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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.

20 comments

1 ☆ Loren ☆ { 05.13.08 at 5:59 pm }

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!

2 Ms.Once { 01.07.09 at 8:05 am }

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.

3 Anonymous { 01.07.09 at 12:43 pm }

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.

4 Anonymous { 01.30.09 at 6:14 pm }

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.

5 Anonymous { 02.24.09 at 10:29 am }

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

6 trying in Manhattan { 08.04.09 at 11:24 am }

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.

7 Sarah { 08.10.09 at 9:27 pm }

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.

8 Heidi { 12.08.09 at 2:53 pm }

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…

9 Type.A.Nightmare { 01.27.10 at 5:46 pm }

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.

10 sara { 05.16.10 at 2:53 pm }

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

11 Liz { 05.27.10 at 1:39 pm }

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.

12 Augusta { 09.16.10 at 5:52 pm }

I do not ovulate, or never have I ovulated in my 36 years on this earth. That makes me sad. I was diagnosed with hypothalamic amenorrhea, but already had a diagnosis of primary amenorrhea since forever. After two royally failed rounds of stims with menopur, I was told that donor eggs was my only hope for pregnancy. While a reported 90% of women will respond to the injectible gonadotropins, I unfortunately, was in the 10% for whom this doesn’t work.
My husband and I have been blessed with the offer of eggs from a dear friend of ours. We are getting ready for a DE cycle this fall. We’re hoping for the best, but also looking into adoption.

13 Breezy Bride { 09.30.10 at 8:24 pm }

I just went to the OBGYN for the first time about my amenorrhea today. I’m 22, and was on birth control for 5 years until 2 years ago. We came off the pill and used condoms, waiting to start ttc for a few more years. Now that I finally have health insurance (no job until recently, thus the lack of insurance), so as soon as that insurance was in effect, I went to the OBGYN to find out why I have had just 3 periods in the last 2 years. I loved the OBGYN I saw today. He did a pap/pelvic exam and says physically, I look perfect, so the problem is likely hormonal, although he has yet to do an ultrasound. I am starting the progesterone challenge test today and I had blood work too, hopefully to find out if I have PCOS, a thyroid condition, a deficiency in estrogen, or if I’m simply annovulatory. I have never had endometriosis or a cyst to my knowledge, and I’m not incredibly overweight, just slightly, even though i do work out semi-regularly. We are not actively trying to ttc yet, I just want to know what’s wrong and what we can do once we are ready for a baby. It’s so confusing navigating the names of these conditions, medications, and complications. I feel like my body is a failure for not being able to do it the old fashioned way, and I am scared to death of what this will mean for my fertility once we are ready to ttc. I am so curious to find out what’s causing this and what it means for my long term fertility. I want to know what to expect. I have no qualms with invetro, clomid, or even adoption, but with so many people I know getting preggo left and right, I can help but get mad at them- why do people who don’t want kids get preggo with the drop of a hat? Ah, so many emotions. I really just want to know what’s wrong with me and what we can do to fix it. A couple of questions, though…. does the progesterone may any one else loopy? It makes me feel DRUNK! Also, I have seen a lot of bloggers say that when Clomid or Provera didn’t work, Metaformin paired with acupuncture helps. Any ideas why?

14 Shelby { 10.22.10 at 12:22 pm }

Wow, this chat helps me out a ton, thank you ladies. I’m 19 years old, and ever since I got my period (12 years old) I’ve only had a “consistent” period probably about 3 times– where I’d have a period consistently 2 – 3 months in a row. That is over the course of 4 years, mind you- having little spots of consistency. Otherwise there hasn’t been ANYTHING. When I was 12-14 I wasn’t super active or anything- work out maybe 2-3 times/week for 30 minutes or so. When I was 15 I began jogging- so that looks like 2-4 times/week between 1-3 miles per jog. Then 16-17 I began running with my Cross Country team at school where we were running SIX days/week- I was running around 30-35 MILES/week (I understand this time in my life definitely could have explained why I wasn’t having periods then, I was super stressed physically), then after high school @ 17-18 I continued to run- not as intense- maybe average 3-4 times/week, 2-4 miles each run. So I was strong and active, and in June I thought I had a period, but looking back and understanding I think it was more like spotting– brownish/red little discharge for about 2-3 days, that was it, very very minimal. But see last summer I cut back a TON from working out- stopped running and worked out in a gym, then during the fall pretty much didn’t work out at ALL (DEF gained weight) and during that time- still no period! Then this past April I had TERRIBLE cramps (I NEVER had experienced cramps hardly before– not intense like that) and I felt sick/weak/feverish, and so I thought I was going to have a period- I was swollen feeling down there with my uterus, etc.- pain, inflamed- all those types of feelings, and yet I barely even spotted– like maybe 2 days there was a small small amount of red/brown discharge, and that was it annd I was fine all over again. I got married in June (4 months ago:) ) and my husband knows how I pretty much never have periods, and I’ve researched and read How to Manage your Fertility, and I’ve daily kept track of my fluids and cervical positioning, (haven’t checked temp though) and I’ve mostly been dry, or white-creamy, no eggwhite though, and we have never used any form of birth control- no condoms, nothing, and I’m not pregnant, and I STILL haven’t had a period since April- which was spotting, before that my last one was in June of 2009- which looking back that seemed more like spotting, and before that it’s probably a similar story. So I think I’ve gone for around.. almost 4 years without a legitimate cycle (ovulating -> menstruation.)
Now, I was never concerned about this because from what I’ve heard from friends who’ve experienced this is, “Oh, your body’s just figuring out it’s hormone levels, it’s adjusting so don’t worry about it,” and I didn’t, I was thinkin’ “I’m the luckiest cat in town!” but this has been going on for almost 8 years, is that understandable? I turn 20 in December, so maybe I am still developing physically- someone please share your thoughts on that- until what age were you still ‘developing’– when would you say you pretty much were set with your lady body, whatever? I also am curious about developing— my breasts have always been and still are very lumpy/bumpy feeling inside– I mean not crazy or anything but they have texture, which I’ve read is the milk ducts forming and developing– but my question is does that go away? I can’t say I’ve squeezed any other 21 year old or older ta-tas in a while, so I’m just wondering– do you still have the little beady-feeling “layers” in your breasts? Or do breasts just turn completely squishy and soft throughout it all- with not much structure? Someone please, tell me about your breasts, lol.

