Anovulation and Treating it

Anovulation (no ovulation) is one of the common reasons of infertility. A number of women are confused about irregular periods. The thing to keep in view here is that having regular periods in itself doesn’t really ensure successful conception. It’s very common for infertile women to have irregular periods; but most women are very confused about how their irregular periods and infertility are connected. They are under the impression that once they start getting their regular periods, they will conceive.

The simplest way to make a woman’s periods regular is to put her on birth control pills; but then this doesn’t help her get pregnant. Patients should keep in mind that infertility isn’t a diagnosis; its and symptom. Similarly, irregular periods are also just a symptom of anovulation.

Tests to confirm anovulation

It is anovulation that causes the irregular periods as well as the infertility, and this is what needs to be treated. Infertile women who have irregular periods will have to get these tests done:

  • Blood test for measuring the level of the reproductive hormones
  • AMH, FSH, LH,PRL and TSH on Day 2 or 3 of their cycle
  • Vaginal ultrasound scan on Day 2 or 3 of their cycle to check the antral follicle count

The treatments

This will help us ascertain what the reason for the anovulation is. The condition is treatable and we get a woman to ovulate by inducing ovulation. There are different treatments to induce ovulation:

  • Clomiphene citrate
  • Follicle stimulating hormone (FSH)
  • Human menopausal gonadotrophin (HMG)
  • GnRH (gonadotropin releasing hormone)
  • HCG (human chorionic gonadotropin)
  • Bromocriptine
  • GnRH analogue

Various Treatments

  • For women who have hypogonadotropic hypogonadism (low FSH and LH levels), HMG is the first choice of treatment. This is a very effective replacement therapy; and it’s possible to achieve very good pregnancy rates in these women.
  • In the case of women who are affected by hyperprolactinemia, cabergoline is the drug of first choice. Bromocriptine is an effective alternative
  • For most other women, clomiphene is the drug used - the "workhorse" of ovulation induction

Those who respond poorly to HMG can be treated with GnRH analogues along with the HMG. In some cases, HGH or the human growth hormone may be added as well. In patients who have high androgen levels (male hormones), dexamethasone may be used as an adjunct; it suppresses the production of androgen.

A significant investment

Ovulation induction treatment and a satisfactory response come only with a certain amount of investment of time, energy, money and emotion. Every woman is different and their body reacts differently to the same treatment. It’s also important that the response to ovulation induction be monitored carefully and this can include blood tests as well as daily ultrasound scans.

The process can be very tedious and in most cases, it involves a certain amount of trial and error. That’s the only way the therapy can be tailored to the patients ovulatory response. Today, there are a number of treatments available and if it’s done right, this treatment can be very rewarding and successful.

Not happy with the attention you are getting from your IVF clinic? Need more information? Please send me your medical details by filling in the form that I can guide you!

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.