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Pregnancy

Ovulation Disorders: Impact On Pregnancy

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Ovulation Disorders

Infertility, or failure to conceive, is a problem that a growing number of couples are having to live with today. The reasons for this can be varied, some due to medical or genetic factors, some age-related, and some due to lifestyle factors like smoking, stress and obesity. When a couple is unable to conceive naturally, and there is no significant medical history that may point towards a cause, the first areas to look at usually are ‘problems with production’ – that is ovulation in a woman and sperm production in a man. Let us try to understand what is ovulation and the role it plays in fertility of a woman.

What is Ovulation?

It is the process where a mature egg is released from the ovaries and moves down the fallopian tube. It stays here for 12 to 24 hours. This is the window when it can be fertilized by sperm. Post sexual intercourse, sperm can live inside the female reproductive tract for about 5 days.

The most common cause of female infertility in often due to an ovulation disorder.

What is an ovulation disorders?

Infrequent ovulation, or no ovulation is termed as an ovulation disorder. This can be caused due to problems with the regulation of reproductive hormones or problems in the ovary.

Some common causes are:

Polycystic ovary Syndrome (PCOS): This is a condition that causes hormonal imbalance and is usually associated with insulin resistance and obesity. PCOS has been seen to be a leading cause of infertility.

Hypothalamic dysfunction: Follicle stimulating hormone (FSH) and Luteinizing hormone (LH), produced by the Pituitary Gland, are responsible for stimulating ovulation every month. Excess stress (both physical and mental), low body weight or a sudden weight gain or loss can cause an imbalance in the normal production of these hormones. This, in turn, can affect ovulation.

Primary ovarian insufficiency, also known as ‘Premature ovarian failure’, could be due to an autoimmune issue or premature loss of eggs from the ovary. This may be due to genetic condition or a fallout of a medical therapy (chemotherapy). In such cases the ovary no longer produces eggs and oestrogen levels are lowered before the age of 40.

Too much prolactin: Hyperprolactinemia is a condition where the pituitary glands produce too much prolactin, which causes the production of oestrogen to reduce, thus causing infertility. This condition can be a fallout of taking medications for some other condition.

How can an ovulation disorder be diagnosed?

If you are unable to conceive after trying naturally over a prolonged period, a visit to a fertility specialist is recommended. The doctor may suggest the following to see whether you have an ovulation problem.

  • An over-the-counter test kit to test whether your LH hormone production is as it should be
  • Blood test to check progesterone and prolactin levels
  • Ovarian reserve testing: To determine the quantity and quality of eggs available for ovulation in your ovary. Women above the age of 35 are more likely to have a depleted quantity of eggs.
  • Hormone testing to check levels of ovulatory hormones as well as thyroid and pituitary hormones that control the reproductive process.
  • In rare instances laparoscopy or genetic testing may be required to detect abnormalities

How are ovulation disorders treated?

Treatment largely depends on the cause. Medications are usually the first option of treatment. Fertility drugs are prescribed to regulate and stimulate ovulation. These drugs do the work of the normal – LH and FSH – hormones and help in inducing ovulation. They may also be used to increase the number of eggs produced and for improving the quality, in women who may have inadequate ovulation.

Are there any risks in taking fertility drugs?

Oral medications usually carry no risk. Injectables may have a risk of inducing multiple pregnancy or Ovarian hyperstimulation syndrome (OHS), but the risk is low. The results are usually positive.

The role of assisted reproduction

In women with ovulation disorders, if fertility drugs alone are unable to produce the desired result, In-vitro fertilization (IVF) is a recommended treatment that can help a couple in getting pregnant. Post stimulating ovulation with the help of drugs, matured eggs are extracted from the ovary and fertilized in a petri dish in the laboratory with sperm donated by the male partner. The fertilized egg is then implanted in the uterus to induce pregnancy.

Pregnancy

Your Pregnancy Journey: The 2nd Trimester

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2nd trimester

Now that you have got through the 1st Trimester, the first three months of your pregnancy, things begin to settle down somewhat. As you enter your 2nd trimester of your pregnancy, the morning sickness and fatigue that you may have felt earlier will slowly fade away. Your system is now more adjusted to your ‘new status’ and the hormonal changes that your body has undergone when you conceived. Now you begin to feel more ‘normal’, less exhausted, and more energetic.

For most women this is the easiest three months of their pregnancy. So, it is time to take advantage of this feel-good phase and start planning for your baby!

What happens during the 2nd trimester?

Now your baby is growing quickly. Your doctor will do an ultrasound between week 18 and 24 to see your baby’s progress. You may even pleasantly learn that you are going to have not twins!

