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.
11 comments
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!
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.
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.
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.
I am anovulatory – Dr. prescribed Femara. We will see how that goes, this is my first month on it.
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.
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.
Amy,
For what it’s worth, my experience mimics yours. We had been trying for 5 months when, one cycle, my period didn’t come but I wasn’t pregnant. (I was most likely anovulatory). I went to an OBGYN and he gave me provera to jumpstart things. I decided to start tracking my BBT that cycle. I spotted and did not ovulate. My period came and I started tracking again. Once again, no ovulation (but at least no spotting). My period didn’t come, so back to the dr. I went. I am quite positive that I have not ovulated for 3 months straight, but I am unaware of what my body did in the previous months. Like you, I had bloodwork and urine tests done, all showing that my hormone and thyroid levels were normal. My OBGYN doubts that I have PCOS or POF as I show no other symptoms.
He has prescribed Clomid for me, and I will start my first round of it in a little more than a week.
You’re not alone in the unexplained anovulation experience! I was encouraged to read your story…
Same here. All hormones great. All insides great. No PCOS. No excessive exercising. Not obese. Definite stress, but that doesn’t explain my entire life or no ovulation. Clomid didn’t do it for me, but Femara is working beautifully (except for the fact that I’m not pregnant yet). I’m on Round 3 of Femara.
I am 34 yrs old and just got married & started the process of trying to conceive. I have known for a while that this may not be as easy as it is for most women since my sister has PCOS and I have had irregular cycles for about 7 yrs. I am not overweight, my hormone tests came back normal, I have no signs of PCOS other than annovulation. Diabetes does run very strongly in my family, but since I’ve never had a weight problem (like my sister with PCOS does), I figured I was safe. I am seeing an RE and he started me on 50mg of Clomid after I started my period. He prescribed provera to start it but I chose to see my acupuncturist instead since I’ve heard horror stories about provera. I did start my period through this avenue 3 weeks into treatment. Only a little longer than taking provera and much healthier. So I then took the 50mg dose of clomid on days 5-9 and had ultra sounds on days 12 & 17. Oh, I forgot, I did do a day 3 ultrasound that showed 21 follicles in one ovary and 15 in another. This too is a sign of PCOS, but with no other symptoms my RE was unwilling to diagnose the condition. So then on day 17 ultrasound, when none of the follicles were larger than 10mm, he prescribed provera again, and this time I started taking it.
I am on day 2 of the provera and am hoping that the higher dose of clomid – 100mg will show some improvement.
My A1C blood sugar test came back at 5.3 which is slightly high. the cutoff for normal was 5.8. I am pretty positive that the metformin would help, but my RE isn’t a fan of it. I agreed to try this cycle with just the Clomid and move to the Metformin next cycle if it doesn’t work. I have also just started a really great exercise program to help deal with my stress levels and I continue to go to acupuncture weekly. This is early in my journey to BABY, but any feedback is much appreciated!
… Sara
My husband and I have been trying for five years to get pregnant, and have finally, just this year, found a doctor that thought there might be a problem. The first three doctors we saw said that we were just trying too hard and it will happen when it’s meant to happen. The new doctor immediately sent me in for bloodwork and a full physical. Four days later she let me know that I am anovulatory (and have been for 11 years) and started me on Prednisone to regulate my hormones. The first month I did not ovulate at all, so I was given Provera to jump-start my cycle. The next four months I took Clomid and Prednisone, but still no luck. This is my last month on the Clomid and if it doesn’t work its either on to the next step, or we’ll be done. Our insurance isn’t paying for any of this, so we may be done.
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