Anovulation

Anovulation is the ovulation absence that occurs when the ovaries are not capable of releasing the eggs they contain. This is usually caused by hormonal imbalances and is one of the most common causes of fertility problems.

Any fertility treatment should be coupled to hormone therapy with estrogen and progesterone, in order to prepare the endometrium for the implantation of the embryos derived from assisted reproductive techniques.

Anovulatory patients should be referred to an assisted reproduction institute where they can start a controlled medicament treatment to induce ovulation.

What is anovulation?

Anovulation is the ovulation absence that occurs when the ovaries are not capable of releasing the eggs they contain.

This is the cause of about 25 percent of female fertility problems and is usually due to hormonal imbalances caused by factors such as stress, eating disorders, excessive physical activity and polycystic ovarian syndrome (PCOS), among others.

Main anovulation symptoms

Main anovulation symptoms are:

  • Amenorrhea or absence of a menstrual period
  • Irregular menstrual periods
  • Menstrual periods shorter than normal
  • Premenstrual syndrome reduction
  • Infertility

Since some anovulatory patients regularly have menstrual periods, it can be difficult to detect this condition.

Anovulation causes

Anovulation can be caused by different hypothalamic, pituitary or ovarian disorders and is usually linked to hormonal imbalances.

Factors such as stress, eating disorders and excessive physical activity can cause hypothalamus disorders. Under normal circumstances, the hypothalamus secrets gonadotropin releasing hormone (GnRH), which acts on the pituitary gland (hypophysis), stimulating the production of luteinizing hormone (LH) and follicle stimulating hormone (FSH), which are essential for ovulation to occur.

Communication failure between hypothalamus and hypophysis can affect ovarian function and lead to disorders such as polycystic ovarian syndrome (PCOS), which is anovulation’s leading cause.

Other ovulatory affecting factors are:

  • Thyroid disorders
  • Premature ovarian failure
  • Hyperprolactinemia
  • Obesity

How is anovulation diagnosed?

In addition to a pelvic examination and a patient’s medical history analysis, anovulation diagnostic procedures may include:

  1. A blood test to measure progesterone level between day 21st and 23rd of the menstrual cycle to determine if your ovaries are functioning properly. After ovulation progesterone level rises. If it does not rise, you’re probably not ovulating.
  2. A gynecological transvaginal ultrasound (or pelvic vaginal ultrasound) to examine your ovaries and determine if there is a size increase or cysts presence in your ovaries, which are common polycystic ovarian syndrome (PCOS) symptoms.
  3. Once the diagnosis is obtained, your doctor may perform additional tests to determine the anovulation causes.

Treatments to achieve pregnancy in patients suffering from anovulation

Any fertility treatment should be coupled to hormone therapy with estrogen and progesterone, in order to prepare the endometrium for the implantation of the embryos derived from assisted reproductive techniques.
Anovulatory patients should be referred to an assisted reproduction institute where treatments include:

  1. Ovulation induction, for which medications such as clomiphene citrate is often used and which administration must be carefully monitored by a specialist. This fertility treatment is particularly useful in women under 32 which have no other infertility causing factors.
  2. If these medications are not enough and there are other causes affecting fertility, the best option is In-Vitro Fertilization (IVF), which allows us to select the patient’s best quality eggs and fertilize them to create embryos which are then transferred back into the patient’s uterus.
  3. If the patient does not have any viable eggs, an In-Vitro Fertilization (IVF) and Egg donation (which offer success rates of up to 60 percent), would be the alternative.
  4. In very specific cases laparoscopic surgery is used to temporarily normalize the ovarian hormonal environment.

Each patient is different. Therefore, it is important you consult a fertility specialist to help you determine the best treatment for your case.