Reproductive Endocrinology and Infertility
Infertility - Ovulation Disorders

Ovulatory dysfunction is a common cause of infertility. Women who are not consistently ovulating typically have irregular menstrual cycles. Periods are usually unpredictable and occur at infrequent intervals, although occasionally they may occur at shorter than normal intervals. For some women their periods have always been like this, whereas in others, the menstrual irregularity is recent in onset. Disorders of the thyroid gland (usually an underactive gland) can be associated with lack of ovulation. Thyroid disease is more prevalent in women than men so women with irregular menses should have their thyroid hormones measured. Excess prolactin production can also cause ovulatory dysfunction. Prolactin is a hormone that stimulates milk production by the breast. Excess prolactin production is usually, but not always, associated with a milky discharge from the breasts (called galactorrhea). Therefore women with irregular menses should have their prolactin measured regardless of whether or not they have galactorrhea.

Stress, whether that be emotional or physical, can affect ovulation. We now know that the higher brain centers that ultimately control ovarian function can be inhibited by various hormones and neurotransmitters that are released in response to stress. The stress could be due to a recent systemic illness or could be psychologic in origin, i.e. recent death in the family, job change, divorce, etc. The ovulatory dysfunction generally resolves when the stress resolves. Weight changes can also disrupt ovulation. This can either be a recent weight gain or weight loss. Women who engage in intense aerobic exercise, i.e. running, can disrupt ovulation by mechanisms that are not clearly understood. The problem usually resolves when the level of exercise is decreased. Women with "polycystic ovarian syndrome" (to be described below) will also not ovulate on a regular basis.