Anovulation

An anovulatory cycle is a menstrual cycle during which the ovaries do not release an oocyte. Therefore, ovulation does not take place. However, a woman who does not ovulate at each menstrual cycle is not necessarily going through menopause. Chronic anovulation is a common cause of infertility.

CauseHormonal or chemical imbalance

This is the most common cause of anovulation and is thought to

account for about 70% of all cases.

1.About half the women with hormonal imbalances do not produce

enough follicles to ensure the development of an ovule. This

could be caused by poor hormonal secretions from the pituitary

gland or the hypothalamus.

2.The pituitary gland controls most other hormonal glands in the human

body. Therefore, any pituitary malfunctioning affects other glands

under its influence, which includes ovaries. This occurs in around

10% of the cases. Mammary glands are also controlled by the

pituitary gland, which can thus also affect lactation.

3.The hypothalamus controls the pituitary gland. In 10% of the cases,

alterations in the chemical signals from the hypothalamus can

easily seriously affect the ovaries.

4.There are other hormonal anomalies with no direct link to the ones

mentioned above that can affect ovulation. For instance, women

with hyper or hypo-thyrodism sometimes have ovulation

problems. Thyroid dysfunction can halt ovulation by upsetting the

balance of the body’s natural reproductive hormones. Polycystic

ovary syndrome (also known as Stein-Leventhal syndrome) and

hyperprolactinemia can also cause anovulatory cycles through

hormonal imbalances.[1][2]

Functional problem

This accounts for around 10-15% of all cases of anovulation.

1.The ovaries can stop working in about 5% of cases. This may be

because the ovaries do not contain eggs. However, a complete

blockage of the ovaries is rarely a cause of infertility. Blocked

ovaries can start functioning again without a clear medical

explanation.

2.A significant emotional shock can temporarily affect the functioning of

the brain and can lead to dysfunction of the hypothalamus.

However, this is not as common as people might think.

3.In some cases, the egg may have matured properly, but the follicle

may have failed to burst (or the follicle may have burst without

releasing the egg). This is called luteinised unruptured follicle

syndrome (LUFS). Physical damage to the ovaries, or ovaries

with multiple cysts, may affect their ability to function. This is

called ovarian dystrophy. Patients who are suffering from Stein-

Leventhal syndrome (also referred to as polycystic ovary

syndrome, or PCOS) can also suffer from anovulation.[3] Up to

90% of cases of anovulation are caused by PCOS; this syndrome

is usually hereditary.[4][5]

Weight loss or anorexia can also cause hormonal imbalance, leading to irregular ovulation (dysovulation). It is possible that this mechanism evolved to protect the mother’s health. A pregnancy where the mother is weak could pose a risk to the baby’s and mother’s health. On the other hand, excess weight can also create ovarian dysfunctions. Dr Barbieri of Harvard Medical School has indicated that cases of anovulation are quite frequent in women with a BMI (body mass index) over 27 kg/m2.[6][7][8] Unfortunately, not only does excess weight have a negative impact on ovulation itself,[9] but also on treatment efficacy and outcomes of ART (assisted reproductive technique).[10][11]

Sign and SymptomAnovulation is usually associated with specific symptoms. However, it is

important to note that they are not necessarily all displayed

simultaneously.

- Amenorrhea (absence of menstruation) occurs in about 20% of

women with ovulatory dysfunction.

- Infrequent and light menstruations occur in about 40% of

women with ovulatory dysfunction.

- Irregular menstruation, where five or more menstrual cycles a

year are five or more days shorter or longer than the length of the

average cycle.

- Absence of mastodynia (breast pain or tenderness) occurs in

about 20% of women with ovulatory problems.

- Increased body mass and facial hair (this is relatively easy to treat, and is often associated with PCOS, or polycystic ovary syndrome).