I say all of this because it was never a big deal before, but now since I’m married (and we’re having sex like rabbits, like newly wed couples do, of course) my husband is really encouraging me to find out how other anovulatory ladies are handling their situation. Like, how do your husbands feel about you not being fertile? See, the thing is– we’re NOT trying to get pregnant right now. I’m 19, and ideally we’d love to wait 3 to…7 years until we want to have children (I mean, I’ll be 26 in 7 years, I could wait TEN years and still be 29, ya know? I’ve got PLENTY of time!) so it’s NOT that we’re trying to conceive- pretty much the opposite of that, and my body is definitely supporting that right now. BUT, I want to know- is this OKAY for my body that I’m not ovulating right now?? Is it detrimental to my health?? Like is there something about not ovulating where after …. 5 years or something of NOT OVULATING your not just SHUTS DOWN reproductively or something? Do I need to try to jump start my system and get a regular cycle and get fertile or is it healthy and okay for my body and health to just relax and not worry about the fact that I’m not ovulating at 19? Is this going to effect my long-term ability to conceive, if I don’t kickstart it now? Like will it be hardER to conceive (I imagine I’ll have to “kick start” my body when we’re trying, and jump into that then, anyways)
I mean, I know I am a very healthy young woman– I eat super healthy, eat lots of fresh fruits and vegetables, don’t eat hardly any processed foods, make everything from scratch, gone on whole body cleanses about every 9 months, all into detoxing, etc. And I exercise around 3-5 times a week, for around….20-40 minutes. SO I have a healthy life style. I just want to know how being anovulatory is going to effect my ability to conceive when we want to conceive, and also– how does that effect Menopause??? Isn’t menopause when your pretty much at the end of your eggs?? What does that mean for me– given that I’ve pretty much saved all but… probably about 12 eggs over the last 8 years– so does that mean if I did get consistent in ovulating I’m gonna have periods until I’m SIXTY-EIGHT instead of FIFTY-EIGHT??? Aye aye aye, can I getta feedback!! :):)

15 Kelsey { 10.08.12 at 3:27 pm }

I am a 25 year old female who has been married since April and in June I got off birth control pills that I had been taking for about three years. Since then I have not had a period or ovulated as far as I know. The Dr said no period means I didnt ovulate, so no pregnancy obvioulsy. I was seen in August because I was just positive I was pregnant due to lactating and breaking out and lack of period even though all the home tests came up negative. They did a blood test to check HCG levels which showed not pregant. They also tested for prolactin because I am lactating and that was normal. They checked my thyroid, normal. Then they tested FSH and it was 8.1 which is within normal range. So now they have scheduled me for an ultasound after last month having me take provera for 7 days and still not even a drop of blood. The Dr seems stumped and I am growing stressed and depressed worrying that I will never be able to have a child. I did get pregnant about 4 years ago that resulted in a miscarriage after 8 weeks. I have no clue what is going on and I want answers!

16 elissa { 04.20.13 at 4:04 pm }

I haven’t had a period since i had a baby 18 months ago.and of course the 9 months of my pregnancy. They checked my bloodwork and its all normal. I dont exercise a lot. I’m not huge. A little chubby. I had a transvaginal ultrasound today so i have to wait for official resultsxbut they said it all looked normal. I’m not sure whats wrong with me.

17 elissa { 04.20.13 at 4:05 pm }

Oh also did provera 10 days with no results.

18 Ashley { 09.10.13 at 11:52 pm }

I am anovulatory. I diagnosed myself. I currently work with a primary care doctor that doesn’t handle fertility, and a fertility specialist that refuses to answer my questions without run around, and won’t listen to my about my own body. Very stressful, expensive, and rude.

Getting another fertility specialist is difficult because I’m in a very small area and the closest is hours away.

I’ve been this way since high school, Used Ovidrel, and femera neither have worked. I have 2 or 3 cycles, I honestly can’t remember how many, I just know they affected me adversely and I’m now leary about any drugs –
How did clomid make you ladies feel? hormonal?

19 lawrencia { 09.27.13 at 2:49 pm }

I have been on and off my period for two to three month.the doctor suspect hormonal imbalance since my pelvic organ is ok. A friend suggest I use m2 tone by charak,am on it now and sure I have seen improvement, its for gyneacological problems . Any body heard about it?

20 bhavya { 12.09.13 at 5:45 am }

i m 19, but my ovulation stoppped when i stopped excercising which i normally did before, i m not fat and scared to get diagnosed

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