Irregular periods and getting pregnant

Irregular or abnormal ovulation and menstruation account for 30% to 40% of all cases of infertility and subfertility. Having irregular periods, no periods, or abnormal bleeding often indicates that you aren't ovulating, a condition known clinically as anovulation.

Although anovulation can usually be treated with fertility drugs, it is important to rule out other conditions that could interfere with ovulation, such as thyroid conditions or abnormalities of the adrenal or pituitary glands. After initial screening, your GP will send you to a specialist obstetrician/gynaecologist for further investigations.

Getting pregnant when you have ovulation problems

Once your doctor has ruled out other medical conditions, he or she may prescribe fertility drugs to stimulate your ovulation.

The drug contained in clomifene is often a first choice because it's effective and has been prescribed to women for decades. Unlike many infertility drugs, it also has the advantage of being taken by mouth instead of by injection. It is used to induce ovulation and to correct irregular ovulation by increasing egg production by the ovaries.

Clomifene induces ovulation in most women with anovulation. Up to 10% of women who use clomifene for infertility will have a multiple gestation pregnancy, usually twins. (By comparison, about 1% of the general population of women delivers twins.)

The typical starting dosage of clomifene is 50 mg (milligrams) per day for five days, beginning on the third, fourth, or fifth day after your period begins. You can expect to start ovulating about seven days after you've taken the last dose of clomifene. If you don't ovulate right away, the dose can be increased by 50 mg per day each month up to 150 mg. After you've begun to ovulate, most doctors suggest taking clomifene for no longer than six months. If you haven't become pregnant by then, your specialist may advise a different medication.

These fertility drugs sometimes make the cervical mucus "hostile" to sperm, keeping sperm from swimming into the uterus. This can be overcome by using artificial insemination to fertilise the egg.

Depending on your situation, your doctor may also suggest other fertility drugs such as follitropin alfa or other injectable hormones that stimulate follicles and egg development in the ovaries. These are the so-called "super-ovulation" drugs. Most of these drugs are administered by injection just under the skin. Some of these hormones may over stimulate the ovaries (causing abdominal bloating and discomfort) so your doctor will monitor you with frequent vaginal ultrasounds and blood tests to monitor oestrogen levels. About 90% of women ovulate with these drugs and between 20% and 60% become pregnant.

Polycystic ovary syndrome (PCOS)

A common ovulation problem that affects about 5% to 10% of women in their reproductive years is polycystic ovary syndrome (PCOS). This condition is also sometimes referred to as the Stein-Leventhal syndrome. PCOS is a hormonal imbalance that can make the ovaries stop working normally. In most cases, the ovaries become enlarged and appear covered with tiny, fluid-filled cysts. Symptoms include:

• No periods, irregular periods, or irregular bleeding
• No ovulation or irregular ovulation
• Obesity or weight gain (although thin women can develop PCOS)
• Insulin resistance (an indicator of diabetes)
• High blood pressure
• Abnormal cholesterol with high triglycerides
• Excess hair growth on the body and face (hirsutism)
• Acne or oily skin
• Thinning hair or male-pattern baldness