Ovulation disorders

One of the causes of female infertility can be ovulation disorders, which can occur for various reasons. These reasons may not all occur but may combine.

Depending on the cause of the disorder or the missing ovulation and based on a physical and laboratory examination, the physician chooses the optimal treatment.

There are a few specific signs that suggest ovulation disorders. An irregular menstrual cycle, missing menstruation, or difficulty conceiving might be considered as symptoms. Subsequent and more detailed examination sometimes reveals other symptoms that usually indicate an endocrine (hormonal) disorder.

Symptoms of ovulation disorders

  • Amenorrhoea (missing menstruation)
  • Irregular duration of the menstrual cycle
  • Oligomenorrhea (irregular duration of the menstrual cycle)
  • Obesity
  • Significant weight loss
  • Galactorrhoea (milk secretion from the breast)
  • Hirsutism (abnormal or excessive body or facial hair growth)
  • Acne

Symptoms can show various combinations. Ovulation disorders can be the result of many different causes, including general body diseases.

Causes of ovulation disorders

1. General body diseases:

  • Thyroid gland function disorders
  • Hyperprolactinemia (abnormally high levels prolactin)

2. Hypothalamus disorders:

  • Tumors
  • Impaired hormonal control and distribution as a result of:
    • Stress
    • Weight loss
    • Cushing syndrome, congenital hyperplasia of the adrenal glands
    • Ovary or adrenal glands tumors

3. Hypophysis disorders:

  • Tumors
  • Impaired hormonal control and distribution as a result of:
    • Polycystic ovary syndrome (PCOS)
    • Weight loss
    • Infections

4. Ovary disorders:

  • Malfunctions:
    • Genetically caused (e.g., Turner syndrome)
    • Infectious origin
    • After surgery
    • Immunologic
  • Polycystic ovary syndrome (PCOS)
  • Tumors


The classification system developed by the World Health Organization (WHO) is used to determine the type of anovulation disorder. This classification divides patients into three groups:

  • Secreted prolactin level
  • Gonadotrophins (LH and FSH) level
  • Estrogen level.

Group: I

Diagnosis: Hypothalamic – hypophyseal failure

Description: The menstrual cycle does not exist, estrogen secretion not proven, prolactin levels not increased, low level of FSH (hypogonadotropic hypogonadism), no organic disorder in the hypothalamus - hypophysis area can be found.

Group: II

Diagnosis: Hypothalamic – hypophyseal dysfunction

Description: Many different menstrual cycle defects (luteal phase insufficiency, anovulating cycles, anovulating syndrome of polycystic ovaries, amenorrhoea), normal levels of prolactin and FSH, and detectable levels of estrogen.

Group: III

Diagnosis: Ovary failure

Description: No menstruation, no signs of ovary functions, higher levels of FSH, prolactin level not increased.

Group: IV

Diagnosis: Congenital or an acquired genital organ disorders

Description: No menstruation, no bleeding response to estrogen withdrawal after repeated estrogen treatments.

Group: V

Diagnosis: Infertile women with hyperprolactinemia and manifest tumorous or inflammation-inducing processes in the hypothalamus - hypophyseal area

Description: Multiple menstrual cycle defects (luteal phase insufficiency, anovulating cycles, amenorrhoea) with higher prolactin levels and diagnosed organic disorder in the hypothalamus - hypophyseal area.

Group: VI

Diagnosis: Infertile women with hyperprolactinemia without manifest tumorous or inflammation-inducing processes in the hypothalamus - hypophyseal area

Description: Same as group V, but without the diagnosed organic disorder.

Group: VII

Diagnosis: Non-menstruating women without higher prolactin levels and without manifest tumorous or inflammation - inducing processes of the hypothalamus or the hypophysis

Description: Low estrogen production, low or normal levels of prolactin and FSH.


According to the WHO classification, about 97% of non-ovulating patients belong to group II and the remaining ones to the group I. These two groups also represent patients who will most likely benefit from gonadotropin treatment to restore ovulation. Classification systems, like this one from the WHO, ensure that optimal treatment will be given to every patient.

This system also allows a comparison of results from clinical and pharmaceutical intervention trials across clinical centers and across different countries around the world because it precisely defines (i.e., standardizes) the individual diagnostic groups. It is important to realize that although the classification systems provide useful guidelines for treatment, an individual treatment will be chosen by your doctor, taking into consideration your anamnesis, physical examination, and laboratory test results.


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