Ovulatory Dysfunction

Written by: Dr. Mohammed Agdi

​

 

 

 

 

 

 

 

 

Ovulation is the release of an egg from the ovary. This must happen in order to achieve pregnancy naturally. If ovulation is irregular, but not completely absent, this is called oligoovulation. Complete absence of ovulation is called anovulation. Ovulatory dysfunction is a common cause of female infertility, occurring in up to 40 percent of infertile women.

 

Usually, women with ovulatory dysfunction will have irregular periods. In the worst case, they may not get their cycles at all. If your cycle occurs 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 blood flow varies widely from month to month, that may also be a sign of ovulatory dysfunction.

 

Ovulatory dysfunction can be caused by a number of factors. The most common cause of ovulatory dysfunction is polycystic ovarian syndrome (PCOS). Other potential causes of irregular or absent ovulation:

 

• Obesity

• Too low body weight

• Extreme exercise

• Hyperprolactinemia

• Premature ovarian failure

• Low ovarian reserves

• Thyroid dysfunction (hyperthyroidism)

• Extremely high levels of stress

 

Ovulatory dysfunction is usually diagnosed by plotting accurate history of your cycle patterns over long time of period. Symptoms like male pattern hair growth, acne and altered body weight are important signs of Polycystic Ovarian Syndrome. Other symptoms like fatigue, weight gain, dry skin, hair loss and cold intolerance are signs of hypothyroidism. Breast engorgement and milky discharge from the breasts additional to acne and excessive body and facial hair growth could be signs of Hyperprolactinemia. Thus thyroid function and Prolactin testing are required in women with irregular cycle as they could be the cause of ovulatory dysfunction.

 

Physician will order blood work to check hormone levels which is done on day 2-3 of your cycle which include FSH, LH and Estradiol. Other hormone tests may include TSH and Prolactin.

 

Next, your physician will order an ultrasound to check the shape and size of uterus and ovaries, and also look to see if your ovaries are polycystic.

 

Treatment  depends on the cause. Some cases of ovulatory dysfunction can be treated by lifestyle change or diet control. If low body weight or extreme exercise is the cause, gaining weight or lessening your exercise routine may be enough to restart ovulation.

 

The same goes for obesity. If you are overweight, losing even 10% of your current weight may be enough to restart ovulation.

 

The most common treatment for ovulatory dysfunction is fertility drugs. Either combined or alone, Clomid, Femara and hMG are the commonly used medications for ovulation induction. Ovulation can be achieved in 80% of women, and help about 50-60% of them to get pregnant within six cycles of treatment.

 

For women with PCOS, insulin-sensitizing drugs like metformin (Glucophage) may help a woman start ovulating again. Six months of treatment is required before you'll know if the metformin will work.

 

If the cause of ovulatory dysfunction is related to hypothyroidism or hyperprolactinemia, treating these conditions may resume normal ovulation after several months of treatment.

 

If the cause of ovulatory dysfunction is premature ovarian failure, or low ovarian reserves, then ovulation induction are less likely to work.