Disorders in Ovulation (failure to ovulate or release an egg from the ovary) account for the cause of failing to conceive in approximately 30% of couples.
The principle sign of failing to ovulate is infrequent periods or oligomenorrhoea ( more than every 35 days, or less than 8 periods per year), or even complete absence of periods (amenorrhoea). For some women with very short intervals between periods (less than 21 days) there is often evidence of ovulatory disorders. However unfortunately even for women with regular monthly periods anovulation can occur.
There are many ways of testing ovulation, simple measures used by patients such as charting temperature changes, cervical mucous changes or breast tenderness are unfortunately not reliable methods of assessing ovulation and are not recommended. Ovulation is best detected by ultrasound monitoring, a blood test for the hormone progesterone 7 days before the next period is due or by using commercially available ovulation prediction kits bought over the counter in Chemists or supermarkets.
There are numerous reasons why women may not ovulate and it is important to consider investigations to try to assess the cause of anovulation as well as choosing the optimal way to induce ovulation in each patient.
Once anovulation is confirmed by your Clinician, a careful history will be taken looking for issues within your medical, social and family history that may indicate a cause for anovulation, an ultrasound scan will be recommended as well as blood tests to assess the hormones that affect the development and release of eggs. If indicated your clinician may also suggest other hormonal blood tests to assess other hormone imbalances that may inhibit ovulation.
The most common cause of anovulation is Polycystic ovarian syndrome, however disorders of the hypothalamus and pituitary gland ( the parts of the brain that control the development of eggs and ovulation), thyroid gland and ovaries, as well as some medication also contribute to anovulation and need to be excluded.
If all other investigations including on your partner are normal then ovulation induction is indicated to help conceive. There are a number of treatments available, from lifestyle issues such as maintaining a more normal bodyweight (anovulation can be associated with both low and high bodyweight), treating other hormonal imbalances and to medication such as Metformin (see info). For many patients however formal ovulation induction using medication such as Clomiphene, injectable drugs( gonadotropins) or even surgery ( ovarian diathermy/ drilling).
When undertaking formal ovulation induction it is important that this is done by clinicians with experience of delivering expert treatment both to choose the optimal treatment regimen and to reduce the principle risks such as multiple pregnancies.
At Cheshire Reproductive Medicine we have Clinicians that have provided expert guidance and management over many years and are happy to provide a tailored solution to your management.