An ovulation disorder is any condition that affects the normal ovulation process, which is necessary in order to conceive. Other factors, such as stress and diet, can also adversely affect ovulation, so you should not assume that you have an ovulation disorder just because your attempts to conceive have been unsuccessful. In normally fertile couples, there is a 25 percent chance of getting pregnant each cycle, meaning that about 75 to 85 percent of women who have regular unprotected sex will get pregnant within one year. If you have been unable to become pregnant after trying for at least one year, then you may want to consider seeing a fertility specialist or a reproductive endocrinologist. A fertility specialist can determine whether you have an ovulation disorder that is affecting your ability to conceive.
Types of Ovulation Disorders
A woman with ovulation dysfunction may have anovulation (absent ovulation), a condition in which the follicles on her ovaries do not release eggs. Or she may have oligoovulation, in which ovulation is irregular—infrequent but not completely absent. In oligoovulation, eggs are released at times that do not coincide with fertilization or implantation.
A problem can occur at any point during the ovulation phase. The problem may begin with the hypothalamus in the brain, which signals when it is time for ovulation to begin. Disorders of the hypothalamus can result in the absence of ovulation and menstrual periods (amenorrhea). Psychological stress can also trigger hypothalamic dysfunction.
In women who are underweight, exercise-induced stress can result in amenorrhea. A woman needs to have a certain percentage of body fat in order for the brain and endocrine glands to function properly and for ovulation to occur. Likewise, women with eating disorders may also have fertility problems.
When a woman’s ovaries stop producing eggs, she stops ovulating. When this occurs in a woman who is not yet menopausal, this condition is termed ovarian failure, or poor ovarian reserve.
Ultimately, a woman with an ovulation disorder has fewer opportunities to conceive and will have difficulty determining when she is fertile.
Symptoms of Ovulation Disorders
Some women suffer from oligomenorrhea—infrequent periods—or they may not menstruate at all. A menstrual cycle that is shorter than 21 days or longer than 36 days is a sign of ovulation dysfunction. Another sign of ovulation dysfunction is when the length of a woman’s cycle fluctuates considerably from month to month—for example, a cycle that arrives a week early one month a week late the next month. In rare instances, a woman may have a regular cycle and not ovulate (this is called an anovulatory cycle). Infertility and hormone irregularities are other signs that an ovulation disorder may be present.
Causes of Ovulation Disorders
A number of factors can cause ovulation dysfunction. Some of the more common causes include:
- Hyperprolactinemia: Excess production of prolactin by the pituitary gland can cause the brain to stop sending the signals that command the ovaries to work. The production of breast milk in a woman who is not pregnant or nursing is a sign of this disorder.
- Hypothalamus dysfunction: The hypothalamus is the region of the brain that helps control the pituitary gland and regulate many body functions, including ovulation.
- Luteal phase defect: In this condition, the endometrium (the mucous membrane that lines the uterus) is inadequately prepared, either because the secretion of progesterone by the ovary is below normal or because the endometrium isn’t responding to progesterone stimulation.
- Polycystic ovarian syndrome: This syndrome is characterized by abnormal menstrual periods and an excess of male hormones. Affected women may have excess hair growth, acne, obesity, and large ovaries with multiple cysts.
- Tumors of the pituitary or adrenal glands or ovaries
Less common causes of ovulation disorders are:
•Autoimmune oophoritis: This condition is an inflammation of the ovaries that results in their destruction. Affected women will lose ovary hormone production and become infertile.
•Primary ovarian failure: Also called premature ovarian failure, primary ovarian failure is the loss of normal function of the ovaries in women under the age of 40.
•Resistant ovary syndrome: This condition is clinically similar to primary ovarian failure, but the ovary has the normal amount of eggs. It is thought a defect on the surface of the ovary prevents the ovary from responding appropriately.
Diagnosis of Ovulation Disorders
If you think you may have an ovulation disorder, you can discuss your symptoms with your gynecologist/obstetrician. Your doctor will review your complete medical history and menstrual history and perform a thorough physical examination. A pelvic examination may also be necessary as part of your evaluation. Your doctor will also want you to have your blood taken for testing.
Laboratory testing for an ovulation disorder may include the following hormones:
- Serum follicle-stimulating hormone (FSH)
- Serum luteinizing hormone (LH)
- Serum prolactin
- Serum testosterone
- Free androgen index
Depending on the results of laboratory testing, your doctor may order a CT scan or MRI scan of the pituitary gland and hypothalamus. Further evaluation with endometrial biopsy or ovarian biopsy or more specific antibody tests may be required in some instances, such as when a tumor is suspected.
Treatment of Ovulation Disorders
Fortunately, many ovulation disorders can be treated. The type of treatment that will be administered depends on the cause. Medical and nonsurgical treatments may include nutritional adjustment, ovulation-inducing fertility medications, and stress reduction. Surgery may be required if a tumor is present.
Ovulation Disorders and Infertility
You should consider seeing a fertility specialist if you:
- Have irregular or absent menstrual periods
- Are still not pregnant after having tried fertility medication
- Have been trying to conceive for a year or more and are 35 years or older
For couples with unexplained infertility, ovulation-inducing medications combined with timed intercourse may help. In some instances, assisted reproductive therapy, such as intrauterine insemination and in vitro fertilization, can help a couple conceive. Unfortunately, women with ovulation dysfunction caused by primary ovarian failure, resistant ovary syndrome, or autoimmune oophoritis are considered untreatable.