Not ovulating while trying to conceive: what next?

What does the evidence show for anovulation?

• A menstrual history is often the starting point. Infrequent or absent periods can establish an ovulatory concern without repeated home testing. Regular cycles are more often ovulatory, but symptoms and the rest of the history determine whether additional assessment is useful. 1
• Pregnancy should be considered first when periods stop. If the explanation remains unclear, the clinician may assess thyroid function, prolactin and reproductive hormones, using the history to guide testing. A single negative home pregnancy test may not settle every clinical situation. 2
• Progesterone varies across the cycle, so the timing and reason for a blood draw matter. An isolated result taken on an arbitrary calendar day should not be interpreted without knowing when ovulation or the next period was expected. 3
• Urine LH kits provide indirect evidence of an approaching ovulatory event and can produce misleading results. ASRM advises earlier fertility assessment when menstrual cycles are irregular or absent rather than waiting through the usual six- or twelve-month interval. 1
• For anovulatory infertility associated with PCOS, now called PMOS in the current ASRM publication, letrozole is a recommended first pharmacologic option when other infertility factors are absent. That recommendation does not apply automatically to every cause of anovulation, and an existing pregnancy must be excluded. 4

When should I call my provider about anovulation?

Seek urgent medical assessment for severe or one-sided abdominal pain, shoulder pain, dizziness or fainting when pregnancy is possible. Persistent absent or irregular periods deserve a scheduled evaluation even without pain. Do not self-start fertility medication or assume a late period excludes pregnancy.