The changes taking place in your body

You may feel cramps, dull ache and sometimes sharp stabs of pain in your abdomen. This could be because:

  • Your uterus is expanding and this puts pressure on the nearby muscles and ligaments
  • Your round ligament muscle stretches causing cramps
  • Of constipation or gas

Minor cramps and aches are normal. A warm bath, relaxation exercises, shifting your body’s position or a hot water bottle compress can be helpful in easing the discomfort. However, if you experience intense pain or discomfort, call your doctor immediately.

Backache is a common problem

The extra weight you are putting on, particularly on your belly, can be hard on your back. The increasing pressure is likely to cause backache. Certain home remedies that can help:

  • Sitting up straight – choose a chair with good back support
  • Sleep on your side with the pillow tucked between your legs
  • Avoid lifting or carrying anything heavy
  • Comfortable, low-heeled shoes are a must for stability as you walk

If nothing works, then a good pregnancy massage can be relaxing both for your body and mind!

Some women may develop gum problems

Hormonal changes during pregnancy cause more blood to flow to your gums, this can make them swollen and tender, and even lead to bleeding. This is usually a temporary problem that goes away after the delivery of the baby. It is, however, necessary to maintain dental hygiene, as women with gum disease are more likely to deliver premature babies. Use a soft toothbrush to ease your discomfort as much as possible.

Short, irregular contractions are normal and not a sign of labour.

During the 2nd trimester, your uterus muscles may tighten for about a minute periodically. These are not real contractions and are not indication of labour. They can be triggered by intense exercise, sex, dehydration, a full bladder or even somebody touching your baby bump. When this happens, try to relax by having a warm bath, have a cup of warm tea, drink some water, or turning on your side if you are lying down.

Your breasts will continue to grow

Though the breast tenderness you felt is likely to be less now, they will keep growing. Wearing a good support bra is recommended for better comfort.

You may develop snoring!

When your partner complains about your snores at night, it may come as a surprise to you. The mucous membranes in the lining of your nose swell due to hormonal changes, causing stuffiness which is the reason for the snore. You may also experience nose bleed due to this. It is advisable to avoid decongestants and use saline water or other natural methods to relieve the stuffy nose.

Some vaginal discharge is normal

A milky white, thin discharge from your vagina may be cause of some discomfort, but it is normal. However, if the discharge is foul smelling, green, yellow or bloody, or happens in large quantities

You may experience some dizziness

This could be caused by your expanded uterus pressing against blood vessels, hormonal changes or low blood sugar. Some precautions you need to take:

  • Avoid standing for too long
  • Stand up slowly from a sitting position
  • Keep yourself well hydrated
  • Eat small, frequent meals
  • Lie on you side, and not on your back
  • Wear loose clothes

The problem of frequent urination will be lesser now, as your uterus rises away from the pelvic cavity, giving you some respite.

The most visible effects of pregnancy will be seen on your skin.

  • The ‘pregnancy glow’ is the result of the changing hormone levels that causes the skin on your face to look flushed
  • Brown marks may appear on your face due to increased melanin levels
  • At this time your skin is overtly sensitive to sunlight. Whenever you go out, choose clothes that give maximum coverage to your skin, always use a broad spectrum sun-screen and if possible, avoid going out in the sun between 10am and 2 pm
  • Stretch marks – reddish-purple lines – may appear on your breasts, thighs and abdomen, as you skin stretches. You doctor may prescribe some lotions or creams for this. These marks will gradually fade after the delivery of your child.

Some common health problems that some of you may experience may include headache, heartburn, constipation or leg cramps. Try to balance your meals, exercise and sleep to reduce the discomfort. Avoid self-medicating. If the discomfort is intense, then talk to your doctor.

Varicose veins may sometimes form as haemorrhoids around the anus, which can be itchy and uncomfortable. Talk to your doctor about how to relieve the discomfort. Varicose (swollen) veins can also form in your legs owing to slower blood flow resulting from the pressure from the growing baby. Taking the pressure of your feet by not standing for a long time and putting your feet up while sitting can help in easing the discomfort.

Urinary Tract Infections (UTI) are common during the 2nd trimester. This may be because the growing uterus often makes it difficult to empty the bladder. Be aware of the symptoms like a burning sensation while urinating, pain in the lower abdomen, smelly or reddish urine, and immediately visit your doctor. Untreated UTI can spread to your kidneys and lead to severe complications.

What happens to your baby during the 2nd Trimester?

  • Your baby will grow about 16 inches and by one and a half kilos.
  • The brain and other organs begin to develop
  • The lungs develop fully though they are not able to breathe on their own
  • The baby can kick, move, turn around, suck and hear your voice
  • The eyes and ears move to the correct position, eye lashes and eyebrows grow
  • Fingers and toes separate, nails grow, they develop finger prints and footprints
  • Eyelids can open & shut, the baby wakes and sleeps in normal cycles
  • Hair grows on the baby’s head
  • The placenta develops fully and through it the baby receives the nutrients from you and is able to discard the waste