Overview

Ovulation — monthly egg release — is essential for natural conception. Ovulatory dysfunction refers to irregular, infrequent, or absent ovulation. Anovulation is responsible for ~25% of female infertility. Most causes are highly treatable.

Symptoms

• Cycles shorter than 21 or longer than 35 days
• Absent periods
• No LH surge on ovulation tests
• No basal temperature rise mid-cycle
• Inability to conceive despite regular intercourse

Causes & Risk Factors

• PCOS — most common cause
• Hyperprolactinaemia
• Thyroid disorders
• Hypothalamic dysfunction — from weight loss, excessive exercise, stress
• Obesity or extreme underweight
• Diminished ovarian reserve or POI
• Certain medications — antidepressants, antipsychotics

Diagnosis

• Menstrual history — cycle length and regularity
• Mid-luteal progesterone — confirms ovulation
• Hormone panel — FSH, LH, oestradiol, prolactin, testosterone, TSH
• AMH and AFC — ovarian reserve assessment
• Pelvic ultrasound and follicle tracking

Treatment

• Letrozole — first-line ovulation induction
• Clomiphene citrate — alternative oral agent
• Metformin — for PCOS with insulin resistance
• Cabergoline — for hyperprolactinaemia
• Thyroid hormone replacement — for hypothyroidism
• Lifestyle modification — weight normalisation can restore ovulation
• Gonadotropin injections — if oral agents fail
• IVF — when other treatments have not succeeded

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