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Investigations for Anovulation

Investigations for anovulation are essential when deciding treatment choices, and as the main cause of female infertility is a lack of ovulation, these tests are crucial. In total, about 30-40% of couple infertility is female based; the same is true for men, with the rest being combined factors between the couple. However, about a third of couples that attend fertility clinics are affected by anovulation, and there are both hormonal and non-hormonal causes.

The three hormonal causes of anovulation are:

  1. Polycystic ovary syndrome (PCOS) is the main reason for anovulation, and it’s caused by abnormally high levels of male sex hormones (androgens)
  2. Hypogonadotrophic hypogonadism is a condition where abnormally low levels of sex hormones fail to trigger new cycles
  3. Hyperprolactinaemia involves high levels of the hormone that stimulates lactation (milk) and also prevents the start of new cycles

The three non-hormonal causes of anovulation are:

  1. LUFS, where the dominant follicle is “luteinised”, but the egg isn’t released, it can’t be fertilised, and a “functional cyst” develops
  2. Genetic conditions that alter the normal development of the ovaries
  3. Premature ovarian failure is the unexpectedly early arrival of menopause (before the age of 40)

morefertile® has extensive information on a wide range of conventional and complementary treatments for anovulation.

Investigation Appropriate timing Interpretation
Progesterone 7 days past ovulation; (e.g. Day 21 if ovulation was on day 14 in a 28-day cycle)
  • Over 30 nmol/l confirms ovulation
  • If 10-30 nmol/l, check the timing of the sampling concerning cycle length
Follicle stimulating hormone


Day 2-3 of the cycle
  • Over 10 IU/l indicates reduced ovarian reserve
  • Over 40 IU/l indicates ovarian failure
  • Below 5 IU/l may indicate a pituitary or a hypothalamus problem

Luteinising hormone


Early in the follicular phase

  • Over 10 IU/l indicates polycystic ovaries
  • Below 5 IU/l may indicate a pituitary or hypothalamic problem


Any time in the cycle

  • Over 2.4 nmol/l indicates polycystic ovaries
  • Over 5 nmol/l suggests congenital adrenal hyperplasia; check DHEAS and 17-OHP levels


Any time in the cycle (but not after exercise or stress)

Over 1000 IU/l indicates a pituitary adenoma; a repeated test will confirm this

Thyroid stimulating hormone


Any time in the cycle if there are signs of hypothyroidism or hyperprolactinaemia

High TSH indicates hypothyroidism

Transvaginal ultrasound scan

Oligomenorrhoea or amenorrhoea or raised LH or testosterone levels

Identifies polycystic ovarian morphology
MRI/CT scan of the pituitary If two prolactin levels are over 1000 IU/l Identifies the presence of macroadenomas


Primary amenorrhoea (never)

Identifies chromosomal abnormalities, translocations or HLA DQ alpha incompatibility between partners

Body mass index


Oligomenorrhoea or amenorrhoea