A normal ovulatory menstruation cycle a woman ovulates every cycle. After ovulation, the level of estrogen drops then raise again in the second part of period. At the same time progesterone raise and keep at a high level. Two weeks later, both hormones retreat and menstruation start. Usually after ovulation you will have period in two weeks unless pregnant.
However, can you have still period without ovulating?
Sometimes although follicles in the ovaries develop periodically, even with menstrual cramps but the follicles do not rupture to release mature eggs, and there is no formation of a corpus luteum in the ovaries. This phenomenon of menstruation without ovulation is called anovulatory menstruation, or anovulatory cycle.
Generally speaking, anovulatory menstruation is caused by hypothalamic hypoplasia, or delayed development, imperfect regulation between the hypothalamus, pituitary gland and ovarian axis, decreased ovarian reserve, hormonal disorders, or long-term emotional stress and fatigue. Those can all can cause abnormal uterine bleeding.
Symptoms of anovulatory menstruation are abnormal bleeding, variable amount, prolonged cycle or repeated irregular vaginal bleeding. Some people’s period seem to have certain time pattern and thinks that they have normal menstruation period. However no evidence of ovulation can be found through ultrasound or basal body temperature.
Typical anovulatory dysfunctional uterine bleeding may have several months of amenorrhea before menstruation, followed by heavy vaginal bleeding, which often changes to vaginal bleeding after a few days. The bleeding can last for a few days or for a couple of weeks. It may even cause anaemia.
The diagnosis of anovulatory menstruation can be judged mainly through clinical examination. It can be checked by observing the thickness of the endometrium and vaginal discharge. According to whether the menstruation has regularity and the symptoms and signs associated with menstrual period cycle, we can generally diagnose whether it is anovulatory menstruation.
To confirm the diagnosis of anovulatory menstruation, the diagnosis can be confirmed by color Doppler ultrasound or blood test for endocrine examination. You can do a ultrasound during ovulation to see if there is follicle development and mature follicle rupture. You can also have blood test to see if estrogen, luteinizing hormone, and progesterone have risen to determine whether it is anovulatory menstruation.
If the cycle length and flows are normal, the menstruation bleeding come and end in time, and it is usually ovulatory menstruation.
An estimated 15% of couples in the world suffer from infertility. According to a survey in 2013 by the National Institute of Health and Clinical Optimization (NICE) in the United Kingdom, male factors have become the main reason for infertile couples to use assisted reproductive therapy (ART).
Male infertility is mainly diagnosed by routine semen analysis (WHO standard), including semen volume, concentration, vitality and morphology.
Although studies have shown that semen quality and ART outcome are correlated, until now, we have not found a conventional semen threshold that can predict the success of ART.
Recent studies have shown that sperm DNA fragmentation (SDF), including sperm DNA single-strand breaks and double-strand breaks, are all related to male infertility factors, which can adversely affect the male reproductive system and increase the risk of genetic diseases in offspring .
Two previous Meta-analysis studies have shown that SDF is related to ART failure and repeated pregnancy loss.
However, human sperm itself does not have DNA repair activity (DRA). Once fertilised, DRA mainly depends on the transcripts produced during the maturation of the oocyte to repair it. The ability of oocytes to repair SDF depends on the degree of fragmentation of SDF and the quality of oocytes.
Therefore, reproductive medicine researchers from Sao Paulo, Brazil, conducted research on women’s age and SDF and the outcome of intra-cytoplasmic sperm injection (ICSI) assisted pregnancy.
Amanda Souza Setti et al. collected 540 couples who underwent ICSI at the centre from May 2017 to December 2019, and divided the ICSI cycle into three groups according to the age of the woman: ≤36 years old (285 cases), 37-40 years old ( 147 cases) and >40 years old (108 cases).
Sperm chromatin diffusion test was used to evaluate the SDF of semen specimens.
For each age group, according to the SDF index, the ICSI cycle is divided into two subgroups: low fragmentation index (SDF <30%) and high fragmentation index (SDF ≥ 30%).
