TLDR: Anovulation is the lack of ovulation, which is a necessity if you’re trying to get pregnant. If you’re not ovulating, there are many causes, and likewise, there are also treatments that can help anovulation.
Have you been trying to get pregnant for a while now? Becoming pregnant might seem like an easy feat by what you see on Instagram or TV, but the truth is, getting that positive result can be difficult for a lot of people, for a number of reasons. So, while you’re not alone in your waiting (1 in 8 couples struggle with conceiving)1 , it doesn’t take away the grief, pain, and longing for a family. If you’ve been trying to get pregnant for a while and are feeling frustrated, we’re here to help you navigate through this uncertainty. While many issues may keep you from conceiving within the first year, one of the most common reasons is anovulation or the lack of ovulation.
We’re breaking down everything there is to know about anovulation, and how it affects you getting pregnant.
What Is Anovulation?
During your menstrual cycle—which is an average of 28 days and starts on the first day of your period—your ovaries release an egg.
If you have an average cycle, the egg is released on the 14th day of your cycle. This is called ovulation. The egg travels down the fallopian tube, where it can become fertilized by sperm. If it does not get fertilized, it continues down to the uterus, where it’s released with the shedding uterine lining.
“The normal range of a menstrual cycle (from the start of one period to the start of the next) is 21-35 days,” says Dr. Ilana Ressler2 , a reproductive endocrinologist at Illume Fertility. “If your cycles are shorter or longer than this, it means that you are having irregular cycles, and you are not ovulating regularly (or not ovulating at all).”
Anovulation is the term for when your ovaries do not release an egg. It’s normal for anovulation to happen once in a while. When anovulation happens more frequently, it can lead to different symptoms. Anovulation has different causes, including underlying medical conditions.
How Does Anovulation Affect Getting Pregnant?
Anovulation affects getting pregnant because for you to become pregnant, an egg must be fertilized by the sperm. If your ovaries don’t release an egg, the sperm will just die off. If you suspect you’re not ovulating, reach out to your doctor.
Talking to a holistic fertility coach also can help you through the fertility process. They can be a great resource when you have questions and can provide emotional support too. Look for one in your area or ask your doctor for a recommendation.
Signs of Anovulation
If you’re wondering if anovulation is what’s causing you to not get pregnant, there are a few signs you can watch for. If you’re unsure about whether you’re ovulating, you can try ovulation tests. These are very similar to pregnancy tests in how they are used (i.e., you pee on them and wait for the result). There are also physical signs that you may be ovulating, including tender breasts, ovulation pain, change in cervical mucus, and increased sex drive.
On the other hand, below are a few signs you may not be ovulating. If you’re concerned that anovulation may be an issue for you, set up an appointment with your doctor. They can run tests to get a better idea of what’s going on.
You’re not getting your period
Amenorrhea3 —lack of your period—may be a sign of anovulation. Amenorrhea can be caused by many different things. Low body weight and stress are both causes. A lack of periods can be caused by medications you are currently on, and it can also be caused by an underlying health condition.
The tricky thing about amenorrhea is that you may still ovulate, although it’s very unlikely.
While the average length is 28 days, a regular full menstrual cycle can be anywhere from 21 to 35 days. Emotional stress, smoking, physical stress, and medication side effects can all cause irregular periods4 .
To find out if your periods are regular, start tracking them. The first day of your menstrual cycle is the first day of your period. When you get your period, mark down the day. At your next period, note that day. The number of days between the two start dates will show you how long your menstrual cycle is, and whether or not you fall into the regular cycle range. If you find the number of days between periods or the duration or heaviness of your period changes, you may have irregular periods.
Very heavy or light periods
For the menstruation cycle to occur as it should, there is a synchronization of hormones. When ovulation occurs, it stimulates progesterone. Progesterone helps to keep your periods regular. Without progesterone, your periods may become heavier or lighter than normal.
