Ovarian Causes

Polycystic Ovary Syndrome:

What is Polycystic Ovary Syndrome (PCOS)?

PCOS is a medical condition that occurs when certain female hormones are abnormal. With the abnormal hormones women may also have irregular menstrual cycles, infertility, excessive hair growth, problems metabolizing sugars and weight gain.

Symptoms:

Irregular Menstrual cycles: Women with PCOS often complain of menstrual cycles that are irregular. This irregularity can be in duration of menstrual flow, how often menstrual flow occurs, and even no menstrual flow.

Hair growth: Many women with PCOS may also have symptoms of abnormal hair growth. The most common places that this growth occurs are on the face (upper lip/chin), chest, lower abdomen and the inner thighs.

Weight Gain: Another common symptom is weight gain. Typically this weight gain is due to excessive production of insulin or diminished effectiveness of the insulin. The abnormal production or effectiveness of insulin often leads to weight gain. This excess weight gain is often difficult to lose without appropriate medical treatment. The Insulin imbalance can eventually lead to an increased risk of developing diabetes.

Why:

Every month women produce an egg in their ovary. This egg is produced in what is called a follicle (a sac or cyst in the ovary). In the follicle there are other cells with the egg that produce hormones. In the first two weeks of a woman’s normal ovulatory cycle these cells produce estrogen, in the second half of the cycle they produce estrogen and progesterone.

In women with PCOS the cells that are found in the follicle produce excessive amounts of male hormones (Androgens). When too much of these androgens are produced it can prevent ovulation. When ovulation is prevented then menstrual cycles become abnormal, infertility can ensue; because androgens are produced then excess hair growth can occur as well.

Since PCOS often stops ovulation from occurring these follicles (cysts/sacs) tend to stay present in the ovary, hence the name POLY (many) CYSTIC (sacs) OVARY. In other words the ovary becomes filled with cysts (ovary with many cysts)

Diagnosis:

Diagnosis of PCOS is typically established by an accurate medical history, blood tests and an Ultrasound. The medical history establishes the signs and symptoms described. The blood tests confirm elevated insulin, elevated androgens and the imbalance of the female hormones. The ultrasound confirms that the ovaries are in fact polycystic (many cysts).

Treatment:

Treating PCOS is a lifelong endeavor. Depending on the patient’s symptoms and the conditions that need to be resolved each patient should have a customized treatment plan. The areas to target are:

  • Symptoms (irregular menstruation, weight gain, excess hair growth)
  • Clinical conditions (infertility, diabetes, insulin resistance)
  • Prevention (diabetes, obesity, endometrial cancer, heart disease)


Medical: Again depending on the age, signs, symptoms and the goal of each patient medical intervention should be customized.

  • Treatment of excess hair growth (topical or system medical treatments)
  • Treatment of insulin resistance or diabetes (Insulin / Glucophage)
  • Treatment of infertility (ovulation induction, Clomid, Gonadotropins, IVF)
  • Treatment of irregular menstruation (Hormone therapy, ovulation induction, birth control pills)
  • Weight gain (Glucophage, other insulin resistance medications)


Surgical: Surgery is sometimes performed on women with severe PCOS, especially women seeking infertility treatment. The surgery performed is called “ovarian drilling”. During this procedure the excessive cysts in the ovary are punctured so as to release the cells that produce the excess androgens. This often causes the ovary to “reset”. Ovulation, regular menstrual cycles and fertility are often restored for a period of time from this simple procedure.

Surgery can also be performed for weight loss. (gastric banding, gastric bypass)

Topical laser therapy can be used for Acne and excessive hair growth that is associated with PCOS.

How you can treat yourself:

Daily exercise: exercise has been shown to decrease insulin levels and can help decrease or relieve many of the symptoms associated with excess insulin.

Weight loss/diet: diet and weight loss can also diminish insulin levels. In conjunction with exercise some women can achieve reversal of many symptoms including spontaneous ovulation and fertility.

Now What?

If you think you have PCOS you should seek medical attention. See your OB/GYN to confirm your diagnosis and start the appropriate treatment and preventive measures necessary to alleviate your symptoms and to prevent worsening of the condition. If you are seeking to get pregnant ask your OB/GYN to refer you to a specialist.

Start Exercising

Start a healthy diet

Quit smoking

See your doctor.

