Successful human reproduction normally requires the maturation and release (ovulation) of an egg from the ovary.
The process that results in ovulation is complex, very delicate (easily disrupted), and involves many different components. If you
learn this material, then many of the reasons for irregular menstrual cycle intervals and poor egg quality will become clear. You can
also focus specifically on problems that your physician has addressed with you.
In this ovulation tutorial, Dr. Eric Daiter presents a great deal of information about ovulation.
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for additional information.
The ovarian reproductive lifecycle ranges from puberty to menopause and generally spans a 30-40 year time interval. Dr. Daiter presents
the events that occur at puberty to allow for the release of a mature egg at ovulation and the events that can affect the overall
duration of the ovarian reproductive lifecycle.
The normal events that occur within the female body to allow for regular ovulation involve the brain (central nervous system and
hypothalamus), the pituitary gland, and the ovary. Dr. Daiter reviews the physiology and clinical importance of the development
of a monthly pool of recruitable follicles (ovarian cysts containing eggs), the role of FSH in follicular development, the development
of a dominant follicle, the role of the midcycle LH surge to trigger ovulation, the changes that allow a follicle to become a corpus
luteum cyst to produce progesterone following ovulation, the window of uterine receptivity during which an embryo can implant into the
uterine cavity, and menses when pregnancy does not occur.
There are different techniques to detect ovulation, each with their own reliability, sensitivity and specificity. In order to perform an ovulation test, Dr. Daiter examines
the significance of a history of regular menstrual intervals with premenstrual symptomatology, basal body temperature records, cervical
mucus characteristics, ovulation predictor kits and monitors, blood work for luteal phase progesterone concentration, serial ultrasound
examinations, and experimental methods.
There are many known causes for ovulation dysfunctions, each with their own specific treatments. Dr. Daiter categorizes and presents
these causes, including ovarian disorders (role of the woman's age, ovarian surgery, pelvic radiation or chemotherapy, premature
ovarian failure, cigarette smoking, pelvic infections, compromised blood supply, endometriosis and medications), pituitary gland
disorders (role of thyroid disease, excessive prolactin, pituitary tumors resulting in Cushing's syndrome or acromegaly, pituitary
damage, the empty sella syndrome and medications), and hypothalamic and central nervous system disorders (polycystic ovarian syndrome,
functional hypothalamic amenorrhea, structural lesions, stress, strenuous exercise, sudden weight loss or anorexia nervosa, illicit
drug use and medications).
A thorough clinical evaluation for ovulation disorders should include certain components. Dr. Daiter discusses his
own approach to the clinical evaluation, including a detailed menstrual history, a detailed medical history, the physical exam and the
initial laboratory evaluation.
There are various treatment alternatives each with their own risks and benefits. Dr. Daiter discusses treatments for thyroid disease,
prolactin disorders, the appropriate use of fertility medications, and when to consider donor eggs.