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Wednesday, July 26, 2006

Diagnosis: Anovulation

Diagnosis: Anovulation
by Amy

What Anovulation Means and Its Impact on Fertility

Anovulation is the word used to describe a woman who does not properly develop and release a mature egg every month (ovulate). Women who are consistently anovulatory often have long, irregular cycles, sometimes not having a period for months or even years. The most common cause of consistent anovulation is Polycystic Ovarian Syndrome (PCOS). Other possible causes of anovulation include high stress, excessive physical exercise, obesity, overeating, birth control, hormone imbalances (thyroid, testosterone, prolactin, etc...), breast feeding, and even Premature Ovarian Failure (POF). Anovulation can be continual (such as with PCOS or other hormone imbalances) or it can be temporary (such as with stress or breast feeding). Doctors agree that even normally ovulating women can experience one or two anovulatory cycles per year. Anovulatory cycles obviously cannot result in a pregnancy (no egg = no baby). Medical intervention is needed when women are consistently anovulatory.

Diagnostic Process

Anovulation is diagnosed either via ultrasound and/or bloodwork (usually both). An ultrasound can reveal whether or not your ovaries are polyfollicular (PCOS). Bloodwork can be used to test hormone levels such as thyroid, prolactin, progesterone, and FSH levels (which can indicate POF).

Treatment Options

Treatment will depend on your diagnosis. If you are diagnosed with PCOS, you'll probably start with clomiphene citrate (Clomid) and/or metformin (Glucophage). Generally, PCOS is treated with a combination of both. Specific medications and/or dosages will be adjusted accordingly, depending on each women's individual response. For women who are anovulatory due to stress or exercise or if anovulation is deemed temporary, simple lifestyle changes can cause ovulation to return. For women with POF, treatment will probably be more in-depth and often includes In-Vitro Fertilization, sometimes requiring donor eggs.

Personal Experience

I, myself, am consistently anovulatory. However, my situation is slightly different because my anovulation is unexplained. All my hormone levels have been repeatedly checked and everything is within normal ranges. I do not have PCOS or POF. I am not stressed or obese, and I can safely say that I do not excessively exercise. No one has been able to tell me why I don't ovulate. I did ovulate once on Cycle Day 50 of an unmedicated cycle and became pregnant (that pregnancy ended in miscarriage). Thankfully, under the care of a knowledgable Reproductive Endocrinologist (RE), we learned that with the right dose, I respond beautifully to Clomid. I have done nine Clomid cycles, eight of them ovulatory (my first round of 50mg of Clomid was anovulatory). I became pregnant on three of the eight ovulatory cycles. Unfortunately, all ended in miscarriage due to chromosomal issues having nothing to do with the Clomid. I am still using the Clomid (as of this writing, I am in the middle of my ninth Clomid cycle) to induce ovulation.

7 comments:

☆ Loren ☆ said...

I myself am Anovulatory, and as far as i know do not have PCOS or POF. Im also not obese and definately don't over exercise haha! I have my fair share of stress, but not enough to make me anovulattory. After 9 month of working with my Gyno, i finally gave up on expexting him to help! He saw me ONCE in those 9 months, and the only procedure he did was a papsmear and bloodwork to determine my thyroid level was not high. Im hoping to see an RE soon and get some more answers!

Thanks for posting this!Its good to know there are others out there like myself!

Ms.Once said...

When I was in the throes of starting to try to conceive, after I went off the pill, I was off and on anovulatory for at least a year. Non PCOS, not POF. I was treated from everything from digestion problems by my (former) gp as a solution to attendant cramps to finally getting an ultrasound of my ovaries to make sure everything was ok, physically (it was). But still, in all that time, little in the way of real solutions.

My sense is that doctors, even OB/Gyns, don't take complaints of anovulation seriously, and that it can take some serious pressing to get them to address the issue. My OB/Gyn finally treated me with Provera--an evil drug if ever there was one, based on the depression it levied for me--but it indeed jump-started my cycle, although I lapsed back into anovolatory cycles, unexplained, again. But it does work for some women to get them back on a regular cycle.

When I got around to seeing an RE, he prescribed Metformin, which is actually a diabetes drug but one that's been shown to help regulate cycles in some women and so help with fertility. It's often used for people diagnosed with PCOS, but it also worked for me within a few months to get me to regular cycles and, in the end, to get pregnant.

I have to say, too, I think acupuncture contributed a lot to my working through this issue--having a knowledgeable practitioner familiar with fertility issues had to help the process. And I write this, knowing full well I used to be one of those people who said, "Needles? In me? Are you CRAZY?" There's a lot to say about how Eastern medicine conceives of the menstrual cycle as part of the whole body and its workings.

Anonymous said...

I was annovulatory per FAM charting for over 1 yr., and on various doses of Clomid (50mg-200mg). I am not overweight, exercise regularly (but not obsessively) and eat a primarily vegetarian diet (salmon occasionally). My labs showed no hormonal imbalance, and I do not have any of the classic PCOS physical characteristics. Still, because I am annovulatory, I have a diagnosis of PCOS.
This summer, I saw an RE, took Letrozole (Femera) once, and went to acupuncture weekly. The 1st time I ovulated, I received an HCG injection, had timed intercourse, and here I am 21 weeks pregnant.
Don't stay with an OB/GYN if you continue to be annovulatory - it wastes time, money, and frustration.

Anonymous said...

I also am consistently anovulatory, unexplained, no PCOS, no POF, not any of the other regular causes.

I do however have perfectly regular cycles, but they're only 21-24 days long.

No luck with Clomid. I did ovulate with Follistim, but no pregnancies, and I didn't release very many eggs, either.

My Gyn is awesome and referred me to an RE as soon as we realized I was anovulatory.

Anonymous said...

I am anovulatory - Dr. prescribed Femara. We will see how that goes, this is my first month on it.

trying in Manhattan said...

I wasted a year with a GYN who apparently didn't know what she was doing. She said she thought I may be anovulatory. On clomid I ovulated but my bloodwork showed it wasn't a very strong cycle. I asked her if I really was anovulatory and she had no answer.

I started seeing a RE specialist for PCOS and he has me on clomid again, this time with Ovidrel. Here's to hoping for success!

My Q: can you take 9 cycles of clomid. I've taken 2 cycles already (100mg/day) and am now taking 150/day.

Sarah said...

I am also on the rollercoaster of anovulation. I am waiting to get my period to start my third round of Clomid, but I did not ovulate last month with the Clomid. Therefore I didn't get my period and was put back on Provera. Unfortunately, the Provera hasn't kickstarted my period yet. I have taken Provera twice before and both times I did not even have to finish all 10 pills. Now I've been off the pills for 3 days!

When/if I do get my period, my GYN has upped my Clomid to 100mg. Although I'm early in the medicine process (I waited way too long on my own), I have a feeling a diagnosis and more tests/pills will be in my future.