Anovulation

Conditions that suppress ovulation or make release of the mature egg erratic and unpredictable reduce fertility. A number of conditions can result in anovulation (lack of ovulation).

• Polycystic ovarian syndrome.  A hormonal imbalance may prevent the prepared egg from breaking free at ovulation. The tough, thick capsule may prevent the egg's release when it matures. Obesity often accompanies this syndrome, and sensible, healthy weight reduction can help to restore fertility by normalizing the amount of fatty tissue, where male hormone converts to estrogen compounds. Without the release of a viable egg, conception cannot occur. A number of procedures have been developed to enhance the likelihood of regular ovulation in women with this condition. In obese women with this disorder, weight loss may help to normalize reproductive hormone levels. The administration of medications to stimulate ovulation (clomiphene or occasionally dexamethasone) or wedge resection of the ovary (surgically opening the thickened ovarian capsule to allow easier ovulation) may enhance the chance of conception.
  
  
• Premature ovarian failure.  Normally, in the fifth or sixth decade of life, women experience anovulation and irregularities in menstrual cycling as ovarian hormonal function wanes. Sometimes this diminution of hormonal output begins earlier in life, a condition termed premature ovarian failure. Simple blood tests demonstrate elevated levels of luteinizing hormone and follicle-stimulating hormone when premature menopause is the cause for anovulation. Consult a doctor to determine whether hormone therapy may be of benefit at this stage.
  
  
• Discontinuation of oral contraceptive pills.  It is uncommon but not rare for women to experience up to six months of continued suppression of ovulation after stopping the birth control pill. If conception fails to occur in the first six  months after stopping the pill, you should not be unduly alarmed. If it fails to occur within the next six months, an evaluation is in order.
  
  
• Thyroid imbalances. Imbalances of both the hyperactive and underactive variety can disrupt menstrual cycling and ovulation and therefore be a cause of infertility. Correction of the imbalance will usually restore fertility promptly.
  
  
• Extreme exercise. Women who engage in excessive amounts of exercise, extensive daily training regimens, marathon and endurance running and the like can suppress ovulation both by disrupting the crucial timing of hormone flux that prompts egg maturation and release and by excessive loss of body fat, a tissue necessary for conversion of androgens (male hormone) into certain estrogen compounds. Reducine exercise frequency and intensity, coupled with a modest gain of weight and body fat (if deficient) will usually restore fertility.
  
  
• Rapid weight loss. Weight loss, particularly as seen with very low calorie dieting, can also disrupt the delicate hormonal balance necessary for regular, predictable ovulation. The condition is temporary, and fertility will usually return to normal within a few months after weight stabilizes or after returning to a balanced diet of sufficient calories to maintain the current weight. The exact mechanisms of this cause for infertility are unclear, but may relate to thyroid or reproductive hormone imbalances.

Last Updated: 9/9/2002
The Johns Hopkins University 1996-2003.  All rights reserved.  This information is not intended to provide advice on personal medical matters, nor is it intended to be a substitute for consultation.