Irregular Periods and Getting Pregnant
Trina Pagano, MD
Irregular or abnormal ovulation accounts for 30% to 40% of all cases of infertility. Having irregular periods, no periods, or abnormal bleeding often indicates that you aren't ovulating, a condition known clinically as anovulation.
Although anovulation can usually be treated with fertility drugs, it is important to be evaluated for other conditions that could interfere with ovulation, such as thyroid conditions or abnormalities of the adrenal or pituitary glands.
Getting Pregnant With Ovulation Problems
Once your doctor has ruled out other medical conditions, he or she may prescribe fertility drugs to stimulate your ovulation.
The drug contained in both Clomid and Serophene (clomiphene) is often a first choice because it's effective and has been prescribed to women for decades. Unlike many infertility drugs, it also has the advantage of being taken orally instead of by injection. It is used to induce ovulation and to correct irregular ovulation by increasing egg production by the ovaries.
Clomiphene induces ovulation in most women with anovulation. Up to 10% of women who use clomiphene for infertility will have a multiple gestation pregnancy -- usually twins. (In comparison, just 1% of the general population of women delivers twins.)
The typical starting dosage of clomphene is 50 milligrams per day for five days, beginning on the third, fourth, or fifth day after your period begins. You can expect to start ovulating about seven days after you've taken the last dose of clomiphene. If you don't ovulate right away, the dose can be increased by 50 milligrams per day each month up to 150 mg. After you've begun to ovulate, most doctors suggest taking Clomid for no longer than six months. If you haven't gotten pregnant by then, you would try a different medication or get a referral to an infertility specialist.
These fertility drugs sometimes make the cervical mucus "hostile" to sperm, keeping sperm from swimming into the uterus. This can be overcome by using artificial or intrauterine insemination(IUI) -- injecting specially prepared sperm directly into the uterus -- to fertilize the egg.
Depending on your situation, your doctor may also suggest other fertility drugs such as Gonal-F or other injectable hormones that stimulate follicles and stimulate egg development in the ovaries. These are the so-called "super-ovulation" drugs. Most of these drugs are administered by injection just under the skin. Some of these hormones may overstimulate the ovaries (causing abdominal bloating and discomfort); thus, your doctor will monitor you with frequent vaginal ultrasounds and blood tests to monitor estrogen levels. About 90% of women ovulate with these drugs and between 20% and 60% become pregnant.
Polycystic Ovary Syndrome (PCOS)
A common ovulation problem that affects about 5% to 10% of women in their reproductive years is polycystic ovary syndrome (PCOS). PCOS is a hormonal imbalance that can cause the ovaries not to work. In most cases, the ovaries become enlarged and appear covered with tiny, fluid-filled cysts. Symptoms include:
- No periods, irregular periods, or irregular bleeding
- No ovulation or irregular ovulation
- Obesity or weight gain (although thin women may have PCOS)
- Insulin resistance (an indicator of prediabetes)
- High blood pressure
- Abnormal cholesterol with high triglycerides
- Excess hair growth on the body and face (hirsutism)
- Acne or oily skin
- Thinning hair or male-pattern baldness