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, they may prescribe fertility drugs to stimulate your ovulation.
The drug contained in 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 recruitment by the ovaries. The drug letrazole is also used to induce ovulation.
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 clomiphene 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, 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 3-6 months before referring to a specialist. 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. It also thins the endometrial lining.
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). This can be dangerous and require hospitalization; 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
Getting Pregnant When You Have PCOS
If you have PCOS and you're overweight, losing weight is one way to improve your chances of pregnancy. Your doctor also might prescribe medication to lower your insulin levels, since elevated insulin levels -- caused by your body's inability to recognize insulin -- has been found to be a common problem among many women with PCOS. Chronically elevated insulin levels can also lead to diabetes. Women with PCOS may be at higher risk for developing heart disease, type 2 diabetes, and endometrial cancer, especially if PCOS is untreated.
PCOS can't be cured, but there are treatments available to treat the symptoms of PCOS and the infertility associated with this condition. By stimulating ovulation, especially in women trying to conceive, and treating insulin resistance, regular ovulation and periods often are restored.
A procedure known as in vitro fertilization, or IVF, is another potential treatment for women with PCOS.
Stress and Fertility
For couples struggling with infertility, it's a particularly cruel fact: Not only can infertility cause a lot of stress, but stress may affect fertility. It's known to contribute to problems with ovulation. For many people, the longer you go without conceiving, the more stress you feel. Fears about infertility may also lead to tension with your partner, and that can reduce your chances of pregnancy even further. After all, it's hard to have sex if one of you sleeps on the couch.
While it's a fact that coping with infertility is stressful, that doesn't mean you have to give into it. If your doctor can't find a medical cause for your ovulation problems, consider finding support groups or a therapist who can help you learn better ways to cope with the anxieties that come with infertility.
The American Society of Reproductive Medicine offers these tips for reducing stress:
- Keep the lines of communication open with your partner.
- Get emotional support. A couples' counselor, support groups, or books can help you cope.
- Try out some stress-reduction techniques such as meditation or yoga.
- Cut down on caffeine and other stimulants.
- Exercise regularly to release your physical and emotional tension.
- Agree on a medical treatment plan, including financial limits, with your partner.
- Learn as much as you can about the cause of your infertility and your treatment options.