Ovulation Problems

Are your menstrual cycles 28 days long? Do you ovulate on day 14 each month? Many of you will answer yes, but for many of you, this is not the case.

If you are having trouble conceiving and do not have regular periods each month, you may experience problems with ovulation. Ovulation problems are one of the most common causes of infertility.

What is ovulation?
Ovulation is the release of an egg from your ovaries. To understand the ovulation process, picture your ovaries. Inside your ovaries lie many ovarian follicles. These follicles are tiny sacs that contain your eggs. Keep that picture in mind as we explain how ovulation works:

  1. On day 1 of your menstrual cycle (the first day of bleeding), several follicles and eggs begin to mature and develop.
  2. About 2 weeks later, the dominant (most mature) egg bursts out of its follicle and out of the ovary.
  3. The egg travels out of the ovary and into the fallopian tube.
  4. When waiting sperm penetrate the egg in the fallopian tube, fertilization occurs.
  5. The fertilized egg travels along into your uterus where it may implant into the uterine wall.

When ovulation, fertilization and implantation are healthy and successful, pregnancy begins! If problems with ovulation, fertilization, or implantation occur, you may have fertility problems. If you suspect that you have irregular cycles, and do not ovulate on or around day 14, ask your doctor for help. Ovulation detection methods can help you learn more about your cycles.

Hormones and Ovulation
For ovulation to go smoothly, your hormones must be in balance. The hormones follicle stimulating hormone (FSH), estrogen, luteinizing hormone (LH), and progesterone all play an important role in the ovulation process. Here is how these hormones work.

  • Follicle stimulating hormone and estrogen-After your period starts, the ovulation cycle begins. Follicle stimulating hormone (FSH) is released. Your ovarian follicles and eggs begin to mature and develop. Estrogen levels rise as your body prepares for ovulation.
  • Luteinizing hormone-About 2 weeks after your period starts, luteinizing hormone (LH) levels rise sharply. This is known as the LH surge. Within 1 to 2 days, you will ovulate and progesterone levels will rise.
  • Progesterone-Following the LH surge and ovulation, progesterone levels rise. This rise in progesterone prepares your uterus for possible implantation of a fertilized egg.

Ideally, your hormones will work in perfect harmony and ovulation will be seamless. Unfortunately, hormone disorders are common causes of infertility and ovulation problems. Your doctor may be able to prescribe you fertility drugs to correct ovulation problems caused by hormone disorders.

Fertility Drugs for Ovulation
The following fertility drugs can be prescribed for ovulation problems:

  • Clomid can help with egg maturation and release, which are both critical for ovulation to occur. Clomid can boost ovulation by signaling the pituitary to produce more follicle stimulating hormone (FSH) and luteinizing hormone (LH), helping the egg mature for release. Clomid success rates are rather high, helping women ovulate about 80 percent of the time.
  • Some women with polycystic ovary syndrome (PCOS) fail to respond to Clomid due to insulin resistance. In these cases, insulin-sensitizing drugs like Metformin can help. Sometimes Clomid and Metformin fail to work when taken alone, but are successful when taken together.
  • Your doctor may recommend fertility drugs called gonadotropins that contain FSH or LH. These drugs come in various forms.
  • Human menopausal gonadotropin (hMG) is an injection containing equal parts FSH and LH. hMG has very high success rates.
  • FSH injections can also help to stimulate follicle growth for those who have problems with ovulation.
  • Human chorionic gonadotropin (hCG) mimics the LH surge, helping you release an egg for conception. hCG triggers the dominant follicle to release an egg and is often used to induce ovulation in conjunction with other gonadotropins or Clomid.
  • Bromocriptine Mesylate (Parlodel) and Cabergoline (Dostinex) suppress the excess production of prolactin, normalizing prolactin levels. These drugs have an 85 percent success rate in helping women ovulate.
  • Gonadotropin-releasing hormone (GnRH) can be administered by a drug delivery system. A belt holding a lightweight pump is worn 24 hours a day for several days. The pump releases small amounts of the fertility drug every 60 to 90 minutes into the bloodstream via a small needle inserted under the skin.

Risk Factors for Ovulation Problems
If you have the following risk factors, you may be at higher risk for ovulation problems.

  • Being underweight or overweight
  • Experiencing high stress
  • Having problems with the thyroid or other hormonal disorders
  • Abusing drugs or alcohol
  • Having health problems, including cysts, tumors, or other masses

Ovulation problems may make pregnancy more difficult. If you suspect menstrual or ovulation problems, consider seeing a fertility specialist. Ask your fertility doctor about ovulation detection and other fertility tests for ovulation problems.