Summarised and analysed the outcome indicators such as embryo implantation rate, pregnancy rate and abortion rate.
The study found that: for young patients (36 years old) and patients between 37-40 years old, whether SDF <30% or SDF ≥ 30%, the laboratory and clinical results of the ICSI cycle were not significantly different.
When female patients are older than 40 years old, compared with SDF<30%, in an ICSI cycle with SDF ≥ 30%, the rate of D3 high-quality embryo acquisition (54.4% vs 33.1%) and the rate of blastocyst formation (49.6% vs 30. 2%), pregnancy rate (20.0%vs7.7%) and implantation rate (19.7%vs11.9%) were significantly reduced, while miscarriage rate (12.5%vs100.0%) increased.
The results of the study showed that, Older oocytes, when injected with sperm derived from samples with high SDF (Sperm DNA Fragmentation) index, develop into embryos of poor quality that lead consequently to lower implantation and pregnancy rates and higher miscarriage rates, in intracytoplasmic sperm injection cycles from women with advanced maternal age.
The results of this study are of great significance to clinical work. Women’s age cannot be changed, but male SDF can be improved through diet, environment, lifestyle changes, antioxidant and other therapies. This study may provide new ideas for improving the ART pregnancy rate of elderly couples and reducing the abortion rate.
Oocyte ability to repair sperm DNA fragmentation: the impact of maternal age on intracytoplasmic sperm injection outcomes
Fertility and Sterility (IF7.329), Pub Date : 2021-02-13, DOI: 10.1016/j.fertnstert.2020.10.045
Amanda Souza Setti, Daniela Paes de Almeida Ferreira Braga, Rodrigo Rosa Provenza, Assumpto Iaconelli, Edson Borges
Is maternal caffeine intake associated with neonatal anthropometry?
In this cohort study of 2055 women from 12 clinical sites, measures of caffeine consumption (plasma caffeine and paraxanthine and self-reported consumption) were associated with neonatal size at birth.
Increasing caffeine measures were significantly associated with lower birth weight, shorter length, and smaller head, arm, and thigh circumference.
A study has found that caffeine consumption during pregnancy, even in amounts less than the recommended 200 mg per day, is linked to smaller neonatal anthropometric measurements.
The longitudinal cohort study in JAMA Network Open concluded that compared to women who drank no, or very little caffeine, women who drank the most caffeine (a plasma caffeine level of ≤ 28 ng/mL) had neonates who weighed 84 g less, were 0.44 cm shorter in length, a 0.28 cm smaller head circumference, a 0.25 cm smaller arm circumference, and a 0.29 cm smaller thigh circumference.
“Most of the research on caffeine and neonatal size at birth focuses on birthweight and length, while relying on self-reported measures of caffeine consumption.,” said senior author Katherine Grantz, MD, an investigator in the Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, in Bethesda, Maryland.
The current study analyzed data from the NICHD Fetal Growth Studies–Singletons, which enrolled 2,055 nonsmoking women at low risk for fetal growth abnormalities with complete information on caffeine consumption from 12 U.S. clinical sites between 2009 and 2013.
“In the NICHD Fetal Growth Studies, we have rich data on multiple measures of neonatal anthropometry to more specifically characterize neonatal size, as well as objective measures of plasma concentrations of caffeine and its primary metabolite, paraxanthine,” Grantz told Contemporary OB/GYN.
The two main sources of caffeine were coffee and soda, which accounted for 35% and 41% of caffeine intake, respectively.
Caffeine was evaluated by both plasma concentrations of caffeine and paraxanthine and self-reported caffeinated beverage consumption measured/reported at 10 to 13 weeks gestation.
Caffeine metabolism was defined as fast or slow, based on genotype information from the single nucleotide variant rs762551.
“Prior caffeine studies have observed lower birthweight after consumption of higher amounts of caffeine — usually 200 to 300 mg, or 2 to 3 cups of coffee, daily,” said Grantz, who served as a co-principal investigator of the NICHD Fetal Growth Studies.
