If the patient has regular menstrual cycles, we have to think that she is ovulating. If she has cycle disorders, such as delays or irregularities, we should think that there could be an ovulatory problem. Ultrasound and hormonal analysis will lead us to a diagnosis.
Importancia de la ovulación
The most frequent causes that prevent a patient from ovulating are:
Polycystic ovaries: Depending on the kind of polycystic ovaries, a different treatment will be recommended. If there is overweight associated, the first thing would be to adopt dietary measures. However, in other cases the treatment consists in inducing ovulation by administering FSH hormone (follicle stimulant) subcutaneous injections, monitoring via ultrasound the development of the follicles and focusing on having sexual intercourse on ovulation day.
Hyperprolactinemia: This is an alteration produced by an excess of secretion of the milk-producing hormone and puts the patient in a similar situation as in breastfeeding. It is solved with medication.
When these are the only causes of infertility, a pregnancy can be quickly achieved, on the first cycles, once ovulation returns to normal.
Are my eggs of good quality?
If the patient is over 35 years, this should be taken into consideration right from the start, because at this age only 10% of the eggs remain.
We know that the amount and the quality of the ovarian reserve of oocytes decreases with age, and that ovarian age does not always match biological age. The follicular amount of each woman is set at birth (they do not multiply, as it is the case in men) and, as years go by, the amount of reserve oocytes subject to fertilise correctly and lead to a pregnancy decrease.
In order to evaluate a woman’s ovarian reserve, it is necessary to carry out a transvaginal ultrasound on the first days of the cycle with a Basal Antral Follicle Count (AFC) and an Anti-Müllerian Hormone (AMH) analysis, which can be carried out at any time of the ovarian cycle. This is obtained from a simple blood test, whose results are compared with those established as normal for each age.
Download the tables of values of the Antimüllerian hormone for the Spanish population
Until now, the values of the Anti-Müllerian hormone that were used to evaluate the results came from blood tests carried out by women of other continents. Now we have those of the Spanish population, thanks to a study carried out by Institut Marquès, which allows us to accurately assess the fertility of women in our country.
Although the study has been carried out only with Spanish women-10,443 participants between 20 and 45 years old took part in the trial-, the results are estimated closer to the European population than to those values represented on the American or Asian tables, used as references up to now.
The study, published in the official journal of the Spanish Society of Gynaecology and Obstetrics (SEGO), shows relevant differences in comparison with those published in other countries and also between Spanish autonomous communities, although no pattern is observed that can explain them.
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