Understanding the Pathophysiology of Female Infertility: A Systematic Review with Special Reference to Anovulation
DOI:
https://doi.org/10.52783/jns.v14.2466Keywords:
Anovulation, Female Infertility, Hypothalamic-Pituitary-Ovarian Axis, PCOS, Kapha-Vata Imbalance, Artava Dhatu, Rajovaha SrotasAbstract
Female infertility is a multifactorial condition influenced by various physiological, hormonal, and environmental factors, with Anovulation being one of the primary causes. Anovulation results from disruptions in the hypothalamic-pituitary-ovarian (HPO) axis, leading to hormonal imbalances such as elevated luteinizing hormone (LH), decreased follicle-stimulating hormone (FSH), hyperprolactinemia, insulin resistance, and thyroid dysfunction. Conditions like polycystic ovarian syndrome (PCOS), primary ovarian insufficiency (POI), and hypothalamic dysfunction further contribute to ovulatory dysfunction. From an Ayurvedic perspective, Anovulation is associated with an imbalance of Vata and Kapha Dosha, affecting Artava Dhatu (reproductive tissue) and Rajovaha Srotas (reproductive channels). Poor dietary habits, sedentary lifestyles, chronic stress, and metabolic disorders contribute to Agnimandya (digestive fire impairment) and Ama (toxins), further aggravating ovarian dysfunction. Ayurvedic interventions, including Panchakarma, Rasayana therapies, herbal formulations, and dietary modifications, aim to restore hormonal balance and improve ovulatory function. This systematic review explores the pathophysiology of female infertility with a special focus on Anovulation, integrating modern biomedical insights with Ayurvedic principles. Understanding these underlying mechanisms is crucial for developing targeted therapeutic approaches to enhance fertility outcomes.
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Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, et al. The International Committee for Monitoring Assisted Reproductive Technology (ICMART) glossary on ART terminology. Hum Reprod. 2009;24(11):2683-7.
Balen AH, Morley LC, Misso M, Franks S, Legro RS, Norman RJ, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update. 2016;22(6):687-708.
Norman RJ, Dewailly D, Legro RS, Hickey TE. Polycystic ovary syndrome. Lancet. 2007;370(9588):685-97.
Franks S, Stark J, Hardy K. Follicle dynamics and anovulation in polycystic ovary syndrome. Hum Reprod Update. 2008;14(4):367-78.
Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, et al. Diagnosis and treatment of polycystic ovary syndrome: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(12):4565-92.
Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2016;31(12):2841-55.
Nair M, Paniagua C, Pease A, Pisal N, Jawad S. Female infertility: Pathophysiology and treatment. BMJ. 2017;356:j372.
Homburg R. Clomiphene citrate—end of an era? A mini-review. Hum Reprod. 2005;20(8):2043-51.
Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018;33(9):1602-18.
Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005;352(12):1223-36.
Laven JS, Imani B, Eijkemans MJ, Fauser BC. New approach to polycystic ovary syndrome and other forms of anovulatory infertility. Obstet Gynecol Surv. 2002;57(11):755-67.
McCartney CR, Marshall JC. Clinical practice. Polycystic ovary syndrome. N Engl J Med. 2016;375(1):54-64.
Fauser BC, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, et al. Consensus on women's health aspects of polycystic ovary syndrome (PCOS): The Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril. 2012;97(1):28-38.
Adams J, Polson DW, Franks S. Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism. BMJ. 1986;293(6543):355-9.
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Hum Reprod. 2004;19(1):41-7.
Carmina E, Legro RS, Stamets K, Lowell J, Lobo RA. Difference in body weight between American and Italian women with polycystic ovary syndrome: Influence of the diet. Hum Reprod. 2003;18(11):2289-93.
Diamanti-Kandarakis E, Christakou C, Marinakis E. Phenotypes and enviro-genetic factors affecting the development of the polycystic ovary syndrome. Endocrine. 2006;30(1):19-26.
Lim SS, Norman RJ, Davies MJ, Moran LJ. The effect of obesity on polycystic ovary syndrome: A systematic review and meta-analysis. Obes Rev. 2013;14(2):95-109.
Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004;89(6):2745-9.
Essah PA, Nestler JE. The metabolic syndrome in polycystic ovary syndrome. J Endocrinol Invest. 2006;29(3):270-80.
Merviel P, James P, Bouée S, Terrault V, Rigan M, Lévy-Mozziconacci A. Impact of obesity on oocyte and embryo quality in women with polycystic ovary syndrome. Obes Surg. 2017;27(7):2132-9.
Balen AH, Conway GS, Kaltsas G, Techatrasak K, Manning PJ, West C, et al. Polycystic ovary syndrome: The spectrum of the disorder in 1741 patients. Hum Reprod. 1995;10(8):2107-11.
Zhao Y, Fu L, Li R, Wang LN, Yang Y, Liu NN, et al. Metabolic profiles characterizing different phenotypes of polycystic ovary syndrome: Plasma metabolomics analysis. BMC Med. 2012;10(1):1-12.
Franik S, Kremer JA, Nelen WL, Farquhar C, Marjoribanks J. Aromatase inhibitors for subfertile women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2018;5(5):CD010287.
Abbott DH, Barnett DK, Bruns CM, Dumesic DA. Androgen excess fetal programming of female reproduction: A developmental aetiology for polycystic ovary syndrome? Hum Reprod Update. 2005;11(4):357-74.
Cedars MI, Taymor ML. Hyperprolactinemia and infertility. Fertil Steril. 1982;37(6):697-713.
Nestler JE, Powers LP, Matt DW, Steingold KA, Plymate SR, Rittmaster RS, et al. A direct effect of hyperinsulinemia on serum sex hormone-binding globulin levels in obese women with the polycystic ovary syndrome. J Clin Endocrinol Metab. 1991;72(1):83-9.
Nestler JE, Jakubowicz DJ, Falcon de Vargas A, Brik C, Quintero N, Medina F. Insulin stimulates testosterone biosynthesis by human thecal cells from women with polycystic ovary syndrome by activating its own receptor and IGF-1 receptor. J Clin Endocrinol Metab. 1998;83(6):2001-5.
Yildiz BO, Knochenhauer ES, Azziz R. Impact of obesity on the risk for polycystic ovary syndrome. J Clin Endocrinol Metab. 2008;93(1):162-8.
Bhattacharya SM. Pregnancy and polycystic ovary syndrome. J Obstet Gynaecol Res. 2015;41(9):1367-75.
Joham AE, Ranasinha S, Zoungas S, Moran L, Teede HJ. Gestational diabetes and type 2 diabetes in reproductive-aged women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2014;99(3):E447-52.
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