How can I find out if I ovulate?
The importance of ovulation and egg quality:
If a patient has normal regular menstrual cycles, it is typically assumed that she ovulates. If there are cycle alterations, such as menstrual delays or irregularities, there may be an ovulatory problem. An ultrasound and a hormone analysis can help the doctor in making the diagnosis.
Polycystic ovary syndrome
Depending on the type of polycystic ovaries, treatment will be necessary. When the patient is overweight, the first step would be dietary measures. Otherwise, the first line treatment is ovulation induction which is in most instances done by letrozole. The appropriate response is evaluated with ultrasound, the ovulation may be observed with urinary testing. Sometimes an ovulation trigger injection (human chorionic gonadotropin; hCG) is used. The optional treatment involves inducing ovulation with subcutaneous injections of FSH (follicle-stimulating hormone), monitoring follicular development with ultrasound. Sexual intercourse and sometimes insemination should be timed with the ovulation.
This condition is caused by excess secretion of prolactin from the pituitary. Prolactin is responsible for milk production, putting the patient in an anovulatory state similar to lactation. Hyperprolactinemia can be treated with medication, which should also enable ovulations. Sometimes, when prolactin levels are significantly elevated, the pituitary needs to be evaluated with imaging techniques.
It is important to note that in women who are over the age of 35 years, the egg reserve starts to significantly decline. It is estimated that at this age, only about 10 % of eggs remain.
The quality of the eggs decreases significantly with age, and there is only little individual variation. However, the ovarian reserve decrease with age, but the reserve does not always match biological age of the woman. The initial number of follicles a woman is born with is fixed (unlike men, where sperm are produced throughout their life) and as the years pass, the number sufficiently good quality eggs that can achieve a correctly and l full-term pregnancy, decreases.
To assess the ovarian reserve, a transvaginal ultrasound with antral follicle count (AFC) and measurement of the anti-Müllerian hormone (AMH) concentration can be done from a blood sample at any time during the ovarian cycle. The measured AMH value is compared to those established as normal for each age.
AMH (Anti-Müllerian hormone) is secreted from pre-antral and small preantral follicles in the ovaries. All of these small follicles cannot be reliably assessed with ultrasound. The most common reason for AMH measurement is to assess the functional reserve of the ovaries.
AMH determination may also be used whenever poor ovarian reserve and in the extreme case premature ovarian failure is suspected. At menopause, the AMH value drops to undetectable levels. Similarly, in polycystic ovary syndrome (PCOS), the AMH value is significantly high.
The AMH level does not directly reflect the female fertility. However, in infertility evaluation, the dose of hormones used for ovarian hormone stimulation can be planned based on the AMH value. A low value reflects a significant risk that the ovaries will not respond well to hormonal stimulation in IVF treatment. Even with a high dose of FSH, the desired follicle growth and desired number of eggs for fertilization will probably not be achieved.
The AMH level does not reflect the quality of the oocytes (eggs), which is primarily dependent on the female age. AMH value alone cannot be used reliably to evaluate female fertility.
The AMH value is significantly dependent on age and interpretation should always be based on the patient's age. The value decreases with age in an individual fashion.
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