Irregular cycles and infertility - is it PCOD or poor ovarian reserve ?

The most common cause for irregular cycle is PCOD - Polycystic Ovarian Disease. Then again, it could be that the Anovulation is due to poor ovarian reserve - a condition called the Oopause. However, if this is mistakenly diagnosed as PCOD, precious time is wasted and the patient never gets a chance to get the right treatment!

Many infertile women have irregular cycles and they know that the reason for their infertility is related to their irregular cycles. However, many are quite confused as to the relationship. Some naively believe that if the cycles are regularised, their fertility will also automatically improve ! This is why they waste months taking birth control pills, without trying to address the underlying problem !

Today, we know that the commonest cause for irregular cycle is PCOD - polycystic ovarian disease. Unfortunately, many gynecologists blindly diagnose every patients with irregular cycles as having PCOD , without bothering to rule out other possibilities !

Let's look at some basics.

Women who ovulate regularly get regular periods. The reason a woman's periods are irregular is because she does not ovulate. This is called anovulation. While it is true that the commonest cause of anovulation is PCOD, it's equally true that this is not the only cause. A good doctor will do a careful workup to evaluate ovarian reserve, in order to determine what the reason for the anovulation is.

Thus, in some women the reason for the anovulation is poor ovarian reserve - a condition called the oopause. However, if this is mis-diagnosed as PCOD, precious time is wasted and the patient never gets a chance to get the right treatment !

If you have irregular cycles, please insist that your doctor do the following simple medical tests.
  1. Blood tests for the following reproductive hormones - FSH (follicle-stimulating hormone),LH (luteinising hormone),PRL (prolactin) , AMH (anti-Mullerian hormone) and TSH (thyroid stimulating hormone) on Day 3 of your cycle, (to check the quality of your eggs).
  2. A vaginal ultrasound scan on Day 3, which should check for the following.
    a. ovarian volumeb. antral follicle countPatients with PCOD typically have a high LH:FSH ratio; a high AMH level; large ovaries; and increased ovarian stroma with many small antral follicles.
Patients with poor ovarian reserve, on the other hand, have a high FSH:LH ratio; low AMH levels; small ovaries and a reduced antral follicle count.

If you are not sure how to interpret your reports, please send me your medical details by filling in the free second opinion form , and I'll be happy to help !

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