Ovarian factor infertility is the most common female factor and also one of the most complicated to work up. Ovulatory disorders account for about one-quarter of all female infertility types and are closer to one-third when hyperprolactinemia is included.
The factor can be divided into two categories, ovulatory dysfunction and diminished ovarian reserve. Ovulatory dysfunction refers to any condition or process that interferes with the follicle development or ovulation. Diminished ovarian reserve is diminished egg quality and count, and includes: advanced maternal age (>35 years old) and naturally occurring ovarian decline.
Clues in determining the presence of ovarian factor infertility from a patients history can include irregular menses, premenstrual or mid-cycle bleeding, abnormally light or heavy menses. A patient may also experience fatigue, hair loss, signs of hirsutism, galactorrhea or obesity. In the case of diminished ovarian reserve an abnormal menstrual history may be accompanied by a variety of menopausal symptoms.
There is no single test for ovarian factor infertility but, we can begin with a serum luteal-phase progesterone reading. Ovulation predictor kits are a convenient at-home way for women to determine ovulation timing by measuring luteinizing hormone levels in the urine. Transvaginal ultrasound can also help demonstrate signs of ovulation by revealing free fluid and/or a collapsed follicle, although not commonly practiced in ovarian factor work up unless the woman is preparing for IUI or IVF.
When testing for ovarian reserve, the most commonly used are early follicular-phase follicle-stimulating hormone combined with estradiol, anti-Mullerian hormone and antral follicle count. As ovarian reserve declines, follicular phase will shorten and FSH will rise. We can run comprehensive labs to check your general health and your genomic health.
Dunlap, C., ND, MS. (2018, February). Ovarian Factor Infertility. Ndnr, pp. 1-5.