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Why haven’t I ovulated?
Anovulation is common during certain stages of a woman’s reproductive life:
- Girls who have recently started menstruating. In the first year following a period, it’s not uncommon for girls to have anovulatory cycles.
- Women close to menopause. Women aged between 40 and 50 are more likely to experience a shift in hormones, which can lead to anovulation more regularly.1
It’s possible to have anovulatory cycles while you are fertile and there are many reasons why. Below are some potential causes. If you are concerned you are having anovulatory cycles you should consult your doctor.
- Polycystic ovarian syndrome (PCOS). This refers to a condition where a hormone imbalance has caused small cysts or underdeveloped egg-containing follicles in the ovaries. It can also cause irregular periods, excess body hair, oily skin, weight gain, depression, and infertility. Some women may have PCOS without experiencing these symptoms and may not know they have the condition until they try for a baby. If you are concerned or suspect you have PCOS, speak to your doctor. If you have been diagnosed with PCOS, ovulation tests or fertility monitors may give you misleading results, so it’s advisable not to use them. Women with PCOS may have high levels of LH throughout their cycle, which can give an LH surge (peak fertility) result even if this is not the case.
- Being under or overweight. If you are under or overweight this can also prevent you ovulating. Reaching a healthy weight can help your fertility and reduce the risk of ovulation disorders.
- Over-exercise. Too much exercise for an extended period, such as long-distance running, can also cause ovulation to stop. Reducing the intensity and volume of exercise can help get things back to normal.
- Stress and anxiety. It is advisable to speak to your doctor if you believe your levels of stress are preventing you from ovulating.
- Medication. Some medication may affect ovulation, including contraception. Always check any medication you are taking.
What are the symptoms of anovulation?
Many women may have an anovulatory cycle and not even notice. Anovulation itself doesn’t show any symptoms. It may be easier to look for signs that you are ovulating.
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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 progesterone
- Lack of fertile cervical mucus
- Shorter luteal phase
- Thinning or over-thickening of the endometrium (the lining of the uterus where a fertilized egg needs to implant)
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.