Not ovulating can make getting pregnant tricky; in fact, it accounts for an estimated 25 to 30 percent of infertility cases in women. Ovulation is a part of your menstrual cycle. It occurs when an egg is released from your ovary. When the egg is released, it may or may not be fertilized by sperm. If fertilized, the egg may travel to the uterus and implant to develop into a pregnancy. If left unfertilized, the egg disintegrates and the uterine lining is shed during your period.
Understanding how ovulation happens and when it takes place can help you achieve or prevent pregnancy. It can also help you diagnose certain medical conditions. Ovulation typically happens around day 14 of a 28-day menstrual cycle. However, not everyone has a textbook 28-day cycle, so the exact timing can vary. In general, ovulation occurs in the four days before or four days after your cycle’s midpoint.
The process of ovulation begins with your body’s release of follicle-stimulating hormone (FSH), typically between days 6 and 14 of your menstrual cycle. This hormone helps the egg inside your ovary to mature in preparation to release the egg later. Once the egg is mature, your body releases a surge of luteinizing hormone (LH), triggering the egg’s release. Ovulation may happen in the 28 to 36 hours after the LH surge.
I Am Not Ovulating What Can I Do?
Anovulation is the lack or absence of ovulation (the release of an egg). It is a common cause of infertility. Anovulation is often the result of an imbalance of the hormones that cause a woman to ovulate and may be part of the condition polycystic ovary syndrome (PCOS). Irregular menstruation can also indicate anovulation, and we have a variety of diagnostic tools to help determine the cause of irregular cycles.
Visit your doctor and depending on the severity and cause, treatment options for anovulation can include lifestyle changes, medication, or even in vitro fertilization (IVF). Commonly prescribed drugs include:
Clomiphene citrate (CC): is often used to correct ovulatory disturbances. Approximately 80 percent of individuals will ovulate and approximately 40 percent will achieve a pregnancy using CC. CC is usually started at a dose of 50 – 100 mg daily by mouth on days 3 to 5 of the cycle and continued for 5 days. Ovulation usually occurs a week after the last dose of clomiphene, from days 12 through 21 of the cycle. The total cycle may be as long as 35 days. Documentation of ovulation may be confirmed with a day 21 progesterone blood test, basal body temperature chart or a urine ovulation predictor kit. If ovulation is not achieved, the dose is increased by 50 mg increments usually to a maximum dose of 150 mg daily.
Human chorionic gonadotropin (hCG): is often added to CC or FSH cycles. HCG causes the ovary to release an egg and help time inseminations. Ovulation usually occurs 36-72 hours after hCG is given. HCG will cause pregnancy tests to be falsely positive.
Follicle-stimulating hormone (FSH): is the hormone that stimulates eggs to mature in the ovary. Recombinant FSH is manufactured in the laboratory. These products do not contain Luteinizing hormone (LH), a hormone that helps regulate the menstrual cycle and egg production (ovulation). Human menopausal gonadotropin (hMG) contains equal parts of FSH and LH that are derived from the urine of menopausal women. FSH may be used in women who can not make their own FSH, who failed CC, or to increase the chance of pregnancy in ovulatory women. FSH treatment requires careful monitoring. Risks include a multiple pregnancy rate of 20-30 percent and an ovarian hyperstimulation syndrome rate of 1 percent. An increased risk of ovarian cancer has been debated and the data are conflicting; however, it is recommended to minimize the number of cycles to those necessary.
FSH is usually begun on the third day of the cycle by either subcutaneous or intramuscular injection. The daily dose is adjusted after monitoring with ultrasound and estradiol blood tests. The injections usually last 7-12 days but may take longer if the ovaries are slow to respond. Once a mature egg is identified on ultrasound ovulation is triggered with hCG or LH. The cycle may be canceled if too few or too many eggs develop.
GnRH agonists and antagonists are synthetic hormones that are administered by injection to control the release of LH. GnRH analogues are used to prevent the spontaneous release of an egg.
Evening Primrose Oil
Evening primrose oil (EPO) supplements are made from the oil extracted from the seeds of evening primrose or Oenothera biennis plant. EPO is rich in essential fatty acids such as linoleic acid and gama-linoleic acid and is recommended by the website Home Remedies to increase fertility. It should be taken from the inception of the menstrual cycle to ovulation to increase fertility but should be discontinued after ovulation as it may lead to uterine contractions and cause abortion.
EPO also helps increase the quality of the cervical fluid which helps the sperm survive longer in the female reproductive tract. EPO is generally safe to use, although mild side effects such as nausea, stomach pain, and headache may occur. It may also interact with certain medications. Hence, it is best to talk to a doctor before using it.
Flaxseed oil comes from the seeds of Linum usitatissimum or flax plant and is available in liquid and capsule form. It is a rich source of polyunsaturated fatty acids that help maintain the overall health of women and thereby, improve fertility, says Jorge Chavarro in the book “The Fertility Diet.” Flaxseed oil also contains phytohormones and lignans that help balance the hormone levels within the body and regulate the menstrual cycle and ovulation. The supplements may lead to gastric disturbances. They may also interfere with certain medications. Hence, flaxseed supplements should not be used without the supervision of a doctor.
The dried fruit of vitex or Vitex agnus castus plant is used to make the vitex supplements which may help regulate hormone production in the pituitary gland and rectify ovulation irregularities. Vitex supplements may, however, cause side effects such as diarrhea, acne, stomach cramps, and headache. Severe allergic reactions may also occur. Dosage depends upon the age and the overall condition of the patient. Drugs.com also recommends talking to a doctor to diagnose the actual cause of irregular ovulation before using vitex.
Unkei-to has been used in traditional Japanese medicine to treat female fertility problems. In fact, according to an article published in a 2003 edition of the “American Journal of Chinese Medicine,” Unkei-to can help improve gonadotropin and estradiol levels in women with irregular ovulation. Like other herbs, Unkei-to may lead to side effects and drug interactions as well. Hence, talk to your doctor before using it.
Tori Hudson, author of the book “Women’s Encyclopedia of Natural Medicine,” says that green tea stimulates sex hormone-binding globulin, which can lower the estrogen and androgen levels in the body. This can correct the underlying hormone problem and induce ovulation. Overuse of green tea may, however, lead to nausea, vomiting, diarrhea, and headache. Women with psychological disorders, stomach ulcers, and kidney disorders should consult a doctor before drinking green tea. SEE: The Effect of Scent Leaf on Ovulation and Menstruation