1. Hormonal Imbalance
2. Obstructed Fallopian Tubes
4. Genetic Diseases
5. Ovarian Insufficiency and Premature Ovarian Failure (POF)
6. Malignant diseases
1. Hormonal Imbalance
A woman’s menstrual cycle is controlled by many different hormones. Hormonal imbalance can result in a variety of disorders. The various underlying causes can be the reason for failure of oocyte maturation (oogenesis), follicle maturation or the absence of ovulation. If the level of the yellow-body (corpus luteum) hormone (progesterone) is insufficient, pregnancy cannot be achieved (corpus luteum insufficiency). Other decisive factors to take into account are e.g. hypothyroidism or hyperthyroidism, elevated prolactin levels, an excessive level of testosterone (polycystic ovary syndrome (PCOS)), extreme physical stress, other stress factors, severe underweight (anorexia, bulimia) or overweight as well as tumors (which is indeed very rare).
Example: Corpus luteum insufficiency
Corpus luteum insufficiency that can be observed in some women occurs when the yellow body that developed from the remnants of the follicle cannot produce enough progesterone
in order to prepare the inner lining for a successful implantation of the embryo and maintenance of pregnancy. A drop in the progesterone level will prompt the shed of the inner lining and thus the onset of the menstruation period.
This hormonal disorder can be assessed by doing a hormone analysis in the second half of the menstrual cycle
or the subsequent days. Too low hormone levels in the days after ovulation indicate such a corpus luteum insufficiency. In these cases a progesterone supplementation may be helpful. Progesterone can be administered orally, vaginally or by an intramuscular injection.
Moreover, it is possible that the corpus luteum doesn’t properly respond to the signals produced by the embryo. This disorder can’t be detected with the help of a hormone analysis. In this case, however, the yellow body can only be prevented from disintegrating by repeated intramuscular injections of HCG
During follicular puncture
performed by aspirating the follicles many of the granulosa cells (which normally develop into the yellow body) are removed, too. This is why an IVF
treatment naturally results in a corpus luteum insufficiency. Here, however, administering progesterone can remedy the situation.
We would like to emphasize that progesterone administered only orally or by vaginal suppositories often provides progesterone levels that are insufficient and interfere with the development of the endometrium. If need be, this way of administering progesterone may be chosen after the 6th week of pregnancy, since at this time the placenta also produces progesterone adding to the dosage provided by suppositories or tablets.