What’re the diagnoses behind fertility issues? Part 1/4: Issues with ovulation

Every year, the Center for Disease Control (CDC) publishes statistics on reproductive health, including a small section on patient diagnoses underlying infertility. These diagnoses are based on data from ~260k IVF cycles that were done at 463 fertility clinics in the US (most recently in 2016). Next to “diminished ovarian reserve” (31% of diagnoses), the most common diagnosis women receive has to do with “ovulatory dysfunction”. We at Ovally set out to unpack what that means:

The CDC’s diagnoses from their 2016 report:

  • 32% male factor
  • 31% diminished ovarian reserve
  • 21% other factor
  • 17% female & male factors
  • 16% ovulatory dysfunction
  • 13% unknown factor
  • 12% tubal factor
  • 8% endometriosis
  • 6% uterine factor

[Note that some patients were diagnosed with multiple issues, so the percentages don’t add up to 100%]

During ovulation, a mature egg (or sometimes two) is released from its follicle once during a cycle. If you’re suffering from “ovulatory dysfunction”, there may be no mature egg to be fertilized by sperm. Unless you’re actively tracking your ovulation to get pregnant, most women don’t know exactly when and if they’re ovulating. Missing, irregular, or particularly short or long periods can point to a problem with ovulation.

According to The Mayo Clinic, issues with the regulation of reproductive hormones by the hypothalamus or the pituitary gland often affect ovulation, as well as problems in the ovaries themselves. In the case of hormonal dysfunction, the pituitary gland may not be able to produce two hormones (follicle-stimulating- & luteinizing hormone) that regulate ovulation each month. Follicle-stimulating- and luteinizing hormone production can be affected if you’re really stressed, your weight is either too high or too low, or you’ve been doing extreme exercise. If the pituitary gland produces too much of yet another hormone called prolactin, this reduces estrogen and affects ovulation as well. This overproduction of prolactin can be a side-effect of medications treating other disorders.

Polycystic ovary syndrome (PCOS), whose symptoms can include male-pattern hair growth, acne, insulin resistance, and elevated weight, is also associated with hormonal imbalance and issues with ovulation. Finally, auto-immune disorders or genetic premature loss of eggs can cause your ovaries to no longer be able to grow eggs.

Regular ovulation is something fertility doctors check if you’re experiencing issues getting pregnant. There are a number of relatively inexpensive oral medications that can help with ovulation by regulating hormone levels in the pituitary gland. If you think you may not be ovulating regularly or have been trying unsuccessfully to get pregnant, talk to your doctor.





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