No ovulation (Anovulation)

Anovulation

Anovulation is a condition in which a woman does not release an egg for fertilization each month during her menstrual cycle. In other words, no ovulation takes place. Typically, the ovaries release a matured egg into the fallopian tubes every month where it can be fertilized. When a woman is anovulatory, a mature egg is not released regularly every month. Instead, this cycle is either erratic or else no eggs are released at all. In either case, conception is very difficult and couples often struggle when trying to conceive. Between 6% and 15% of women of childbearing age are believed to be affected by anovulation.

Anovulation Causes

Anovulation is caused by an imbalance of the hormones within the body, which affects the regulation of menstruation as well as ovulation. When these hormones are imbalanced, the entire reproductive system may be affected, leading to infertility. Factors that may cause anovulation include breastfeeding, over exercise, stress, frequent travel, eating disorders and drug use. Anovulation is also sometimes associated with underlying problesm such as:

• polycystic ovarian syndrome (PCOS),
• thyroid and / or pituitary problems
• weight loss or obesity

Symptoms of Anovulation

Since women with anovulation can also continue menstruating, it can be difficult to detect the symptoms of anovulation. However, when no ovulation takes place, the following symptoms may appear:

• irregular basal body temperature (BBT)
• heavy or excessive bleeding during menstruation
• no menstrual period (amenorrhea)
• irregular menstruation (oligomenorrhea)
• decreased or absent symptoms of pre-menstrual symptoms

Diagnosing and Treating Anovulation

Anovulation can be diagnosed by charting and reviewing basal body temperatures (body temperature rises immediately prior to ovulation and a basal body temperature measurement (BBT Chart) can be used to signal when ovulation will occur), and performing blood tests to assess the levels of certain hormones including luteinizing hormones (LH), follicle stimulating hormones (FSH) and thyroid – stimulating hormones. Further tests may include ultrasounds, laparoscopy and pelvic examinations.

Treating anovulation  may include the following treatment options:

• Lifestyle Changes: eating a balanced diet, reducing exercise, relaxation and stress relief

• Medications: clomiphene or gonadotropin therapy may be recommended to induce ovulation
• Surgical: removal of parts of the ovaries (ovarian wedge resection or ovarian drilling) may help balance hormones

Ovulation Induction Medications

• Clomiphene citrate (Clomid): is often used as a first line therapy to “induce and regulate” ovulation.

This medicine causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth, and is often now combined with Metformin treatment, with likelihood of higher success rate, especially in women whose ovulation problem is due to polycystic overian syndrome – PCOS (see below).

• Human menopausal gonadotropin or hMG (Pergonal): is used for women who don’t ovulate due to problems with their pituitary gland. hMG acts directly on the ovaries to stimulate ovulation. It is only given by injection.
• Follicle-stimulating hormone or FSH (Gonal-F): FSH works much like hMG. It causes the ovaries to begin the process of ovulation. This is also given as injection.
• Gonadotropin-releasing hormone (Gn-RH) analogues: are often used for women who don’t ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. It prepares the ovary to better respond to to ovulation induction medication.
• Metformin (Glucophage): is used for women who have insulin resistance and/or PCOS. This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin.
• Bromocriptine (Parlodel): This medicine is used for women with ovulation problems due to high levels of prolactin. Prolactin is a hormone that causes milk production.