Many patients believe that the ovaries alternate in their ovulatory function in an orderly manner. One month the right ovary ovulates and the next month the left ovary ovulates. The reality is that both ovaries work simultaneously, sometimes both ovaries can ovulate, and most of the time it is the largest follicle that breaks away, but this does not follow any order. In fact, it is not uncommon for one ovary to ovulate more frequently, and obviously after a surgical procedure to remove one ovary, patients do not skip ovulation because the remaining ovary always ovulates since the other one is not there to compete with it.
It is a widespread false belief that ONE EGG is usually used with each ovulation. The reality is that it is one or at most two eggs that manage to leave the ovary each month to reach the tube, but dozens of follicles from both ovaries compete each month (antral follicles), and hundreds or thousands of (primordial) oocytes do not even compete and are also lost every month.
It is estimated that from before birth until menopause, a woman uses between 500 and 2000 eggs each month regardless of whether she ovulates or not. Therefore, having the first period at a young age, having taken the contraception pill, having had few periods, having undergone ovarian stimulation treatments, etc. does not change the monthly loss of eggs, it only changes the number of eggs that have managed to leave the ovary. Throughout a woman’s life, more than 500 eggs are not usually ovulated outside the ovary, but she uses several million eggs during that period of time until menopause.
The term polycystic ovaries indicates the presence of more than 12 small follicles spread across the cortex of one or both ovaries. In other women, the distribution of follicles is usually spread more evenly throughout the ovary.
Having polycystic ovaries and having polycystic ovary syndrome is not the same thing. Many women have polycystic ovaries, which means that their number of follicles is higher than usual, but in these cases there are usually no fertility problems.
However, polycystic ovary syndrome (PCOS), which is a hormonal disorder affecting 10-15% of all women of reproductive age, is (sometimes) associated with fertility problems.
Women with PCOS have high levels of hormones called androgens (a male hormone found in small amounts in women), characterised by the presence of at least 2 of the following 3 criteria:
PCOS is a very heterogeneous disorder and does not present or develop in the same way in all women. It can be associated with menstrual irregularities and obesity (with hyperinsulinism or metabolic syndrome) and lead in some women to the failure to release mature eggs, causing fertility problems and sometimes sterility in those women.
These high levels of hormones, which are produced in the ovary or adrenal glands, can make it difficult to release mature eggs because either ovulation does not always occur, or ovulation may be delayed. It is usually associated with an inversion of the FSH/LH index.
Some of the most prominent symptoms in women with PCOS may include:
Endometriosis occurs when tissue that naturally lines the inside of the uterus (endometrium) is found outside the uterus, most often affecting the ovaries and tubes. This tissue can irritate the structures it touches, causing pain and adhesions (scar tissue) in these organs. Endometriosis may decrease your chances of getting pregnant.
30% to 50% of infertile women have endometriosis. Sometimes endometriosis can grow inside the ovary and form a cyst (endometriomas) that can be seen on a high-resolution ultrasound.
Endometriosis can influence fertility in several ways: it distorts the anatomy of the pelvis; produces adhesions that could affect the mobility of the tubes and prevent the correct uptake of the oocyte leaving the ovary; causes inflammation in some organs of the pelvis; causes inflammation in the body; alters the functioning of the immune system; changes the hormonal environment of the eggs; impairs the implantation of pregnancy; and sometimes alters the quality of the egg.
