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.
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 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.
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.