regularly.

Women with primary ovarian insufficiency can have irregular or occasional periods for years and might even get pregnant.

Signs and symptoms of primary ovarian insufficiency are similar to those of menopause or estrogen deficiency. They include:

Irregular or skipped periods, which might be present for years or develop after a pregnancy or after stopping birth control pills

Difficulty getting pregnant

Hot flashes

Night sweats

Vaginal dryness

Dry eyes

Irritability or difficulty concentrating

Decreased sexual desire

Image by Sarah Pflug

In reality, there is no normal!! The menstrual cycles and timing intercourse begins and ends with menstruation and is divided by ovulation into the follicular and luteal phases. The fertile window, during which there is a probability of conception from unprotected sex, is defined as the day of ovulation and the 5 days preceding it (the time window for sperm survival).

All available data suggests that there may be significant variability in fertile days- i.e.. not exactly 14 days before your next period!

We suggest tracking your basal body temperature AND your LH surge to determine your fertile days- and really try to determine if you are getting ovulation each month to time intercourse very well.

Late Ovulation

Late ovulation is when you ovulate (i.e. your ovary releases an egg) after day 21 of your menstrual cycle. Women with regular cycles consistently have periods every 21 to 35 days. … Very rarely, women have a normal 28-day cycle but ovulate around day 17, 18, or 19 instead of around day 14.

In true late ovulation, you will have a short luteal phase. Some doctors think that the uterus may not have enough time between cycles to build up its lining for an embryo to attach. That could theoretically lower your odds of getting pregnant, but it’s far from certain.

Any time your cycles are long and irregular, it’s a good idea to check in with your doctor to rule out PCOS, hyperprolactinemia or hypothyroidism. Getting treatment for these conditions can greatly increase your chances of getting pregnant and having a healthy pregnancy.

Azoospermia: TESE, MESA, and PESA

In some individuals, spermatozoa may not be present in the ejaculate. This condition is called Azoospermia. This can be either due to problems in sperm production itself or due to obstruction to the flow of semen during ejaculation. Reproductive tract obstruction can be acquired – as a result of infection, trauma, iatrogenic injury which can occur during bladder neck, pelvic, abdominal or inguino-scrotal surgery.

Congenital anomalies may be relatively uncommon in the general population, but can occur in up to 2 percent of infertile men. Best known condition is congenital bilateral absence of the vas deferens (CBAVD) which occurs in almost all men with cystic fibrosis.

Two techniques – Epididymal sperm retrieval & micromanipulation have revolutionized treatment of male infertility in the past decade. Men with congenital bilateral absence of the vas defences (CBAVD) or reproductive tract obstruction are now able to achieve pregnancies with use of these advanced techniques. You must know the normal Menstrual Cycles and Timing Intercourse.

PESA

PESA or Percutaneous Epididymal Sperm Aspiration (PESA), does not require a surgical incision. A small needle is passed directly into the head of the epididymis through the scrotal skin and fluid is aspirated. The embryologist retrieves the sperm cells from the fluid and prepares them for ICSI.

MESA

Microsurgical Epididymal Sperm Aspiration (MESA) is used in conditions like obstructive azoospermia, involving dissection of the epididymis under the operating microscope and incision of a single tubule. Fluid spills from the Epididymal tubule and pools in the Epididymal bed. This pooled fluid is then aspirated. Because the epididymis is richly vascularized, this technique invariably leads to contamination by blood cells that may affect sperm fertilizing capacity in vitro.

TESA and TESE

TESE or testicular sperm extraction is a surgical biopsy of the testis whereas TESA or testicular sperm aspiration is performed by inserting a needle in the testis and aspirating fluid and tissue with negative pressure. The aspirated tissue is then processed in the embryology laboratory and the sperm cells extracted are used for ICSI.

A common misconception in the world of infertility is that when an individual has successfully conceived a child, they will always be able to successfully conceive a child after that. Unfortunately, that is not always true. So, what is secondary infertility? Secondary infertility is the inability to become pregnant for a full term or conceive after giving birth to a baby. This community of individuals who experience secondary infertility are often forgotten about because they have had children prior to experiencing infertility. They may even be guilted or shamed for being upset about their secondary infertility, because they already have a child.

But that isn’t fair.