A normal amount of blood loss during a period is between 30 ml to 80 ml5 —or about 6 to 16 teaspoons. Most of us are not measuring the amount of blood we are losing each period. A rule of thumb is that a heavy pad or tampon can hold a little less than one teaspoon, so if you’re trying to see how heavy your period is, count how many pads or tampons you soak during your average period. If they’re very heavy or very light, definitely talk with your doctor.
Lack of cervical mucus
During ovulation, your cervical mucus changes.6 Thanks to estrogen, your mucus will become more like the texture of an egg white. It’s wet, slippery, and stretchy. This gives the sperm a better environment for its journey to the egg.
Once ovulation is finished, progesterone makes your discharge less wet. It can become thick and tacky, and some women feel a lot drier during this time.
If you don’t notice these changes in your cervical mucus, you may be experiencing anovulation. Everyone’s body is different, so pay attention to the changes in your cervical mucus to see if you can spot a difference between different times of the month.
Irregular basal body temperature
After ovulation, your basal body temperature will rise between one-half of a degree to one degree. If you don’t see these changes, or your basal body temperature is irregular, you may be experiencing anovulation.
The best time to take this temperature is as soon as you wake up in the morning. Have your thermometer by your bed for a quick morning check. When you wake up, before you have time to even wipe the sleep from your eyes, take your temperature to get the most accurate reading. You should track your temperature for three to four months to be able to see a clear pattern.
Causes of Anovulation
If you’re trying to get pregnant, and you suspect you’re not ovulating, the next thing to do is find out why. There are many reasons a woman may not ovulate.
Extremes in body weight
Being overweight or underweight can affect the hormones in your body. Being overweight can cause you to have too much estrogen, and being underweight can cause estrogen to be too low. If your estrogen is too high or too low, it can cause anovulation.
A woman’s weight is very personal. If you have concerns about your weight, talk to your doctor or a nutritionist.
If you follow an average exercise program, you will most likely not have issues with ovulation. Women who regularly participate in vigorous exercise (more than 60 minutes a day) may suffer from anovulation. Women who participate in extreme exercise are 44% more likely to not have their periods,8 which can be a sign of anovulation.
Another cause of anovulation is stress. Everyone experiences stress from time to time, but when it’s constant, it can begin to cause issues with your menstruation cycle. Stress can do a number on your hormones. Women who experienced high daily stress were 70% more likely to experience an anovulatory cycle9 than those who did not have excessive stress.
The balance of hormones is extremely important to ovulation. If your hormones are out of balance, it can lead to anovulation. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), and gonadotropin-releasing hormone (GnRH) are three hormones that are specific to ovulation. Other hormones play a role as well, like estrogen and progesterone.
Your pituitary gland, thyroid, and hypothalamus—an area in your brain—all work together to release these hormones. If you have an underlying medical condition that affects any of these areas, you may experience anovulation. You can work with your doctor to determine if any of these issues may be affecting your fertility.
Polycystic ovary syndrome is the most common cause of anovulatory infertility10 . While the exact cause of PCOS is unknown, it does create an imbalance of reproductive hormones, including androgen.
Androgen is often called the “male hormone,” but women produce it as well. Usually, it’s only produced in small quantities in the ovaries and adrenal glands. This imbalance of hormones can affect the ovaries.
PCOS can cause abnormal periods, excess body hair, weight gain around the belly, acne, and infertility. Ovaries may become larger or develop cysts. Many women with PCOS experience insulin resistance as well. One way to help reduce your symptoms of PCOS is to change some lifestyle habits, including adding in physical exercise and changing your nutrition.
A natural cause of anovulation is menopause. Menopause, which is the ending of your menstrual cycles, happens somewhere around your late 40s or early 50s. Perimenopause is the time leading up to menopause. During perimenopause, your reproductive hormones will start to naturally decrease, and you may have some beginning signs of menopause.
