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Dr. Eric Daiter

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Dr Eric Daiter has served Monmouth and Middlesex Counties of New Jersey as an infertility expert for the past 20 years. Dr. Daiter is happy to offer second opinions (at the office or over the telephone) or new patient appointments. It is easy, just call us at 908 226 0250 to set up an appointment (leave a message with your name and number if we are unable to get to the phone and someone will call you back).


"I always try to be available for my patients since I do understand the pain and frustration associated with fertility problems or endometriosis."


"I understand that the economy is very tough and insurance companies do not cover a lot of the services that might help you. I always try to minimize your out of pocket cost while encouraging the most successful and effective treatments available."

NJ Center for Fertility and Reproductive Medicine - Infertility Tutorials

Ovualtory Dysfunction: Pituitary Causes

The pituitary causes for ovulatory dysfunctions include:

* (1) hypothyroidism

The mechanism for the ovulatory dysfunction associated with hypothyroidism has not been entirely worked out.

Hypothyroidism probably interferes with ovulation via an increase in circulating active estrogen. Increased bioactive estrogen may be due to decreased metabolism of estrogen in the liver (seen with both hypothyroidism and hyperthyroidism) or due to decreased levels of the protein that binds estrogen in the circulation. Sex hormone binding globulin (SHBG) decreases the bioactivity of bound hormones by reducing the "free" (bioactive) fraction of the hormone. Persistent elevations of bioactive estrogen can interfere with follicular growth and can disrupt the midcycle preovulatory LH and FSH surges that are required for normal ovulation.

Hypothyroidism may also interfere with ovulation through an elevation in TRH. With decreased circulating thyroid hormone there is enhanced secretion of hypothalamic thyrotropin releasing hormone (TRH) which acts on the brain's pituitary gland to release thyrotropin or thyroid stimulating hormone (TSH). This TSH then stimulates the synthesis and release of thyroid hormone in a normal thyroid gland. Elevated TRH can "crosstalk" within the pituitary gland to release other pituitary hormones such as prolactin. Elevated prolactin levels are known to interfere with ovulation .

* (2) hyperthyroidism

The mechanism for the ovulatory dysfunction associated with hyperthyroidism is not entirely clear.

There may be elevated bioactive estrogen concentrations either due to decreased liver metabolism of estrogens or due to an increase in the activity of the enzyme that forms estrogens (called aromatase). Persistent elevations of estrogen interfere with follicular growth and can disrupt the midcycle LH and FSH surges.

* (3) excessive circulating prolactin

The mechanism for the association between excess prolactin concentration and ovulatory dysfunction is not entirely clear.

Increased prolactin released from the pituitary gland can increase the brain's dopamine levels (which will then normally feedback to decrease the prolactin secretion) and increased dopamine can inhibit GnRH release from the hypothalamus to in turn decrease pituitary FSH and LH secretion. A decrease in FSH may be the basis for most prolactin associated ovulatory problems.

There are prolactin receptors on the adrenal glands. The adrenal glands may respond to increased prolactin by increasing their own androgenic hormones. The adrenal androgenic hormones are known to interfere with ovulation.

Prolactin can decrease progesterone production by granulosa cells (the cells that line ovarian follicles) when grown in culture. If there is a direct effect of prolactin on granulosa cell progesterone production in vivo (in a woman's ovaries) then this could also lead to an ovulatory dysfunction, called a luteal phase defect.

* (4) non-prolactin secreting pituitary tumors

These are uncommon but included for completeness sake. The more common of these are ACTH secreting tumors (resulting in Cushing's syndrome) and Growth Hormone secreting tumors (resulting in acromegaly). Also, there are gonadotropin secreting tumors of the pituitary that secrete excess amounts of FSH (and rarely LH) that may result in an ovulatory dysfunction but rarely amenorrhea (these frequently go undetected due to the difficulty in finding these tumors with the relative lack of identifiable symptoms).

* (5) pituitary damage

Thrombosis or hemorrhage around the pituitary gland can result in permanent pituitary destruction and amenorrhea. This is rare, but possibly due to a hypotensive episode occurring during a severe postpartum hemorrhage, called "Sheehan's syndrome." In the situation where pituitary damage is the cause of the ovulatory dysfunction, it is very important to evaluate the non reproductive pituitary hormones as well since they may also be insufficient. Adrenal insufficiency due to a deficiency of pituitary ACTH can be life threatening.

* (6) empty sella syndrome

The sella turcica is a depression in the spenoid bone (a bone at the base of the skull) that contains the pituitary gland. The sphenoid bone is covered by a "diaphragm" of dura mater (a tough fibrous membrane). The empty sella syndrome is a disorder characterized by a congenital imperfection in the sellar diaphragm that allows for the herniation of both the subarachanoid space and cerebrospinal fluid into the sella turcica to flatten the enclosed pituitary gland. This may result in increased prolactin and decreased FSH and LH secretion. Amenorrhea and galactorrhea (milky discharge from the breasts) are associated. Some women have a nasal cerebrospinal fluid discharge or headaches. On radiologic imaging the sella turcica looks empty, to give the condition its name.

* (7) medications

Progesterone or progestagenic medications can inhibit ovulation. An excess circulating progesterone concentration just prior to the LH surge will possibly inhibit the LH surge and thereby prevent ovulation.. This is one of the mechanisms of the progesterone only birth control pills. If progesterone supplementation for luteal support is (accidentally) taken during the follicular phase of the cycle, this can also inhibit ovulation


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Eric Daiter, M.D. - Edison, NJ - E-Mail: - Phone: (908)226-0250

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