ANOVULATION

Siklus haid yang anovulatoir adalah siklus haid dimana ovulasi (=lepasnya sel telur) tidak terjadi. Ini artinya haid tetap timbul seperti biasa tetapi tidak melepaskan sel telur, disebut dengan istilah anovulasi. Hal ini biasa terjadi pada usia perimenopause. Jika terjadi haid tanpa ovulasi maka akan sulit untuk bisa hamil (infertilitas).Anovulasi bisa disebabkan oleh berbagai hal, mulai dari pengaruh diet sampai dengan dan olah raga sampai ke gangguan kelenjar kecil yang ada di otak yang mengontrol fungsi2 dasar manusia. Beberapa penyebab mudah diidentifikasi sedangkan sebagian lainnya sulit.

Gangguan keseimbangan hormon merupakan penyebab terbanyak siklus anovulasi. Penyebab lainnya adalah olahraga yang berat seperti, lari bisa mempengaruhi siklus haid dengan cara menekan keluarnya hormon yang disebut gonadotropins dari hypothalamus di otak. Ansietas dan stres emosional juga berperanan sebagai penyebabnya.

Siklus anovulasi secar umum disebabkan: gangguan makan, gangguan hypothalamus, hiperprolaktin (hormon susu yang tinggi), PCO/SOPK, defek fase luteal, atau adanya tumor kelenjar hipofise, kelenjar anak ginjal (adrenal) atau ovarium (indung telur) dan penyebab lainnya. Penyebab lain yang mungkin adalah pemakaian obat2an tertentu dalam jangka panjang. Obat golongan steroid serta pil KB kadang2 dapat menyebabkannya.

Begitu penyebabnya sudah diketahui, maka segera

dihindari, terutama bagi yang belum memiliki anak. Hindari olahraga yang berlebihan, dan hindari diet (mengurangi makan) yang berlemak. Belajar mengatasi stress dan bergaya hidup yang sehat.

Anovulasi bisa sulit di deteksi. Pada beberapa wanita bahkan haidnya sangat normal walaupun tidak ada ovulasinya. Paling sering wanita yang tidak berovulasi juga mengalami tidak haid (=amenorrhea), atau haidnya sedikit (=oligomenorrhea). Sehingga jika mengalami haid yang sedikit , singkat dan tanpa nyeri bisa menjadi alarm bagi wanita dan dokternya akan adanya siklus anovulasi.

Jika mengalami perdarahan antara siklus haid lebih dari 2-3 siklus haid, besar kemungkinan siklusnya anovulasi. Banyak siklus-siklus anovulasi ini berhubungan dengan perdarahan yang tidak teratur atau hiperplasia endometrium. Pemeriksaan yang dilakukan bisa seperti di bawah ini (tergantung anjuran dokter).

* LH (hari ke 13 dan 15 siklus mens)* FSH* Progesteron* Prolaktin* DHEA-SO4* Testosteron and SHBG* CT scan atau MRI scan hipofise dan hypothalamus* Biopsi Endometrium* Biopsi Ovarium

Pengobatan siklus anovulatoir bervariasi tergantung penyebabya dan faktor lainnya seperti usia dan riwayat medis. Pada banyak wanita infertil dengan anovulasi, pengobatan obat2 pemicu ovulasi sering membawa keberhasilan (hamil). Clomiphene citrate (Clomid) merupakan obat pilihan pertamabagia wanita yang anovulasi yang menghasilkan estrogen.

JIka pemberian clomiphene saja tidak berhasil, ditambah dengan Pergonal untuk memacu matangnay sel telur (folikel). Obat ini langsung nerangsang indung telur, dan jika folikel tumbuh dengan ukuran yang cukup, maka diberikan injeksi hormon HCG agar ovulasi bisa segera

terjadi.

Beberapa pengobatan lainnya yang dapat dipergunakan secara bersamaan adalah:

* Pengobatan untuk penyakit yang ada (penyebab)* Modifiaksi nutrisi* Mengurangi stress* Pembedahan tumor