Before starting their analyses, the current authors knew that the average consumption in the sample was much lower, about 35 mg/day, and only 16 women reported drinking more than 200 mg/day.
Because of this low consumption, we were uncertain we would see any significant results, so it was surprising that we still found that increasing caffeine consumption, even at low levels, was associated with some smaller anthropometric measures in the offspring,” Grantz said. “Also, the finding that the decreases in birthweight were manifested by decreases in bone and muscle measures, but not skin folds and fat mass, were unexpected. These findings may indicate decreases in lean tissue as caffeine consumption increases.”
The clinical implications of the study are unknown, considering there were only small reductions in some neonatal anthropometric measures, Grantz said. “Other evidence suggests that even small amounts of caffeine intake during pregnancy (50 mg/day) could be associated with a higher risk of excess growth in infancy and childhood that could put children at higher risk of later cardiometabolic disease,” she said.
“Therefore, our results could indicate some disruption in normal fetal growth patterns, but will require more research to confirm.”
Although the study authors are unable to make recommendations based on the results of their single study, “we encourage pregnant women to talk to their providers about caffeine consumption, and suggest that caution may be warranted,” Grantz said.
The next step for the investigators is to evaluate the serial ultrasounds and fetal volumes conducted throughout pregnancy by the NICHD Fetal Growth Studies to determine when changes begin in fetal growth in relation to caffeine measures, and how these changes may be manifested in fetal volumes.
Grantz reports no relevant financial disclosures.
Gleason JL, Tekola-Ayele F, Sundaram R, et al. Association between maternal caffeine consumption and metabolism and neonatal anthropometry: a secondary analysis of the NICHD Fetal Growth Studies–Singletons. JAMA Network Open. Published online March 25, 2021. doi:10.1001/jamanetworkopen.2021.3238
broccoli is the star but eating plenty of green vegetables of the cruciferous family help the liver metabolise oestrogen.
Other cruciferous vegetables include: Bok-Choy, Brussels sprouts, Cabbage, Cauliflower, Chinese cabbage, Daikon radish, Horseradish, Kale, Radish, Turnip and Watercress.
Eat high fibre foods to help oestrogen bind in the bowel and assist elimination.
One source suggests that eating 1/2 cup of raw grated carrots can be enough fibre to assist in elimination
Decrease alcohol consumption
Assist the liver by drinking St Mary’s Thistle and Dandelion tea
Eat a no sugar and no gluten diet
sugar and gluten are both highly inflammatory in susceptible people so should be avoided when possible
Be mindful of too many vitamins, supplements, medications and even caffeine that all need to be processed by the liver, where possible space them out through the day.
Chinese herbal medicine
Some Chinese herbal medicine /formula may help assist in balance your hormone. You may contact us for details.
Natural Ways to Increase Progesterone
google progesterone steal if you are more interested in how stress affects progesterone levels
750 mg vitamin C per day (increased progesterone 77% and improved fertility)
600 mg vitamin E (increased progesterone in 67% of patients)
6 g L-arginine (increased progesterone in 71% of patients)
Increasing beta carotene in your diet, as found in:
Apricots, Asparagus, Broccoli, Carrots, Chinese cabbage, Chives, Dandelion leaves, Grapefruit, Herbs and spices – chilli powder, oregano, paprika, parsley, Kale, Onions, Peas, Peppers, Plums, Pumpkin, Spinach, Squash, Sweet potatoes. So again, get onto those carrots!
Vitex Agnus Castus 1000mg daily
Black Cohosh or as we call it in Chinese Medicine ‘Sheng ma’ on days 1 to 12 (increases progesterone and fertility).
Improving insulin sensitivity (for example metformin increases progesterone levels 246%, chromium supplementation can help in regulating blood sugar in combination with a low sugar and low carbohydrate diet)
Replacing saturated fat in the diet with unsaturated fat
Eating a high protein, low carbohydrate diet
Lowering TSH levels in subclinical hypothyroidism
Chinese herbal medicine
Some Chinese herbal medicine /formula may help assist in balance your hormone. Contact us for details.