Secondary infertility is as real as primary infertility. Approximately 3 million women in the United States are affected by secondary infertility. The emotional burden that comes with it is as real for many families.

What people say about Secondary Infertility

Infertility, regardless of whether it’s primary or secondary, is only truly understood by those who experience it. Has anyone said to you, “but you already have a child” “you should be grateful for what you have,” or, “just keep trying” ? These pieces of “advice” are NOT supportive.

You may be surprised to experience resentment from other couples with infertility who are unable to have their first child.

Some critics may even go so far as saying you’re not spending enough time with your current child, or you are spending too much money, jeopardizing your current child’s future. That kind of negative energy isn’t welcome. People have no business undermining the struggle and hardships of infertility, secondary OR primary!!

Confide in the friends, family and other support systems that do not try and tell you how to navigate your fertility journey. Surround yourself with people who you know will act as the shoulder to lean on. People who encourage you to take control of your fertility journey. Secondary infertility can be overcome!

Why does Secondary Infertility happen?

Secondary infertility can be confusing. When someone was easily able to conceive a child once, what could have possibly changed to prevent them from having a second one?

Let’s break it down:

It can occur in either men or women due to several reasons:

· Hindered sperm production, function or delivery in men

· Damage to the Fallopian tube

· Disorders regarding ovulation

· Endometriosis among other uterine conditions in women

· Complications related to prior pregnancy or surgery (Ashermans)

· Changes in risk factors for one of the two people involved (age, weight and use of certain medications).

· Heavy alcohol drinking can impair sperm production and disrupt hormones in men while in women it can increase the time it takes to conceive.

· Smoking can damage sperm DNA in men or damage eggs and affect ovulation in women.

· Uterine fibroids which are non-cancerous growths in or on a uterus can close off fallopian tubes or crowd the uterus

· Endometriosis (when the uterine lining cells grow outside the uterus.) This results in inflammation on the ovaries and fallopian tubes, which affect egg quality and the embryo implantation.

· Endometritis (sounds similar to endometriosis) is where the uterus becomes inflamed and impairs the ability of an embryo to properly implant into the uterus.

· Pelvic inflammatory disease resulting from a previous cesarean

When should you approach a fertility doctor?

Normally, it is suggested that those who are over 35 and have been actively trying to conceive for over 6 months should visit their primary care physician or ob-gyn. However, this is not the same for everyone. Those who have experienced pelvic inflammatory disease, painful periods, miscarriage, irregular cycles, or a low sperm count, definitely should not wait for a year before confiding in their physician. They should do so sooner.

What happens at the infertility doctor’s office?

During your appointment, the doctor will begin with questions about your current health as well as your medical history. This provides them with sufficient background information. They will also collect a blood sample and perform ultrasounds to find out whether you’re ovulating and to check your egg supply. Performing an X-ray would help identify blocked fallopian tubes and a semen analysis establish the sperm count and quality. All these measures will enable the fertility doctor (reproductive endocrinologist) to get a better understanding of what has potentially changed since the last time you conceived a child.

Talking to your child about infertility

Maybe prior to finding out about your infertility openly discussed a possible sibling. Or maybe you simply want to explain to your child why you are upset sometimes. You can always tell them you hope to bring them a sibling. If you prefer not to hint at a possible sibling but, have already mentioned a sibling in the past, remind them that they are everything you ever wanted and so much more. Let them know how much they mean to you.

Deciding on Infertility Treatments

Strategizing is key. Whether you opt for assisted reproductive technology, gestational surrogacy, adoption or any other option, having a plan is important. All of these options require investing time as they can sometimes be a handful to navigate. So, take it step by step. Self-care is critical. Reach out to your support systems. Eat well. Rest. Hydrate. Say NO. Say YES. Take social media breaks. Budget. Self-care can look like so many things other than a “spa day” – every mom knows that spa days are hard, if not impossible- to come by!!!

Infertility Support

Most people fail to understand the misery and feelings of hopelessness that accompany secondary infertility. That doesn’t mean there aren’t others out there who are enduring the same struggle as you. If you feel uncomfortable approaching your usual support systems such as friends and family, reach out to a group who specifically addresses the hardships of secondary infertility. Find a support group in your area and share your story. Resolve has some great resources. By listening to others’ stories, you’ll also be able to connect and know you are not alone.