Ovulation is when a woman’s ovary releases an egg (oocyte) — typically every 28 days. If a woman’s ovaries do not produce an egg or something else interrupts this process, she will have problems becoming pregnant. This is called infertility.

Many women who do not have regular menstrual cycles (periods) may not be ovulating. Even some women with normal cycles may have ovulation problems.

If you have irregular periods, you may have a condition called polycystic ovarian syndrome (PCOS). PCOS is when a hormonal imbalance causes your ovaries to enlarge and develop small cysts on the outer edges. Beyond having problems with the menstrual cycle, PCOS can also affect fertility, cardiac function and appearance.

If you have an ovulation disorder such as PCOS, the Women's Health team at University of Missouri Women’s and Children’s Hospital is here to help you understand your treatment options so you can have the best possible chance of getting pregnant.

Symptoms of PCOS

If you have at least two of the following criteria, you might have PCOS:

  • History of irregular or no periods
  • Increased testosterone (as determined by lab tests or physical characteristics like excessive body or facial hair)
  • Evidence of polycystic ovaries (as determined by ultrasound imaging)

Testing for ovulation

If you have an irregular menstrual cycle — such as a period only every three months — you may not be ovulating regularly. It’s important to determine if your ovaries are producing eggs. Here are some of the ways our doctors test for ovulation.

Basal body temperature (BBT)

You will chart your temperature as soon as you wake up every morning. Approximately two days after ovulation, women experience a sustained basal body temperature (BBT) increase of about .5 degrees Fahrenheit. Most women ovulate in the middle of their cycle (about the 14th day), although every woman is different. If your BBT does not increase during the time between the first day of your period and the first day of your next period, it could mean you did not ovulate.

Urine luteinizing hormone (LH) testing 

You will test your urine in the middle of your cycle for an LH surge using a one-step over-the-counter ovulation predictor kit. Ovulation usually occurs 24 to 40 hours after you see the color change on the predictor test, meaning your LH has risen.

Transvaginal ultrasound

A technician will perform this test in the middle of your cycle, prior to when ovulation typically occurs. This imaging test is used to confirm the presence of a dominant follicle (ovarian cyst with an egg inside). Using this image, your doctor can also measure the thickness and pattern of the uterine lining at this time.

Progesterone level

Progesterone is a hormone that increases significantly in women only after ovulation occurs. This is a simple blood test that you would undergo about one week after the middle of your cycle.

Ovarian reserve testing

A woman is born with all the eggs she will ever have. As a woman ages, her eggs may become less viable (able to produce a pregnancy). Ovarian reserve refers to the ability of the eggs remaining in a woman’s ovaries at a given age to produce a viable pregnancy. This “reserve” decreases with age. The most common tests to evaluate ovarian reserve are:

  • Basal FSH, estradiol. A single blood test that is performed between days two and four of your menstrual cycle. We routinely use this test.
  • Clomiphene citrate challenge test (CCCT). A test involving the use of clomiphene citrate with two blood test measurements taken on day three and day ten of the menstrual cycle. This will identify ovarian dysfunction. We use this test less commonly.
  • Basal antral follicle (BAF) count. In this test, a technician performs a transvaginal ultrasound to count the number of small follicles (cyst with egg inside) available for stimulation at the beginning of a treatment cycle.

Treatment for ovulatory disorder

If you are diagnosed with PCOS, our experts will create an individualized treatment plan for you. Treatment may include:

  • Weight loss. If you are overweight or obese, your menstrual cycle may become more regular when you lose weight. However, even with weight loss, some women with PCOS still require fertility medication.
  • Medication. Your doctor may prescribe an oral (pill) or an injectable (shot) fertility medication to help stimulate your ovaries to produce and release eggs.
  • Intrauterine insemination (IUI). Some patients who receive fertility medication also undergo IUI. Your doctors will inject specially prepared sperm into your uterus in a simple in-office procedure. The doctor can perform IUI using either your husband’s sperm or donor sperm.