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Because the fertility evaluation and all treatment rely on an understanding of the reproductive process, in order to understand the evaluation and treatments, one must understand the body.
A normal menstrual cycle reflects the integration of several tissues in a tightly controlled routine. This process should lead to the release of a single egg. The machinery needed to develop and mature eggs exists within the ovaries, however, the motivating forces behind what transpires in the ovaries rests in a small area within the brain called the hypothalamus.
By working with the nearby pituitary gland, the hypothalamus is able to coordinate this ovarian process much like a coach guiding a team. In turn, the ovaries direct the uterus to generate a hospitable lining for a potential embryo.
Ovaries contain thousands of egg containing cysts called follicles. These follicles are grouped in clusters much like grapes on a vine. Monthly, a cluster is available from which one follicle is selected to release an egg. Early on in the cycle, the hypothalamus tells the pituitary gland to release a hormone called follicle stimulating hormone (FSH).
Upon reaching the ovaries, FSH acts upon that awaiting cluster urging development. Over the course of the next 10-14 days, the cluster is whittled down to one follicle.
As that single follicle matures, it makes and releases estrogen (which it makes from testosterone), the hormone responsible for generating the uterine lining or endometrium (uterine lining). By mid- cycle, the pituitary senses that the remaining egg is mature and releases luteinizing hormone (LH), which tells the follicle to release its egg.
Hopefully, the ovulated egg gets picked up by a fallopian tube. Within 24 hours of the eggs arrival within the tube, a sperm must negotiate the vagina, cervix and uterus thereby reaching the far end of the tube. It is there that egg and sperm unite in a process called fertilization.
Following fertilization, the newly formed pre-embryo begins a four day journey from the tube to the uterine cavity As this trip begins, the ovary starts making progesterone, a hormone that matures the endometrium. This enables the arriving embryo to attach or implant into the lining. Progesterone is also responsible for the breast tenderness, bloating and food cravings frequently seen during the menstrual cycle.
If implantation occurs, then the ovary maintains estrogen and progesterone production and endometrium remains intact. If no implantation takes place, then the endometrium is shed as a period, occurring roughly two weeks following ovulation.
