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Ovarian failure is a condition in which the ovaries fail to produce eggs. This is uncommon, occurring in only about 10% of women whose periods do not occur at all, a condition called amenorrhea (absence of periods). Ovarian failure may be genetic (for example, in girls with Turner's syndrome, a chromosomal disorder) or may be acquired (for example, following radiation or chemotherapy for cancer; surgery to remove the ovaries for treating ovarian cancer or severe endometriosis; autoimmune ovarian failure; or for unexplained reasons.) Ovarian failure is diagnosed by finding a high FSH level. In such patients it is usually not possible to stimulate ovulation, because they do not have any eggs, and they suffer a premature menopause. The only effective medical treatment for these patients is the use of egg donation for IVF or GIFT. However, in a very small proportion of these patients, ovulation can resume spontaneously.
What forms of treatments are available for inducing ovulation?
The most commonly prescribed medicines for induction of ovulation include the following: clomiphene citrate, human menopausal gonadotrophin (HMG) and follicle stimulating hormone (FSH), HCG (human chorionic gonadotropin), bromocriptine, GnRH (gonadotropin releasing hormone) and GnRH analogue.
For women with hypogonadotropic hypogonadism (low FSH and LH levels), the treatment of first choice is HMG. This is effective replacement therapy; and excellent pregnancy rates can be achieved in these women.
For women affected by hyperprolactinemia, the drug of first choice is bromocriptine.
For most other women, the drug of first choice is clomiphene - the "workhorse" of ovulation induction. If this does not work, then HMG is resorted to.
Poor responders to HMG can be treated with GnRH analogues in conjunction with the HMG; or by adding a hormone called the human growth hormone (HGH).
HCG (human chorionic gonadotropin) is given to trigger off the release of the egg.
In patients with high androgen levels (high blood levels of male hormones), dexamethasone can be used as an adjunct, since this suppresses androgen production.
Often ovulation induction requires an investment of considerable time, money, energy and emotion before a satisfactory response is achieved. After all, every woman is different and there can be no standard "formulae". Careful monitoring of the response to ovulation induction is the key to therapy - and this usually involves daily ultrasound scans and/or blood tests. It is often a tedious process - which may involve "trial and error" to tailor the therapy to the individual patient's ovulatory response. With the treatments available today, however, correcting ovulatory dysfunction is one of the most rewarding and successful of infertility treatments.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