Once you hit menopause, ovulation will stop altogether. During perimenopause, you may not ovulate regularly or even get your period regularly. And with irregular periods, it can be hard to track when you may be ovulating. Perimenopause can start in your 30s but usually begins between 40 and 45.
If you’re trying to get pregnant during this time, you may want to track your basal body temperature and use ovulation tests. If you’re older than 35, you should talk to your doctor if you have been trying to get pregnant for more than six months.
When Is It Time To Call the Doctor About Anovulation?
If you ever have questions about your body, you should always reach out to your doctor. A specialist also can help with anovulation. “If you suspect that you are not ovulating, you should see a board-certified reproductive endocrinologist to help assess the reason for this,” says Dr. Ressler. “There are many successful treatments that can be utilized to help a woman ovulate and achieve a successful pregnancy.”
If you have been trying to get pregnant for over a year, and you are under 35, it may be time to see a doctor, If you’re older than 35, give them a call at the six-month mark of trying. If you have been tracking your ovulation, bring that info in with you. If you have a known medical condition that may cause anovulation or infertility, you should talk to your doctor right away to make a fertility plan.
How Is Anovulation Diagnosed?
If your doctor suspects the reason you’re not getting pregnant is anovulation, they will most likely run some tests, and these will hopefully help you understand what’s going on with your body.
The first thing your doctor will order is blood tests. These tests can test hormone levels and thyroid levels. This can give a clear picture of what’s happening on the inside. If your anovulation is caused by an imbalance in hormones or your thyroid, these tests will reveal that.
Your doctor will probably order an ultrasound as well, to get a look at your ovaries. Before ovulation, the follicle that will release the egg grows in size. Your doctor can look for signs of ovulation by looking for these follicles.
Treatments for Anovulation
Anovulation can usually be corrected. Once you and your doctor have determined why you may be experiencing anovulation, you can decide on the best treatment for you.
We all go through stressful times—stress is a normal part of life. Knowing how to manage your stress can help reduce the effect it has on your hormone levels, and one of the best ways to manage stress is to practice meditation.
Meditation can help with your fertility journey by lowering stress, balancing hormones related to stress, and in terms, supporting ovulation.
Adjusting your exercise routine
If your workouts are incredibly intense, you may want to change them up a bit while you’re trying to get pregnant. You don’t have to completely stop working out—in fact, exercise is great for reducing stress. Talk to your doctor about how you can change your workout routine to support ovulation.
As we have learned, weight—both over and under—can create issues with your hormones. Talking to a fertility nutritionist may be the best place to start to manage your weight. They can help you come up with a plan to eat the best for you and your fertility.
During testing, your doctor may find that you have an underlying medical condition. Perhaps your thyroid is overproducing or underproducing the thyroid hormones. If this is the case, they can prescribe you medication. They may also prescribe medication if you have PCOS.
Adjusting your current medication
If you are currently on medication, your doctor may need to review your dosages to see if they are causing your anovulation. They may be able to adjust your dosage or prescribe another medication that doesn’t affect ovulation, if available.
Your doctor may recommend that you take hormone injections to help support your ovaries. To ovulate, your ovaries must release a mature egg. There are different hormone injections11 available, and your doctor will determine if one is right for you. Some are used to block estrogen, reduce insulin, and support testosterone levels, and others are follicle-stimulating hormone injections.
Anovulation, or the absence of ovulation, can affect your ability to get pregnant. To get pregnant, an egg must be released from the ovaries to be fertilized by the sperm. Without ovulation, there is no egg to get fertilized.
There are many causes of anovulation. Extremes in body weight, excessive exercise, and stress can all be causes of anovulation. Hormonal imbalances, gynecological conditions, and menopause or perimenopause can also be causes of anovulation.
There is hope for anovulation. Working with your doctor, they can determine the cause and provide treatments such as weight and stress management, adjusting your exercise routine, reviewing medications, and providing hormone injections, if needed.