Ovulation Disorders are the most common conditions affecting female fertility probably affecting 35% of patients referred to the fertility service. Treatments for ovulation disorders are amongst the most successful treatments offered.

We offer investigation of ovulation by a variety of methods.

History

Most women who ovulate have a regular menstrual cycle. If you have no periods or very irregular periods it is likely that you are not ovulating

Ovulation tests

The basal body temperature rises after ovulation and there is a characteristic pattern. It is sometimes hard to interpret and requires you to take your temperature at the same time each morning. Some find this stressful.

Ovulation testing kits can be got from your chemist. They measure the hormonal trigger telling the ovary to release the egg and are highly accurate. They may be less accurate if your cycle is very irregular.

Measurement of the hormone Progesterone is commonly used to confirm ovulation has occurred. The level of progesterone peaks in an ovulatory cycle 7 days before menstruation. This would be day 21 of a 28 day cycle. The day should be adjusted dependant upon cycle length. Progesterone levels mimic body temperature rise. If pregnancy occurs both remain elevated.

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Ultrasound Scans

If it is unclear from tests as to whether ovulation is happening or not we arrange for follicle tracking to be done.

Ovulation Treatments

We offer several types of medical treatment for ovulation disorders. Details of each programme are detailed below. Other information is in the investigations/treatments surgery section.

The medications are

1. Clomiphene. This drug helps the pituitary gland to produce more of a hormone called FSH (Follicle Stimulating Hormone) by reducing oestrogen receptor sites. This results in lower oestrogen levels and FSH levels rise in response, stimulating the ovary. The FSH stimulates the ovary to produce follicles and thus ovulation. It is a tablet. A similar drug called Tamoxifen can also be used. This is chemically very similar to Clomiphene but there is less research on it when used for fertility treatment.
2. Letrozole. This is a drug that is called an aromatase inhibitor. It inhibits the production of oestrogen. This results in lower oestrogen levels and FSH levels rise in response, stimulating the ovary. Although the mechanism is different the effect is similar to clomiphene. It is not licensed in the UK for this purpose but is licensed in reducing oestrogen levels in breast cancer. It is as effective as clomiphene.
3. Gonadotrophins. These contain the FSH hormone and are injections, usually given daily. There are several different types. The FSH stimulates the ovary directly. This treatment requires regular monitoring with ultrasound to ensure response and to avoid excessive stimulation.
4. Metformin. This drug is a treatment for diabetes. It makes insulin metabolism more efficient. It can be used in women with Polycystic ovaries who may have an insulin metabolism problem. It is less effective than Clomiphene. This is usually used only if you have insulin resistance as demonstrated by an abnormal glucose tolerance test. It can be used in conjunction with any of the above medications.

All ovulation treatments give a risk of multiple pregnancy that exceeds that given by natural ovulation. Please see information sheets regarding actions you could take to reduce this risk.

Oral Treatments

If you do not have a period at all or they are very irregular, we may try to give you an artificial period to help time the start of medication. We use Provera 10mg daily for 7 days. You should have a period within 10 days after stopping the tablets and can start Clomiphene timed to that event.

If you do not have a period within 14 days, then do a pregnancy test and start treatment assuming an arbitrary day 1 to time medication.

If you have a period you are producing some oestrogen already and are more likely to ovulate with Clomiphene therapy.

Prolactinoma

A rare cause of ovulation failure is a high Prolactin level. Usually you have no periods at all and may have milk secretion from the breasts.

The cause is usually a microscopic tumour of the pituitary gland. Rarely this tumour may be large enough to see on a CT scan. Although benign it may compress adjacent structures and so needs proper assessment.

The treatment is to block the excess secretion using bromocriptine or cabergoline (unlicensed). Both treatments are highly effective and restore normal cycles.

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