Ovulation is essential for conception. When ovulation is absent or irregular, getting pregnant is difficult. Although many women believe that regular periods mean normal ovulation, that’s not always the case.
If you’re planning to start a family, it’s important to understand what’s causing anovulatory infertility, what symptoms to look out for and how to deal with the issue.
First, what is anovulation?
Ovulation is the release of a mature egg from the ovaries. Depending on the length of your cycle, it can take place on any day between days 12 and 16.
Anovulation happens when a woman does not release an egg from her ovary during a menstrual cycle. Without an egg available for fertilisation, the chances she will become pregnant are basically zero. If ovulation is infrequent, this is called oligo ovulation.
A lack of ovulation doesn’t necessarily mean you are going through menopause. For women in their 20s, it’s not uncommon to experience an occasional anovulatory cycle. Anovulation becomes a problem when it is chronic because of an underlying medical condition.
How to tell if you ovulate or not?
Sometimes there are no signs you haven’t ovulated and you may continue to have regular periods. In other cases, symptoms may be misleading (for example, heavy bleeding due to progesterone insufficiency).
However, in most cases, there are warning signs suggestive of ovulatory dysfunction, including:
- Irregular or absent menstrual cycles
- Shorter (<21 days) or longer cycles (>35 days)
- Very light bleeding (spotting) or unusually heavy flow
- A drop and subsequent rise in body temperature in the middle of the menstrual cycle (around day 10-16)
Other problems associated with anovulatory cycles could be:
- Lack of fertile cervical mucus
- Defective endometrial receptivity
- Low levels of progesterone
Additional symptoms
Women with anovulatory cycles may experience symptoms related to the medical condition that is causing the problem. These may include:
- Low sex drive
- Decreased energy/fatigue
- Mood swings
- Weight gain
- Vaginal dryness
- Breast discharge
- Hot flashes
- Night sweats
- Abnormal hair growth
- Irritability
If you notice any changes in your cycle or you experience some of the above-mentioned symptoms, schedule a visit with a gynaecologist or fertility doctor.
Anovulation and LH surge
Luteinizing hormone (LH) is a sex hormone that triggers the release of a mature egg from the ovary. When LH reaches its peak levels, ovulation usually occurs within 10 to 12 hours. Sometimes, ovulation doesn’t take place despite the rise in LH.
When to see a doctor?
If you suspect you might have an ovulation problem, the first step is to check your progesterone level. This involves collecting a small sample of blood and testing it for the levels of mid-luteal progesterone. If the concentration is below 30 nmol/L, it means that no egg was released during that cycle.
In addition to progesterone, you may also want to test your anti-Mullerian hormone (AMH) using an AMH blood test. Lower-than-normal levels may signal an ovarian problem which requires medical attention.
If your hormone levels are in the normal range but you’re struggling to conceive, or if your test results come back abnormal, we advise you to seek medical advice from a specialist.
How are anovulatory cycles diagnosed?
Diagnosing anovulation is easier in cases where periods are absent or infrequent, but that’s not the case for every woman.
To make a correct diagnosis, a doctor will order the following tests as part of your routine checkup:
- Hormone blood test (e.g. prolactin, luteinizing hormone, follicle-stimulating hormone, oestradiol, anti-mullerian hormone)
- Antibodies blood test
- Ultrasound test
Your doctor may order an ultrasound scan to assess the health of your uterus and ovaries. In addition, you may need to measure your basal body temperature to see if there’s rise in temperature mid-cycle. Based on the findings of your initial fertility evaluation, further diagnostic testing may be required.
