Knowledge | Anovulation: An Often-Unnoticed Cause of Difficulty Conceiving
When trying to conceive, you may pay closer attention to your menstrual cycle than ever before. Yet some women have difficulty becoming pregnant even when their periods appear regular. One possible, often-overlooked barrier is anovulation.
Anovulation means the ovaries do not release an egg during a menstrual cycle. Without this critical step, natural conception cannot occur. Medical data indicate that anovulation is involved in about 30% of female infertility cases.
What causes anovulation?
Ovulation is a complex process coordinated by the brain, ovaries, and multiple hormones. A problem at any point may cause anovulation. Common causes include:
Polycystic ovary syndrome (PCOS): The most common cause. PCOS may cause irregular or absent ovulation, sometimes with signs of excess androgens such as excess hair growth and acne.
Primary ovarian insufficiency (POI): Loss of ovarian function before age 40, also called premature menopause. The cause is unknown in some women, but 5%–10% may still conceive naturally.
Hypothalamic or pituitary dysfunction: These brain regions regulate ovulatory hormones. Conditions such as benign pituitary tumors may disrupt ovulation.
Diminished ovarian reserve (DOR): Women are born with their lifetime supply of eggs, which declines with age. Women with low ovarian reserve may retrieve fewer eggs even with assisted reproduction, but natural conception may still be possible.
Functional hypothalamic amenorrhea (FHA): Usually associated with excessive exercise, very low body weight, or stress, and may also be linked to anorexia nervosa.
Menopause: The natural decline in ovarian function, usually around age 50, accompanied by the end of menstruation, hot flashes, sleep problems, and mood changes.
What are the symptoms?
Anovulation sometimes causes no obvious symptoms. Even regular periods do not confirm that ovulation is occurring. Possible signs include:
No menstrual periods
Markedly reduced discharge (no cervical mucus)
Unusually heavy or light menstrual bleeding
An irregular basal body temperature pattern
How is anovulation diagnosed?
A doctor will review your medical history and symptoms and perform a physical examination. Tests may include:
Pregnancy test
Hormone testing
Thyroid function tests
Glucose tolerance testing for insulin abnormalities
Transvaginal ultrasound
Endometrial assessment if needed
How is anovulation treated?
Treatment depends on the cause. Some people need lifestyle changes, while others require medication or surgery.
Lifestyle changes
These may help when anovulation is related to high or low body weight, excessive exercise, or psychological stress. Changes in diet, exercise, or stress alone may restore ovulation.
Medication
Many women with anovulation can ovulate and conceive with medication:
Clomiphene citrate: About 80% of women ovulate after taking it, and about 40% become pregnant.
Human chorionic gonadotropin (hCG): Often used with clomiphene or follicle-stimulating hormone to trigger ovulation and time conception. It can interfere with pregnancy tests and cause a false-positive result.
Follicle-stimulating hormone (FSH): Used when the body does not produce enough FSH or clomiphene is ineffective.
Gonadotropin-releasing hormone agonists/antagonists (GnRH agonists/antagonists): Control luteinizing hormone (LH) release and prevent premature ovulation, particularly during IVF cycles.
Surgery
For patients with PCOS who do not respond to medication, doctors may recommend ovarian drilling, a minimally invasive laparoscopic procedure. Several small holes are made in the ovarian surface to lower ovarian testosterone levels and potentially restore ovulation and menstruation.
Knowledge | Anovulation: An Often-Unnoticed Cause of Difficulty Conceiving
Knowledge | Anovulation: An Often-Unnoticed Cause of Difficulty Conceiving
When trying to conceive, you may pay closer attention to your menstrual cycle than ever before. Yet some women have difficulty becoming pregnant even when their periods appear regular. One possible, often-overlooked barrier is anovulation.
Anovulation means the ovaries do not release an egg during a menstrual cycle. Without this critical step, natural conception cannot occur. Medical data indicate that anovulation is involved in about 30% of female infertility cases.
What causes anovulation?
Ovulation is a complex process coordinated by the brain, ovaries, and multiple hormones. A problem at any point may cause anovulation. Common causes include:
Polycystic ovary syndrome (PCOS): The most common cause. PCOS may cause irregular or absent ovulation, sometimes with signs of excess androgens such as excess hair growth and acne.
Primary ovarian insufficiency (POI): Loss of ovarian function before age 40, also called premature menopause. The cause is unknown in some women, but 5%–10% may still conceive naturally.
Hypothalamic or pituitary dysfunction: These brain regions regulate ovulatory hormones. Conditions such as benign pituitary tumors may disrupt ovulation.
Diminished ovarian reserve (DOR): Women are born with their lifetime supply of eggs, which declines with age. Women with low ovarian reserve may retrieve fewer eggs even with assisted reproduction, but natural conception may still be possible.
Functional hypothalamic amenorrhea (FHA): Usually associated with excessive exercise, very low body weight, or stress, and may also be linked to anorexia nervosa.
Menopause: The natural decline in ovarian function, usually around age 50, accompanied by the end of menstruation, hot flashes, sleep problems, and mood changes.
What are the symptoms?
Anovulation sometimes causes no obvious symptoms. Even regular periods do not confirm that ovulation is occurring. Possible signs include:
No menstrual periods
Markedly reduced discharge (no cervical mucus)
Unusually heavy or light menstrual bleeding
An irregular basal body temperature pattern
How is anovulation diagnosed?
A doctor will review your medical history and symptoms and perform a physical examination. Tests may include:
Pregnancy test
Hormone testing
Thyroid function tests
Glucose tolerance testing for insulin abnormalities
Transvaginal ultrasound
Endometrial assessment if needed
How is anovulation treated?
Treatment depends on the cause. Some people need lifestyle changes, while others require medication or surgery.
Lifestyle changes
These may help when anovulation is related to high or low body weight, excessive exercise, or psychological stress. Changes in diet, exercise, or stress alone may restore ovulation.
Medication
Many women with anovulation can ovulate and conceive with medication:
Clomiphene citrate: About 80% of women ovulate after taking it, and about 40% become pregnant.
Human chorionic gonadotropin (hCG): Often used with clomiphene or follicle-stimulating hormone to trigger ovulation and time conception. It can interfere with pregnancy tests and cause a false-positive result.
Follicle-stimulating hormone (FSH): Used when the body does not produce enough FSH or clomiphene is ineffective.
Gonadotropin-releasing hormone agonists/antagonists (GnRH agonists/antagonists): Control luteinizing hormone (LH) release and prevent premature ovulation, particularly during IVF cycles.
Surgery
For patients with PCOS who do not respond to medication, doctors may recommend ovarian drilling, a minimally invasive laparoscopic procedure. Several small holes are made in the ovarian surface to lower ovarian testosterone levels and potentially restore ovulation and menstruation.
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