At American Reproductive Centers our doctors specialize in the care of patients with PCOS. Learn how we customize your care based on your specific symptoms and goals.

 

Infertility Relating to the Ovary

Anovulation Definition:

Is suspension or cessation of ovulation.  Anovulation is one of the most common causes of infertility. There are many conditions that cause women to stop ovulating. These conditions include:

Premature Ovarian Failure

  • Fragile X (FMR1) premutations
  • Autoimmune disorders
  • Radiation therapy
  • Chemotherapy
  • Chromosomal abnormalities
  • Galactosemia


Polycystic Ovarian Syndrome (PCOS)
Hypogonadotropic Hypogonadism

  • Anorexia Nervosa
  • Kallman Syndrome
  • X-Linked idiopathic hypogonadotropic hypogonadism


Premature Ovarian Failure:

Premature ovarian failure is commonly referred to as “premature menopause”. This conditions presents with symptoms similar to menopause. It is essentially menopause prior to age 40. Due to the fact that there are many causes for premature ovarian failure the symptoms and the ability to conceive with this disorder can vary significantly.

Causes:

Autoimmune Disorders:

Autoimmune disorders are disorders where certain organs (in this case the ovary) are attacked by the immune system. Conditions below are some of the most common cause:

  • Autoimmune Polyglandular Syndrome Type 1-( APS1)
  • Autoimmune Polyglandular Syndrome Type 2-( APS2)
  • Lupus
  • Myasthenia gravis


Chromosomal abnormalities:

Usually involve the X chromosome. This includes:

  • o45, X (Turners Syndrome)
  • o45, X / 46 XX Mosaicism.
  • o47, XYY.
  • o47, XXY.
  • oX Chromosome translocations or deletions.


Fragile X (FMR1) Premutations:

Is a mutation in the FMR1 gene where certain genetic sequences repeat more than is usual. Once these repeated gene sequences reach 200 repeats the X chromosome becomes “fragile” leading to fragile X syndrome (causes mental retardation and autism). When the repeated gene sequence is elevated but less than 200 repeats (50-200) premature ovarian failure can occur.

Radiation Therapy:

Radiation affects the ovary based on the dosage of the radiation as well as the patient’s age. Older patient’s oocytes (eggs) appear to be more sensitive at older age. Radiation therapy outside the pelvis rarely causes premature ovarian failure.

A Procedure called “Ovarian Transposition” can help prevent permanent ovarian failure. In this procedure the ovaries are surgically moved away from the field of radiation. Other pre-radiation methods can also help, such as embryo freezing, egg freezing or ovarian tissue freezing.

Chemotherapy:

Chemotherapy medications are drugs that kill cells that are actively dividing (hence their effectiveness against cancer cells). Chemotherapy, as in radiation therapy, is more likely to cause premature ovarian failure in older patients then in younger ones.

Cyclophosphamide: is a common chemotherapeutic agent that can cause premature ovarian failure.

List of chemotherapeutics that cause High toxicity to the ovaries:

  • Nitrogen Mustard
  • Melphalan
  • Busulphan
  • Procarbazine
  • Chlorambucil


Galactosemia:

Is a relatively rare genetic disorder that prevents proper metabolism of galactose. It is believed that the galactose metabolites damage the developing eggs and causes POF.

Rare Causes:

BMP15 gene mutation

Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES)

StAR Enzyme gene mutations.

 

Why Age Matters

Women in western society over the last 50 years have chosen to delay childbearing.  With women’s rights movement providing more opportunities to women, women have increasingly chosen to delay marriage and childbearing in exchange for higher educational and career aspirations.

More and more women are going to college and an increasing number are continuing their educations beyond college.  Ivy League schools now boast that their classes are 50% women.  In many colleges and universities around the country, women actually out number men.  Women are also pursuing careers in what was traditionally considered male careers.  Many of these careers are lifetime careers; like medicine, accounting, law, and the military.

All these positive and long sought after social changes have made women’s lives more full and rewarding.  They have also bestowed on women the sense of power and control of their own destinies.  With women in control of their destinies, education, and careers societies pressure to "marry and have children" has greatly diminished.  With the availability of contemporary birth control pills and other birth control methods women have also taken control of the reproductive lives.

