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Abnormal Menstrual Periods

Although two-thirds of reproductive age women have menstrual cycles that occur every 25-31 days, the definition for normal menstrual cycles are cycles that occur between every 23-35 days. Most women whose menstrual cycles occur less frequently than every 35 days suffer from infrequent ovulation. This may be due to a hormone abnormality with the thyroid gland or due to an elevation in a hormone called prolactin which is involved with breast milk production. Polycystic ovarian syndrome is a condition that affects 5 percent of reproductive women and is the most common cause of infrequent menstrual cycles. This condition is due to a hormone imbalance that prevents the ovary from forming and releasing an egg every month leaving the ovary with several small cysts present within it hence the term polycystic ovarian disease. Women who do not have any periods at all are referred to as suffering from amenorrhea. This condition is due to a hormone imbalance that prevents the ovary from forming and releasing an egg every month leaving the ovary with several small cysts present within it; hence, the term "polycystic ovarian disease".

Women who bleed more frequently than every 21 days may suffer from inflammation or abnormal cells on the cervix. They may also have benign growths such polyps or fibroids inside the uterus. Women may also have abnormal cells that develop inside the cavity of the uterus which is referred to as hyperplasia. This condition is a precursor to some cancers of the uterus and is more common in women who do not ovulate on a regular basis.

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Delayed Puberty

Delayed puberty is defined as a woman who has not initiated breast development by age 13 or who has not had menstrual periods by age 16. A delay in puberty can be caused from abnormal development of the ovaries or from a lack of the hormone messages from the pituitary gland stimulating the ovaries. The most common cause of lack of ovarian formation is a condition called Turner syndrome. In this syndrome, a woman is born missing an X chromosome. These individuals tend to be of short stature and do not have ovaries that develop. These women tend to be of shorter stature, generally less than 5’ 0” tall, and can have other characteristics that are typical of other people with Turner syndrome.

Some women who actually go through puberty but never have menstrual periods by age 16 have a lack of development of some of the internal female organs such as the uterus, vagina and fallopian tubes. The most common cause of this condition is a syndrome called Rokitansky-Kuser-Hauser syndrome. About 20 percent of these individuals also have abnormalities in their kidneys.

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Frequent Miscarriages

The miscarriage rate of women in their early 30s is approximately 16 or 17 percent. Most miscarriages are due to abnormalities of the fertilized egg so that the pregnancy stops developing at some point after implantation. This development may stop within a few days following implantation or following several weeks after implantation. The miscarriage rate is increased as women get older. In women over the age of 40, the chance of having a miscarriage is between 30-50 percent. Women who are younger and get pregnant in their early 20s have miscarriage rates that are closer to 10 percent. The classic definition of recurrent pregnancy loss is three or more miscarriages in a row. This occurs in about 1 percent of the general population. Some causes of recurrent pregnancy loss include abnormalities of the uterus itself. These abnormalities can be evaluated through either a special ultrasound test or an x-ray test called a hysterosalpingogram. Another cause of recurrent pregnancy loss is a condition called a balanced translocation. This is a situation in which either the mother or father does not carry the normal 23 pairs of chromosomes. Instead, they may have chromosomes that are attached to each other in such a way that when they separate to form a sperm or an egg, there is either too little or too much chromosomal information. When the sperm or egg fertilizes the resulting embryo does not have the normal amount of chromosomal or genetic material. This balanced translocation situation occurs in about 3 percent of couples who suffer from recurrent pregnancy loss. A much less common cause of recurrent pregnancy loss is a syndrome called antiphospholipid antibody syndrome. In this condition, there is an elevation in antiphospholipid antibodies or the presence of lupus anticoagulant. It is believed that women who have this condition may form blood clots within the placenta interrupting the blood supply to the embryo resulting in pregnancy loss. Individuals with this condition generally have miscarriages that occur later in the pregnancy. Unfortunately, many couples that have recurrent pregnancy loss do not have an identifiable cause explaining their losses. Fortunately, women who have had three miscarriages in a row and have never had a delivery of a baby, have a 50 or 60 percent chance of having a live birth with their fourth pregnancy. If women have delivered a baby and then have had three miscarriages, they have a 75 percent chance of delivering a healthy infant with their fifth pregnancy.

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Basic and Advanced Fertility Treatment

There are a number of causes of infertility and corresponding treatments for these causes. Basic treatment for infertility may be performed by family physicians and OB/GYNs. These include treatment with fertility pills such as clomiphene citrate and also intrauterine insemination in which the sperm is injected in the uterine cavity at the time of ovulation.

Advanced fertility treatment involves the use of expensive fertility medicines that require careful monitoring to avoid having individuals getting pregnant with a multiple pregnancy. These injections can also be used in conjunction with an intrauterine insemination. More advanced fertility treatment involves in vitro fertilization in which these fertility medicines are used to cause a woman to create several eggs. These eggs are removed with a needle, fertilized in a petri dish and incubated for up to five days. Two or three of the resulting fertilized eggs, or embryos can then be placed into the uterine cavity of woman to attempt a pregnancy.

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InVitro Fertilization (IVF) - 2005 Success Rates
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InVitro Fertilization (IVF) - 2000-2005 Success Rates
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