Improving Pregnancy Chances for Women Who Don't Ovulate

Aging decreases the number of eggs in the ovaries that a woman can ovulate and therefore the odds of of conceiving also decreases as one age. The 24 million eggs that are present in the ovaries of a female fetus only result in about a million follicles at birth, and we only ovulate about 400 times. As the number of reserve eggs decreases the rate of regular ovulation goes down and in order to conceive a woman may require help in ovulating. Although previously it was thought that a single follicle awakes from a group of eggs that are stimulated in the weeks before ovulation, always thought to occur in a cycle before the cycle in which we ovulate, there is evidence now that the process takes more like 3 months. The cycle is mostly controlled by the brain hormone FSH (follicle stimulating hormone) from the pituitary gland. FSH stimulates follicles, which are sacs of cells that contain an egg, to develop during those important last two weeks when rapid growth in a follicle occurs.. And FSH is controlled by signals that feed back to the gland from the estrogen that the follicle begins to make as well as higher brain centers We know that local hormone signaling within the ovary
is important as well. And this may help to explain the fact that as women age there seems to be a poorer response to the hormone stimulation used to help her get pregnant. If a woman is not completing the process on her own medications have been used to help ovulation, the best known medication used for this is clomiphene, but medications such as aromatase inhibitors, like letrozole, and actual FSH injections are also used for this. Still some women will not respond with ovulation. Various strategies have been tried to improve a woman's chances, including pre-treatment with insulin sensitizing agents, birth control pills, GNRH (gonadotrophin releasing hormone), LH (luteinizing hormone) and the hormone DHEA (dihydroepiandosterone). The pretretment can help the follicle cells become more responsive to the FSH signals. A group of Korean fertility researchers just published their results with pretreatment using testosterone gel in low doses 12.5 mg (note this level is fairly low, or 0.125 grams, as compared to the 1.25 grams which is the lowest male androgen level available in the Androgel 1% testosterone gel that is used for male testosterone treatments) to help improve rates of success in their IVF patients. The testosterone gel is thought to mimic a normal step in the sequence necessary for a successful ovulation process by which the soon to be ovulatory follicle gets stimulated by local hormones to increase it's ability to respond to FSH. Although these women could potentially get side effects of the male hormone, it might help people who didn't get enough ovulation response from their other treatments, to be successful. Other fertility factors to be treated improve chances would include being sure the timing of sex is correct during the ovulation process, having healthy fallopian tubes, having a partner with an optimized sperm count, and using insemination techniques.

Comments

  1. Their can be many reasons behind the late time pregnancy. Aging decreases the number of eggs in the ovaries that a woman can ovulate and therefore the odds of conceiving also decreases as one age. This can be improved such that many new techniques are available.

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  2. I agree with your comment that many new techniques for the treatment of infertility due to poor ovulation are available. These new techniques available are also helping women become pregnant later in life than ever before, when their egg supple is diminished. For women over the age of 35 should seek advice if she is trying to get pregnant and it has been over 6 months. What treatments do you recommned?

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