Anovulation and Fertility

Anovulation is the absence of ovulation that occurs when the ovaries do not release eggs. It is usually due to hormonal imbalances and is one of the most common causes of fertility problems.

Any fertility treatment should be accompanied by hormone therapy with estrogen and progesterone to prepare the endometrium for embryo implantation with assisted reproductive techniques.

Patients with anovulation should be referred to an assisted reproduction institute where they can undergo ovulation induction treatment with medication.

What is Anovulation?

Anovulation is the absence of ovulation that occurs when the ovaries do not release eggs.

It accounts for about 25 percent of female fertility problems and is generally due to hormonal imbalances caused by factors such as stress, eating disorders, excessive exercise, and polycystic ovary syndrome, among others.

Main Symptoms of Anovulation

The main symptoms of anovulation are:

• Amenorrhea or absence of menstruation
• Irregular menstrual periods
• Shorter than normal menstrual periods
• Decrease in premenstrual syndrome
• Infertility

Because some women with anovulation continue to menstruate regularly, this condition can be difficult to detect.

Causes of Anovulation

Anovulation can be due to various disorders at the level of the hypothalamus, pituitary gland, or ovaries and is generally linked to hormonal imbalances.

Factors such as stress, eating disorders, and excessive exercise can cause alterations in the hypothalamus, which under normal circumstances secretes gonadotropin-releasing hormone (GnRH). GnRH acts on the pituitary gland, stimulating its production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are essential for ovulation.

Failures in communication between the hypothalamus and the pituitary gland can affect the hormonal function of the ovaries and lead to disorders such as polycystic ovary syndrome, which is the leading cause of anovulation.

Other factors affecting ovulation include:

• Thyroid disorders
• Premature ovarian failure
• Hyperprolactinemia
• Obesity

How is Anovulation Diagnosed?

In addition to a pelvic exam and a review of the patient’s medical history, procedures to diagnose anovulation may include:

• A blood test to measure progesterone levels between days 21 and 23 of the menstrual cycle to determine if the ovaries are functioning properly. After ovulation, progesterone levels rise. If they do not, likely, ovulation is not likely to occur.
• A gynecological vaginal ultrasound, which allows the doctor to determine if there is an increase in size or presence of cysts in the ovaries, common symptom of polycystic ovary syndrome.

Once the diagnosis is obtained, the doctor may perform additional tests to determine the causes of anovulation.

Treatments to Achieve Pregnancy in the Presence of Anovulation

Any fertility treatment should be accompanied by hormone therapy with estrogen and progesterone to prepare the endometrium for embryo implantation with assisted reproductive techniques.

Patients with anovulation should be referred to an assisted reproduction institute where treatments include:

• Ovulation induction, for which drugs such as clomiphene citrate are commonly used. This medication must be carefully monitored by a specialist. This fertility treatment is particularly useful when the woman is under 32 years old and there are no other infertility factors.
• If medication is not sufficient and other factors are associated, the best option is in vitro fertilization (IVF), which allows the selection of the best quality eggs for subsequent fertilization and implantation in the woman's uterus.
• If the woman does not have viable eggs, IVF with egg donation offers success rates of up to 60 percent.
• In very specific cases, laparoscopic surgery is used to temporarily normalize the hormonal environment of the ovaries.

Each case is different, so it is essential to consult a fertility specialist who can help determine the best treatment for you.