Struggling to get pregnant can involve an entirely new vocabulary you probably wouldn’t need otherwise, and “oligo-ovulation” and “anovulation” are words that may become familiar to women with trouble conceiving. Anovulation, or failure to ovulate, is the most common reason for infertility in women of childbearing age. Oligo-ovulation, sometimes called oligomenorrhea, is a term used for women who ovulate sporadically (“oligo” comes from the Greek word for “few") and may need treatment for infertility, though this is not always the case. Oligo-ovulation typically results in successful ovulation just eight times (or fewer) annually. Let’s look at why both anovulation and oligo-ovulation happen, as well as how they are diagnosed and treated.

Can I get pregnant with anovulation (a failure to ovulate)?

You cannot get pregnant while you are not ovulating, but with successful treatment for anovulation—and all your partner’s biological stars aligned—you can get pregnant.

Can I get pregnant with oligo-ovulation (irregular ovulation)?

You can absolutely get pregnant with oligo-ovulation and may not even need treatment. A clear idea of when you are ovulating successfully can be enough to help you to conceive successfully.

Anovulation

Why does anovulation (a failure to ovulate) happen?

We do not always know why anovulation happens. Failure to ovulate is most often caused by a hormonal imbalance (remember, ovulation is prompted by a surge of luteinizing hormone, which is itself the result of a complex hormonal dance), which in turn can happen for a variety of reasons. Birth control methods, including the pill, coil, ring, implant, and injection, stop you from ovulation by synthetic hormonal means, but things should proceed as normal once you’ve either had one of these removed or stopped taking it.

Lifestyle factors can keep you from ovulating. Excessive exercise, stress, smoking, excessive alcohol intake, doing illegal drugs, a BMI outside of the healthy weight range, and certain STIs can cause ovulation failure.

You can stop ovulating for health reasons. A diverse list of health problems can interfere with ovulation or stop it from happening outright. This includes but is not limited to Polycystic Ovary Syndrome, fibroids, diabetes, endometriosis, thyroid trouble, overproduction of prolactin, pelvic inflammatory disease, depression, perimenopause, and cancer. It is very important that anyone looking after you while you’re attempting to get pregnant have a full understanding of your health and medical history. As some of these problems have symptoms that can be mistaken for other things and doctors will usually look at the most obvious things first, keeping a daily diary of all potential symptoms could help you to get the right diagnosis more quickly.

How is anovulation (a failure to ovulate) diagnosed?

This depends on your health profile, but you will likely be asked questions about your period and perhaps sent for blood tests or an ultrasound of your uterus. In some cases, your doctor will ask for a sample from the lining of your uterus to be tested to diagnose a condition that can cause anovulation.

How is anovulation (a failure to ovulate) treated?

Your anovulation treatment will depend on the cause and what’s safest for your overall health. Treatments can include:

