Been doing the baby dance for months but no positive pregnancy test just yet? You may be wondering if you're not ovulating. Here’s what you need to know about this relatively common condition, also called anovulation, including causes, symptoms and treatments.
What is anovulation?
Anovulation is when your ovaries don’t release an egg during a menstrual cycle. Ovulation happens about two weeks before you get your period.
Can you get pregnant if you don’t ovulate?
If you don’t ovulate, you can’t get pregnant during that cycle. Fortunately, many treatments can trigger your body to release a mature egg so that you can conceive.
What causes anovulation?
Your brain tells your body to secrete the hormones estrogen and progesterone and stimulates the ovaries to produce a mature egg every month. With anovulation, there is usually a problem with this signaling process.
A few common causes of anovulation include:
Polycystic ovary syndrome (PCOS)
PCOS is the most common cause of anovulation. The disorder, which affects between 8 and 10 percent of women of childbearing age, causes an imbalance in the hormonal signals that regulate ovulation.
Hypogonadotropic hypogonadism (HA)
In this condition, your pituitary gland isn’t making the hormones that stimulate ovulation. Blood tests reveal that follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels are very low.
Ovarian insufficiency
For women over 40, hormone levels might be irregular because there are few eggs left to ovulate. For women under 40, premature ovarian failure is when ovaries stop working normally. In 90 percent of cases of premature ovarian failure, the cause is unknown.
However, it could be linked to a genetic disorder like Fragile X premutation, a condition that can result in developmental problems, or Turner syndrome, a rare disorder that causes women to be short in stature and have early ovarian function loss. Autoimmune diseases — like Addison disease, a very rare but serious disorder affecting hormone production — can also contribute.
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Sometimes, anovulation can be caused by very high prolactin levels (hyperprolactinemia) or severe thyroid dysfunction (hypothyroidism).
Other factors
Anovulation can also be related to:
- Poor diet
- Insufficient exercise
- Obesity
Anovulation symptoms
Women who aren’t ovulating usually have irregular cycles, which can include light periods with very little bleeding or heavy ones with unusually heavy flow. A short cycle (meaning there are fewer than 21 days between your periods) or a long cycle (there are more than 35 days between periods) can also point to ovulation problems.
PCOS symptoms vary, but can include breakthrough bleeding between periods, acne, weight gain and abnormal hair growth. On an ultrasound, your practitioner may note multiple cysts on your ovaries, which appear when your body doesn’t release a mature egg.
Other symptoms can include:
- Hypogonadotropic hypogonadism: low libido, decreased energy, mood swings and weight gain
- Hyperprolactinemia: irregular or absent periods, vaginal dryness and breast discharge when you’re not breastfeeding
- Hypothyroidism: extreme fatigue and weight gain
- Ovarian insufficiency: menopause-like symptoms including missed periods, hot flashes, night sweats, decreased sex drive and irritability
How does anovulation affect your chances of getting pregnant?
Anovulation can make getting pregnant tricky; in fact, it accounts for an estimated 25 to 30 percent of infertility cases in women. Even if you do ovulate occasionally, irregular periods can make it hard to time sex.
The vast majority of women with PCOS who go on ovulation medications, however, do conceive. The same goes when you start taking medications to treat other conditions, including hypogonadotropic hypogonadism, hyperprolactinemia and hypothyroidism.
If you’re going through ovarian failure, it is possible to spontaneously conceive — but the chances are low, especially if you haven’t had a period in several months. Although medications can increase your odds of conceiving by stimulating ovulation, they can’t make new eggs grow.
Fertility and other treatments if you don’t ovulate
Many treatments can balance the hormones you need to have regular periods.
Clomiphene citrate or letrozole can help regulate your hormone levels if you have PCOS. These drugs can maximize your odds of getting pregnant if you’re nearing menopause too.
Some medications can lower prolactin production and decrease the size of prolactin-producing tumors, while other drugs can regulate thyroid hormone levels to treat hypothyroidism.
If you have ovarian insufficiency, IVF may help you to get pregnant. But since the number of eggs in your body is fixed at birth, you may need to use donor eggs.
When to call the doctor
If you have irregular cycles or any other symptoms of anovulation, schedule a visit with your practitioner. Treating conditions including PCOS, hypothyroidism and hyperprolactinemia can greatly increase your odds of getting pregnant.
Also call your doctor if you’re under 35 and haven’t conceived within a year of trying, or if you’re over 35 and haven't conceived after six months. He or she may refer you to a specialist who can figure out why you’re not getting pregnant and suggest treatments that can help.
If you think you might have anovulation, don’t hesitate to check with your doctor. While anovulation is a major cause of infertility, in many cases the problem can be treated to boost the odds that you'll conceive soon.
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