Insight into the causes of anovulation
Possible reasons for anovulation include:
Hypothalamic disorders
- Hypogonadotropic hypogonadism (low levels of gonadotropin-releasing hormone)
- Amenorrhoea (lack of periods) due to excessive body weight or too much exercise
- Kallmann syndrome (delayed/absent puberty)
- Idiopathic (unknown reason)
Pituitary disorders
- Hyperprolactinaemia (elevated prolactin levels)
- Pituitary failure (dysfunctional pituitary gland)
- Sheehan’s syndrome (abnormal blood loss during/after childbirth)
- Craniopharyngioma (benign brain tumour)
- Cancer treatment (e.g. cerebral radiotherapy)
Ovarian disorders
- Polycystic ovary syndrome (high levels of male hormones in women)
- Unexplained (unidentified cause)
Other endocrine disorders
- Hypothyroidism (underactive thyroid gland)
- Congenital adrenal hyperplasia (disrupted hormone production due to absence of certain enzymes)
Lifestyle factors
Some lifestyle factors can also contribute to developing anovulation, including:
- Having a poor diet or unhealthy eating habits (e.g. anorexia)
- Not getting enough exercise
- BMI outside the normal range
Stress and anovulation
Prolonged or chronic stress (such as obsessive thoughts, anxiety, anger, sleep problems, eating disorders) can have a negative impact on a person’s hormone balance and general health. Stress hormones, like cortisol and corticotropin-releasing hormone, can suppress the production of the female reproductive hormones, leading to ovulation and/or menstrual problems. During pregnancy, stress can cause certain complications, like preterm birth or foetal development issues.
Birth control pills and ovulation
Contraceptives (e.g. implants, injections, patches, intrauterine devices) can cause menstrual irregularities, which often results in absent or delayed ovulation. While it can take a while for your period to get back to normal after stopping contraception, these changes are temporary and they won’t affect your fertility.
Odds of getting pregnant without ovulation
Anovulation problems account for about 30% of infertility cases in women.
A complete absence of periods indicates a lack of ovulation which makes it extremely unlikely to conceive without the use of assisted reproductive procedures. Occasional ovulatory cycles do offer some hope, but in the absence of regular periods, it’s very difficult to track and predict your ovulation window.
Treatment for anovulatory infertility
Depending on what’s causing your fertility problem, a doctor will advise the most effective treatment plan for you.
Ovulation induction
Fertility drugs can successfully restore ovulation by balancing the hormones that regulate menstruation. Common ovulation-inducing drugs include:
- Clomiphene citrate (brand name Clomid)
- Letrozole (brand name Femara)
- Gonadotropins (such as Follistim, Gonal-F, Bravelle, Menopur, Ovidrel, Pregnyl)
- Metformin (ovulation induction for PCOS patients)
Medicines may also be required to decrease your prolactin (e.g. hyperprolactinemia) or thyroid hormone levels (e.g. hypothyroidism). Some conditions like hypogonadotropic hypogonadism require hormone supplements to increase estrogen and progesterone production.
Surgery
Surgeries are used to correct certain conditions or obstructions of the reproductive system. Common types of female reproductive surgery are:
- Ovarian drilling (PCOS)
- Bariatric surgery (severe obesity)
Assisted reproductive technology
If the above treatments are not effective, our euroCARE IVF fertility doctor will recommend an assisted reproduction method like in vitro fertilization (IVF). By fertilising the eggs outside the woman’s body, IVF completely eliminates the need for ovulation. It also gives you greater control over multiple pregnancies compared to fertility drugs. What’s more, with IVF you can postpone your pregnancy and start a family when you feel ready thanks to procedures like egg and embryo freezing.
Positive lifestyle changes to improve fertility
A healthy lifestyle can positively influence hormone health and increase your chances of getting pregnant. Here are some simple ways to improve your reproductive and overall health:
- Eat a healthy, balanced diet
- Get regular exercise
- Reduce stress (e.g. acupuncture, yoga, meditation)
- Quit smoking
- Avoid alcohol
Stay empowered on your journey to parenthood!
Anovulation is a common cause of infertility, but with the right treatment it can be successfully overcome. Improved nutrition, exercise and stress relief can also aid your pregnancy efforts.
If you’re ready to take the plunge into parenthood, talk to a fertility specialist to help you find the right treatment to restore your ovulation and improve your chances of conceiving. Start your fertility journey today by booking a FREE fertility consultation with our euroCARE IVF fertility experts!