What Is Anovulation, And How Does It Affect Fertility?

Anovulation happens when an egg doesn't get released during the menstrual cycle. Here's what to know about causes, symptoms, and how it affects fertility.

Female hands looking menstrual cycle calendar on mobile app at home

Eloisa Ramos/Stocksy

Anovulation happens when your body skips ovulation, which means your ovaries don't release an egg during your menstrual cycle. If an egg doesn't get released, fertilization and conception can't occur. Keep reading to learn more about the causes of short-term and chronic anovulation, how it's diagnosed and treated, and whether it can affect your fertility.

What Does Anovulation Mean?

In a typical menstrual cycle, ovulation is that pivotal phase when an increase in hormones prompts the release of a mature egg from the ovary. The egg can get fertilized with sperm in the reproductive tract, which might result in conception. If fertilization doesn't happen, the egg simply sheds with the uterine lining during the next menstrual period.

Sometimes, however, an egg doesn't get released from the ovaries—and when that happens, the result is anovulation. Pregnancy isn't possible in anovulatory cycles. That's because "in order to conceive, an egg must be released and fertilized with sperm to create an embryo for implantation," says Jane L. Frederick, M.D., a board-certified reproductive endocrinologist at HRC Fertility in Orange County, California.

What Is Anovulation?

Anovulation happens when your body skips ovulation, which means your ovaries don't release an egg during your menstrual cycle.

How Common is Anovulation?

Anovulation is a common finding in 25% of infertility cases involving those with ovaries. Indeed, about 1 in 10 people of childbearing age will experience anovulation at some point, according to the Cleveland Clinic.

Some people may encounter a one-off anovulatory cycle, which isn't usually cause for concern. Others may have chronic long-term anovulation, which has different underlying factors and negatively affects fertility.

What Causes Anovulation?

Figuring out the cause of anovulation can seem like piecing together a complicated puzzle for even the most experienced fertility specialists. "Since more than one hormone is involved in ovulation, there are many causes," says Dr. Frederick.

According to the Cleveland Clinic, some common hormonal conditions and imbalances may lead to anovulation. These include hypothyroidism (low thyroid levels), pituitary gland dysfunction, hyperandrogenism (high levels of androgens), hyperprolactinemia (high prolactin levels), and low levels of gonadotropin-releasing hormone (GnRH).

But what sets off these hormone imbalances in the first place? That's where things can get tricky. "Anything that can impact the delicate sequence of hormonal events between the brain and ovary can impact ovulation, sometimes leading to anovulation," says Laren Narapareddy, a registered nurse and researcher specializing in pregnancy and fertility at Emory University in Atlanta, Georgia. "Environmental, nutritional, and emotional factors like stress can impact the brain-ovary connection, as well as certain health conditions."

Risk Factors for Anovulation

Figuring out the cause of anovulation can be tricky, but the following factors might increase your risk:

  • Hormonal conditions and imbalances that affect the thyroid, pituitary glands, hypothalamus, and adrenal glands
  • Polycystic ovarian syndrome (PCOS)
  • High stress levels
  • Having a low or high body mass index (BMI)
  • Long-term extreme exercise habits
  • Not consuming enough calories or having an unbalanced diet
  • Going through a hormonal change; for example, you just starting getting periods, you're breastfeeding, or you're transitioning to menopause
  • Premature ovarian insufficiency
  • Certain medications, such as birth control pills, steroids, and antipsychotics

Anovulation is actually common during certain stages of life, such as during puberty, after pregnancy, while breastfeeding, and in the transitional years leading up to menopause. Narapareddy notes that anovulation and irregular periods during these times are not typically cause for concern.

Some people may also experience anovulation and irregular periods during times of high stress, due to jet-lag, and with changing seasons, she adds. "For example, it's not uncommon to miss ovulation and a period while moving, starting a new job, taking finals, or experiencing a loss. Anovulation in these types of situations is typically short-term and ovulation should resume after the stressor resolves."

On the other hand, long-term anovulation is a greater concern because it may be caused by underlying conditions. Chronic anovulation can be triggered by hormonal imbalances, polycystic ovarian syndrome (PCOS), high stress levels, being overweight or underweight, excessive exercise, hypothyroidism, and more.

Symptoms of Anovulation

It might be hard to recognize the signs of anovulation, especially because some people still get their period without ovulating. Some common symptoms of anovulation include:

  • Irregular periods
  • Lack of periods (amenorrhea)
  • Extremely heavy periods
  • Extremely light periods
  • Not having cervical mucus
  • Irregular basal body temperature

Sometimes people won't detect any unusual symptoms that signal anovulation.

How Is Anovulation Diagnosed?

When diagnosing anovulation, health care providers will typically start by looking at your menstrual cycle for any irregularities, such as lack of periods or irregular periods. A combination of bloodwork and visualizing the reproductive organs can help make a diagnosis.

"If you're experiencing chronic anovulation and irregular periods, it's vitally important to work with your provider to determine the underlying cause," says Narapareddy. "Your provider will likely do bloodwork to measure hormones that can influence ovulation, such as prolactin, thyroid hormones, and progesterone. Additionally, they may want to do a pelvic ultrasound to visualize your ovaries and uterus."

Treatment for Anovulation

There's no one magic pill to treat anovulation; the approach will be based entirely on the underlying cause. "Treatment depends on correcting the hormonal imbalance that's causing anovulation, such as adjusting current medications to achieve adequate thyroid levels, and adding a medication to help correct ovulatory irregularities," says Dr. Frederick.

Medication can be especially helpful for more chronic and serious underlying conditions, adds Narapareddy. "For instance, if the underlying cause is hypothyroidism, beginning treatment with thyroid medication will help regulate ovulation. Sometimes, hormonal medications are used to treat anovulation, especially if the goal is to conceive."

If medication management is needed, it's often beneficial to pair this with supportive dietary and lifestyle changes. In fact, sometimes diet, exercise, and stress management can be enough to get a menstrual cycle back on track.

Keep in mind that it's important to seek treatment for chronic anovulation even if you're not trying to conceive. "This is because anovulation during these years is linked to long-term health outcomes like osteoporosis, dementia, cardiovascular disease, and certain types of cancer," says Narapareddy.

How Might Anovulation Affect Your Fertility?

There's no question about it: Anovulation and fertility are directly linked. "If you are trying to conceive and you are currently experiencing anovulation, it will impact your chances of becoming pregnant," says Narapareddy. "This is because conception is an intricately timed event that cannot occur without the release of an egg from the ovary."

The good news is, anovulation is usually treatable with lifestyle changes and/or medication, and many people with anovulation go on to have healthy pregnancies.

"Depending on the underlying cause of anovulation, there are many fertility treatment options available—ranging from stress, diet, and exercise management to in vitro fertilization," says Narapareddy. "Which one is best for you to pursue is determined by the underlying cause of anovulation, your personal preferences, and your fertility goals."

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