Lifestyle improvements. These can include abandoning or improving any of the lifestyle habits mentioned above, from stopping smoking, drugs, or drinking to seeking treatment for sexual health problems and managing stress. Getting enough sleep and regular gentle exercise are extremely important to the natural regulation of your hormones and can positively affect ovulation.
Healthy weight loss or weight gain can be enough to regulate the ovulation cycles of some women. Ask for your doctor’s support with any attempts at changing your BMI while trying to get pregnant. Do not take weight loss medication or try to lose weight if there’s a chance you might be pregnant.
Clomiphene is a highly effective fertility drug that binds your oestrogen receptors, making your body think your oestrogen is low and stimulating the production of the follicle-stimulating hormone that causes your eggs to grow in preparation for ovulation.
Letrizole is an aromatase inhibitor (meaning it reduces the production of oestrogen in the body) used to treat breast cancer that has also been found to improve fertility in women with PCOS.
Gonadotropin hormone injections for ovulation.
Thyroid problems can be treated with medication.
High levels of prolactin, which can slow or stop ovulation, are treated through discontinuation of certain medications (if these are what are causing the problem), the introduction of new medications, or radiation or surgery for a tumour, if that is the cause.
Ovarian drilling is a minimally invasive surgery performed on women with PCOS. It involves drilling through the hard outer layer of their ovaries, thereby lowering testosterone and encouraging the regulation of their ovulation. It has a 50% success rate with helping couples conceive, but results are temporary.
Proper management of depression, diabetes, endometriosis, and other chronic problems that impact fertility can help to regulate ovulation.
Surgery can also be used to treat endometriosis, though this does not always result in enhanced fertility.
Cancer treatments can cause ovulation disruption that is temporary or damage the ovaries permanently. Some women freeze their eggs before undergoing cancer treatment as a precaution.
Metformin is a drug typically prescribed to people who are at high risk of developing Type 2 diabetes, but it is also used in the management of Polycystic Ovary Syndrome (which can cause ovulation problems), even though it is not specifically approved for this.
You can seek support with symptoms of perimenopause to make yourself more comfortable if this is keeping you from ovulating, but it is an irreversible life stage. Pregnancy through IVF can be successful after menopause.
Natural remedies for balancing hormones in pursuit of regular ovulation, such as acupuncture, are based on little or inconsistent evidence but may be worth a try if they are of interest to you.

Oligo-ovulation

Why does oligo-ovulation happen?

As with anovulation, we don’t always know the reason, and, while hormones are most often to blame, the reasons for their disruption can vary widely. Irregular periods are a common sign, but it is important to note that you can bleed every month without also ovulating regularly, making oligo-ovulation difficult to diagnose without help from a doctor or careful ovulation tracking with a kit or basal body temperature measurement.

If you have been taking or using hormone-based birth control for an extended period, you may not be aware your periods are irregular until you stop doing this. Irregular periods are always worth investigating, even if you are not trying to get pregnant. Understanding your menstrual cycle can help to give you a strong sense of your overall health, allowing you to predict mood and energy changes at different times of the month. Staying aware of changes that may be symptoms of underlying conditions can ensure you get early and appropriate intervention.

Oligo-ovulation is one of the three “Rotterdam criteria” that a doctor can use to diagnose polycystic ovary syndrome. The other two are biochemical evidence of hyperandrogenism (e.g., elevated testosterone), which is checked through a blood test, and checking out your ovaries, which is done by ultrasound. Oligo-ovulation does not always mean you have PCOS, but it is worth looking into, especially if you have other symptoms, such as diffuse hair loss from your head or excessive hair growth on your face and/or body. PCOS is one of the leading causes of infertility in women. It’s thought to affect as many as one in ten women in the UK, but accurate numbers are challenging because of the number of cases that go undiagnosed (70%, according to the World Health Organization). PCOS does not mean you will never ovulate regularly or that you can’t get pregnant, but you may need extra support.

There are many other reasons why you ovulate in an irregular way. As with anovulation, lifestyle factors and underlying health problems like thyroid disorders can cause oligo-ovulation. There are a number of medications that can disrupt your cycle. Injuries to your fallopian tubes caused by pelvic surgery, endometriosis surgery, and even caesarean sections can affect the way you ovulate.

How is oligo-ovulation diagnosed?

Oligo-ovulation is diagnosed through awareness of your menstrual cycle (this condition means you have a cycle greater than 35 days in length) and how often you are ovulating. Your doctor may also recommend hormonal testing. If oligo-ovulation is a symptom of an underlying health condition, a diagnosis may happen as a result of your assessment for this.

How is oligo-ovulation treated?

As with anovulation, treatment for oligo-ovulation depends on the cause. Treatment may happen through lifestyle changes, weight loss, surgery, hormone therapy, or either taking or discontinuing certain medications. If your sleep or mental health is believed to be disrupting your ovulation, talking therapies may be recommended.

For more information on your getting pregnant faster, check out Unii’s Preconception Journey video course with Dr. Shree Datta.

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