Ovulation Disorders

Ovulation disorders at a glance

• Ovulation disorders are a spectrum of conditions that affect a woman’s endocrine system, which controls her hormones and her patterns of ovulation, the process by which a woman’s ovary releases an egg during her menstrual cycle.
• Ovulation disorders can cause infrequent and irregular ovulation, as well as anovulation, or the absence of ovulation, which is a common cause of irregular menstrual cycles.
• Some medications, conditions and lifestyle factors can affect hormone levels and cause an ovulation disorder.
• Disordered ovulation is the cause of couple’s infertility in about 25 percent of cases, according to the World Health Organization.

Ovulation disorders and infertility

Ovulation disorders are a common cause of infertility in women. During a normal menstrual cycle, the endocrine system prepares the body for pregnancy by secreting hormones, most notably gonadotropin-releasing hormone (GnRH), follicle stimulating hormone (FSH) and luteinizing hormone (LH).

GnRH and FSH are the hormones that are largely responsible for causing an egg to mature within a woman’s ovary. LH spurs the eventual release of the mature egg (ovum) into the fallopian tube where it can be fertilized by a man’s sperm.

Though cycle lengths vary, women who ovulate regularly tend to have a menstrual cycle that is 28 days in length and ovulate once in that 28-day period. Women who have a hormone imbalance or hormone deficiencies may experience infrequent or absent ovulation (anovulation), and infertility as a result.

More on the menstrual cycle & getting pregnant

Common ovulation disorders & symptoms

The endocrine system plays a critical role in the menstrual cycle and the process of becoming pregnant. Some medications, conditions and lifestyle factors, such as being overweight or underweight, affect the hormone levels and can cause irregular hormone production or damage the ovaries, resulting in an ovulation disorder.

The two most common symptoms of disordered ovulation are irregular or absent periods and difficulty becoming pregnant. But most disorders present a unique set of symptoms. Following are the primary ovulation disorders we treat most often.

Polycystic ovary syndrome (PCOS)

Scientists don’t know the exact cause of PCOS but it is likely due to hormone imbalances affecting a woman’s androgen (testosterone) levels and insulin receptivity. Low levels of insulin receptivity can lead to an increase in blood glucose levels and result in an increase of testosterone.

Though women naturally produce some testosterone, women with elevated testosterone levels associated with PCOS can experience irregular or absent periods, anovulation, and they may have ovarian cysts. The production of multiple cysts over time can block ovarian follicles from producing mature eggs, and testosterone androgen excess can disrupt ovulation and cause infertility. Other symptoms of PCOS include excessive hair on the face, chest, stomach and upper thigh, weight gain, severe acne and oily skin, and male pattern baldness.

Hypothalamic amenorrhea

FSH and LH are essential to obtaining pregnancy. During the menstrual cycle, the pituitary gland releases FSH to signal to the ovaries that a follicle needs to mature into an ovum. FSH levels begin to decline as LH levels begin to increase, signaling the release of the newly matured egg from the follicle. Women with hypothalamic amenorrhea may experience irregular or absent ovulation because their bodies don’t have the nutrients or fat content it needs to send hormone impulses to the ovaries.

Excess stress, high or low body weight, and excessive weight gain or weight loss can all be contributing factors. Hypothalamic amenorrhea is common in professional athletes, dancers and women with anorexia nervosa.

Premature ovarian failure & menopause

Premature ovarian failure (POF), also referred to as primary ovarian insufficiency (POI), is the onset of menopause prior to the age of 40. During premature ovarian failure and menopause, the ovaries stop producing estrogen. Premature ovarian failure typically occurs because the body has “run out” of functioning ovarian follicles (the sacs that turn into eggs) early or the ovarian follicles are working improperly.

A woman’s body does produce less estrogen as she ages, but the causes of premature ovarian failure are still largely unknown. Women with autoimmune disorders, who have received chemotherapy or radiation, or who have certain genetic disorders are more likely to experience premature ovarian failure.

Hormone imbalances

An excess of certain hormones can result in female infertility. For example, an excess of prolactin, a hormone produced by the pituitary gland, may cause hyperprolactinemia. During hyperprolactinemia, the excess of prolactin reduces the estrogen levels, causing infertility.

Lifestyle factors that can affect ovulation

Certain lifestyle factors such as a woman’s level of activity, weight and medication use can affect hormone levels and cause infertility. Women who are overweight or obese, may also experience hormone imbalances that impact their ability to conceive.

Medications like nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can affect ovulation when taken for extended periods of time. Steroids, even those prescribed by a doctor for medical use, interfere with the hormones needed for ovulation as do some epilepsy medications. Many birth control methods use hormones to interfere with the ovaries’ ability to produce and release eggs.

Though medication can alter ovulation, it’s important to discuss eliminating medications with the prescribing physician before eliminating them.

Diagnosing and treating ovulation disorders

Some ovulation disorders can be diagnosed with an examination, medical history and menstrual history. But other disorders require laboratory blood testing to positively diagnose. Based on the symptoms that a woman presents, doctors will test for different hormone levels. If a woman has PCOS symptoms, for example, the doctor will likely test her testosterone and insulin levels to make a determination.

Once diagnosed, most ovulation disorders can be treated with lifestyle changes or medication. A doctor may recommend nutritional adjustment, fertility inducing medications that supplement missing hormones, or stress reduction.

Women who have irregular or absent menstruation should see a fertility specialist if they are unable to become pregnant within 12 months of unprotected sex with regular frequency (six months if the woman is over 35 years of age).

Do I need to see a fertility specialist?