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Failure to ovulate, and how to get help

Dear doctor,
I have been told that I don’t ovulate and hence am unable to conceive. Is there any remedy for me?

Ovulation is the term used to denote the release of an egg every month. Women who have regular menstrual cycles, meaning they bleed every month, will almost inevitably be ovulating so long as they are not using hormonal contraception. Those with irregular periods have a higher chance of not having a predictable ovulation pattern. The degree of irregularity of the periods can vary from missing periods for several months, to bleeding in a very unpredictable pattern.

If delay in conceiving is suspected to be due to failure to ovulate, a comprehensive gynecological evaluation must be done to diagnose the exact cause. The evaluation includes reviewing your menstrual pattern, followed by hormone tests and imaging of the reproductive organs. Additional testing for uncommon conditions may be recommended for a few. Once a diagnosis is made, specific treatment can be offered to correct the situation and facilitate conception.

The majority of women with ovulation problems get diagnosed with a condition called ‘polycystic ovarian syndrome’, or PCOS for short. Women with PCOS hardly ovulate, and periods can disappear for several months. Some struggle with maintaining a normal weight, and others may notice skin and hair changes. Luckily, most will be helped with relatively simple strategies to help with conception.

Optimizing weight with diet and exercise may correct the PCOS disorder and lead to return of periods, regular ovulation and spontaneous conception. But some women will require medications to stimulate ovulation. Such medications are best prescribed by a gynecologist, rather than self-medicating. Your response to ovulation drugs will be monitored to confirm appropriate response. Many will conceive within three to six months of taking appropriate doses of ovulation drugs. Other options like surgery or advanced fertility treatment are only advised following failure of simple strategies.

If a simple ovulation problem has been corrected and there’s still no conception over a reasonable period of time, then additional evaluations must be done. This will include doing a sperm test for your partner, and checking that your fallopian tubes are normal. Any additional reproductive issues identified must be specifically addressed. However, the overall expectation is successful conception following institution of remedial measures addressing ovulation problems.

A minority of women may get diagnosed with rarer conditions that affect ovulation. These may include disordered production of hormones from the brain, premature ovarian failure, or even complex genetic syndromes. Such conditions require very specific treatment, ranging from correction of hormonal disorders to advanced fertility treatment within specialized fertility centres. Those with irreversible conditions may end up with donated eggs, or other options like adoption or just accepting to live childless.

Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist. amurage@mygyno.co.ke

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