Fertility Challenges Causes & Concerns Anovulation and Ovulatory Dysfunction Symptoms, Causes, and Treatments for When You Can't Ovulate By Rachel Gurevich, RN facebook twitter linkedin Rachel Gurevich, RN, is a registered nurse, fertility advocate, author, and recipient of The Hope Award for Achievement, from Resolve: The National Infertility Association. Learn about our editorial process Rachel Gurevich, RN Medically reviewed by Medically reviewed by Leyla Bilali, RN on August 10, 2020 Leyla Bilali, RN is a registered nurse, fertility nurse, and fertility consultant in the New York City area. Learn about our Review Board Leyla Bilali, RN Updated on August 10, 2020 Print Verywell / Nusha Ashjaee Table of Contents View All Table of Contents Anovulation and Infertility Symptoms Causes Diagnosis Treatment Ovulation is the release of an egg from the ovary. It must occur for pregnancy to be achieved naturally. Anovulation means a lack of ovulation or absent ovulation. When ovulation is irregular—but not completely absent—it is called oligo-ovulation. Both anovulation and oligo-ovulation are types of ovulatory dysfunction. Ovulatory dysfunction is a common cause of female infertility. Up to 40% of infertile people with ovaries experience dysfunctional ovulation. Anovulation and Infertility When a couple is not experiencing infertility, the chances of conception are about 25% each month. However, even when ovulation happens normally, a couple is not guaranteed to conceive. When a person is anovulatory, they cannot get pregnant because there is no egg to be fertilized. If a person has irregular ovulation, they will have fewer chances to conceive because they ovulate less frequently. Late ovulation does not produce the best quality eggs, which can also make fertilization less likely. Additionally, irregular ovulation usually indicates there is something off about a person's hormone levels. Hormonal irregularities can lead to other health issues, including: Abnormally low levels of progesteroneLack of fertile cervical mucusShorter luteal phaseThinning or over-thickening of the endometrium (the lining of the uterus where a fertilized egg needs to implant) Symptoms People with anovulation usually have irregular periods. Some do not get their cycles at all. If your cycles are shorter than 21 days, or longer than 36 days, you may have ovulatory dysfunction. If your cycles fall within the normal range of 21 to 36 days, but the length of your cycles varies widely from month to month, that could also be a sign of ovulatory dysfunction. For example, if one month your period is 22 days and the next it's 35, the variations between cycles could signal an ovulation problem. While it is possible to get your menstrual cycle on an almost normal schedule and still not ovulate, it isn't common. A menstrual cycle where ovulation does not occur is called an anovulatory cycle. Causes Anovulation and ovulatory dysfunction can have several causes. The most common cause of ovulatory dysfunction is polycystic ovarian syndrome (PCOS). Other potential causes of irregular or absent ovulation include: Extreme exerciseExtremely high stress levelsHyperprolactinemiaLow body weightObesityPerimenopause or low ovarian reservesPremature ovarian failureThyroid dysfunction (hyperthyroidism) Diagnosis Your doctor will ask you about your menstrual cycles at your annual wellness visit. If you report irregular or absent cycles, your doctor will want to determine if you have ovulatory dysfunction. To start, you might be asked to track your basal body temperature at home for a few months. Next, your doctor will order blood tests to check your hormone levels. One test might be a day 21 progesterone blood test. After ovulation, progesterone levels rise. If your progesterone levels do not rise, you are probably not ovulating. Your doctor might also want to perform an ultrasound. This will let them see the shape and size of the uterus and ovaries. They can also see if your ovaries are polycystic (a symptom of PCOS). This can often look like a pearl necklace; it's a string of many follicles clustered together. Ultrasound can also be used to track follicle development and ovulation, though it is not commonly done. If your doctor decides to go this route, you might need to have several ultrasounds done over a one- to two-week period. Treatment The treatment for anovulation will depend on what is causing it. Some cases can be treated with changes to your lifestyle or diet. For example, if your low body weight or extreme exercise habit is the cause of anovulation, gaining weight or easing up on your workout routine might be enough to restart ovulation. The same is true when anovulation is caused by obesity. If you are overweight, losing even 10% of your current weight might be enough to restart ovulation. The most common treatment for anovulation is fertility drugs. Clomid is the first fertility drug that is usually tried. If Clomid does not work, your doctor might want to try other fertility treatments. Clomid can trigger ovulation in 80% of anovulatory women. It has been shown to help about 45% get pregnant within six months of treatment. If you have PCOS, insulin-sensitizing drugs like metformin might help you start ovulating again. However, six months of treatment is required before you'll know if the metformin will work. Afterward, try taking a pregnancy test. Although prescription metformin is best for insulin regulation, some people opt to try myo-inositol, an over-the-counter supplement. It's said to work on the same insulin-regulating pathways as metformin. If metformin or myo-inositol doesn't help, your doctor might recommend taking fertility drugs combined with metformin. The combination has been shown to increase the chance of success in women who did not ovulate using fertility drugs alone. For people who have PCOS, the cancer drug letrozole (Femara) might be more successful at triggering ovulation. Fertility drugs are less likely to work when the cause of anovulation is premature ovarian failure or low ovarian reserves. That doesn't mean you can't get pregnant with your own eggs, but some people will be unable to conceive using their own eggs and will need IVF treatment with an egg donor. Was this page helpful? Thanks for your feedback! Get diet and wellness tips to help your kids stay healthy and happy. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Bhattacharya S, Johnson N, Tijani HA, Hart R, Pandey S, Gibreel AF. Female infertility. BMJ Clin Evid. 2010;2010:0819. Boyle JA, Teede HJ. Irregular menstrual cycles in a young woman. CMAJ. 2014;186(11):850-2. doi:10.1503/cmaj.130667 Mccartney CR, Marshall JC. Clinical practice: Polycystic ovary syndrome. N Engl J Med. 2016;375(1):54-64. doi:10.1056/NEJMcp1514916 Prajapati K, Desai M, Shah S, Choudhary S, Aggarwal R, Mishra V. Treatment outcome of ovulation-inducing agents in patients with anovulatory infertility: A prospective, observational study. J Pharmacol Pharmacother. 2017;8(3):116-121. doi:10.4103/jpp.JPP_43_17 Additional Reading National Library of Medicine. Infertility. Updated August 5, 2020.