First births for women over the age of 30 have risen over the last few decades.  In 1975 women over the age of 30 having their first child accounted for only 5% of births.  In 1995 the same age group accounted for 22% of births.  In 5 years the birth rate for women over the age of 40 has increased by 20%; and increased by 75% from 1981 to 1995.

Women are also delaying childbirth until later in life because they have an exaggerated belief that fertility treatments will help.  The media has also fueled this exaggerated belief.  Media accounts of celebrity mothers achieving pregnancy at an older age using IVF and other fertility treatments has given women a sense that it is "OK" to delay childbearing.

Fertility clinics and physicians often encounter women who have read or seen on TV a celebrity in there 40’s or 50’s "who just got pregnant".  These women wonder if the same can be done for them.

Medical professionals often share many of the misconceptions of the effectiveness of infertility treatment.   It is not uncommon to find patients at fertility clinics that were given misguided advice by their physicians.

The American College of Obstetricians and Gynecologists put out a committee opinion stating, "Age is a significant factor influencing a woman’s ability to conceive.  Social trends have led to deferred childbearing, and an increasing number of women are experiencing age-related infertility and pregnancy loss.  Women older then 35 years should receive expedited evaluation and treatment after 6 months of failed attempts to conceive, or earlier if clinically indicated"

Why Does Age Impact Reproduction

There are several ways in which age affects fertility.

Quantity:  Women are born with one million oogonia (oogonia are the cells that mature into eggs), and by onset of puberty the number of oogonia declines to 300,000.  The oogonia number continue to decline as women age, by age 37-38 the oogonia decline to approximately 25,000.

Quality:  Since the eggs are present from birth, women cannot produce new eggs as they age.  The existing eggs that women are born with diminish over time.  This dwindling of eggs called atresia.  The eggs also start to diminish in quality over time. It is also noted that DNA fragmentation increase as women age, as well as an increase chromosomal degeneration.  Recently research has shown that the structures that separate the chromosomes during cell division may also be affected by age.  These structures are called Microtubules.  These tube like structures are similar to anchors and they pull one chromosome to each side of the dividing cell.  When these Microtubules function improperly or are damaged then the cells division of chromosomes is compromised.  This is likely to be the cause of increased chromosomal abnormalities in children born to older mothers.  Some new studies also show that a group of proteins called Cohesins are responsible in holding Chromosomes together.  These studies indicate that these Cohesins may be reduced as women age.

Whats Next?

As we now know fertility declines for women as they get older.  The decline in fertility declines at different rates for different women.  If you are over the age of 35 and desire to have children it is important that you talk to your gynecologist or family doctor.  Obtain the information that you need to help you through the process.  Ask your doctor if testing is appropriate for you. Remain realistic about your goals and your chances for success.

Simple Steps:

  1. Talk to your Gynecologist or Family doctor.
  2. Simple tests can be helpful (see below)
  3. Be your own advocate
  4. Talk to your partner openly
  5. Keep a record of your menstrual cycles.
  6. Keep a record of any symptoms
  7. If you have tried to conceive for over 6 months without success then seek help.


Simple Tests:

  • FSH: measuring your FSH (follicle stimulating hormone) early in your menstrual cycle [day 2,3 or 4] will evaluate your "ovarian reserve".  Perhaps one of the most simple and informative tests a woman can do to help assess her chances of getting pregnant.  (blood test)
  • AMH:  (Anti-Mullerian Hormone.) It is also known as MIS (Mullerian Inhibiting Substance) . AMH is a hormone that is produced directly by the ovarian follicles, AMH levels correlate with the number of follicles in the ovaries .Women with lower AMH have lower follicular counts and produce a lower number of oocytes compared with women with higher levels.
  • Semen Analysis: although a male test, it is simple to do, non-invasive and inexpensive.  Male infertility accounts for 20-30% of infertility cases. (evaluates sperm under a microscope)
  • HSG: evaluates your fallopian tubes.  It is a special radiologic study that will determine if your fallopian tubes are patent or if there are any blockages.   Fallopian tube problems account for 20-25% of infertility cases.  (uncomfortable procedure, more involved, lasts about 10 mins)


With three tests a woman can determine 80-90% of the causes for infertility.

If you are worried about your age and fertility potential and you live in the Los Angeles area, San Diego area, Orange County, or Riverside County feel free to contact us via phone or email to schedule your appointment.  We recommend that our international patients contact us via Email to help schedule them for a phone consultation.