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Ovulation Problems


There can be a number of reasons why a woman may have ovulation problems. If a woman has anovulatory periods, there would be less than the normal number of menstrual cycles per year. If the sex partner is missing the few fertile days where trying to conceive would have been most likely, it might appear that there is infertility. However, with a hormone test the gynecologist can often find a solution how to regulate the menstrual cycle an increase the number of fertile days helping the couple to conceive.

With polycystic ovary syndrome there often is an association with obesity or dietary imbalance and the zone diet would be a good first treatment approach as in a significant portion of cases this might regulate the problem. However, the physician should closely watch the patient and follow her along.

Clomiphene to induce ovulation

If the dietary approach does not lead to ovulation, a gynecologist would need to carefully use a combination of progesterone followed by a few days of clomiphene to induce ovulation and conception. Another approach is to use human menopausal gonadotropin (=HMG). However, there are risks associated with fertility treatments, both for clomiphene and HMG therapies. Too many cycles induced with clomiphene can increase ovarian cancer risk. Overuse of HMG can lead to multiple pregnancy in about 25% (as can clomiphene). HMG has been associated in about 15% with ovarian hyper-stimulation syndrome.

Treatment of ovarian hyper-stimulation syndrome

With this syndrome the ovaries are extremely large associated with it there are major fluid shifts and ascites (=fluid in the abdomen), which can be so severe that it can become life threatening. If this happens, the physician withholds the medicine, the fluid shifts are corrected, if necessary, in a hospital setting where this can be achieved more easily with intravenous rehydration and close observation for a few days. Finally, progesterone that has been given as injection birth control for contraception can accumulate and lead to prolonged anovulatory periods for many months. The treatment for this is withholding the hormone and to follow the LH levels to see when ovulation reoccurs. Occasionally a short trial of ovulation stimulation with the help of a gynecologist may be necessary.

Ovulation Problems

Ovulation Problems

Use of Bio-identical Progesterone

An anti-aging physician, may be able to help you. When this physician orders a saliva hormone screening test or blood test, the result may show that you have too much estrogen and not enough progesterone, a condition called “estrogen dominance” by Dr. Lee (Ref. 27). Treatment is specifically directed at the cause of each case, which will differ according to the underlying condition. In the case of polycystic ovaries or estrogen dominance in association with obesity often simple bio-identical progesterone hormone replacement therapy will often cure the problem.

Bioidentical progesterone

It is important that you use bioidentical progesterone cream for treatment, not a “substitute” like Provera, which is a de-natured progesterone as a methoxy-group was attached to it. This will cause heart attacks, strokes, blood clots, breast cancer, colon cancer and Alzheimer’s disease, as the Women’s Health Initiative has shown in 2002. Natural progesterone does none of this, but gets rid of your polycystic ovaries naturally (as there is a 100% fit between the bioidentical progesterone hormone and the progesterone receptors of a woman’s body).


1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse  Station, N.J., 1999. Chapter 235.

2. B. Sears: “Zone perfect meals in minutes”. Regan Books, Harper  Collins, 1997.

3. Ryan: Kistner’s Gynecology & Women’s Health, 7th ed.,1999 Mosby,  Inc.

4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse  Station, N.J., 1999. Chapter 245.

5. AB Diekman et al. Am J Reprod Immunol 2000 Mar; 43(3): 134-143.

6. V Damianova et al. Akush Ginekol (Sofia) 1999; 38(2): 31-33.

7. Townsend: Sabiston Textbook of Surgery,16th ed.,2001, W. B.  Saunders Company

8. Cotran: Robbins Pathologic Basis of Disease, 6th ed., 1999 W. B.  Saunders Company

9. Rakel: Conn’s Current Therapy 2001, 53rd ed., W. B. Saunders Co.

10. Ruddy: Kelley’s Textbook of Rheumatology, 6th ed.,2001 W. B.  Saunders Company

11. EC Janowsky et al. N Engl J Med Mar-2000; 342(11): 781-790.

12. Wilson: Williams Textbook of Endocrinology, 9th ed.,1998 W. B.  Saunders Company

13. KS Pena et al. Am Fam Physician 2001; 63(9): 1763-1770.

More references

14. LM Apantaku Am Fam Physician Aug 2000; 62(3): 596-602.

15. Noble: Textbook of Primary Care Medicine, 3rd ed., 2001 Mosby,  Inc.

16. Goroll: Primary Care Medicine, 4th ed.,2000 Lippincott Williams &  Wilkins

17. St. Paul’s Hosp. Contin. Educ. Conf. Nov. 2001,Vancouver/BC

18. Gabbe: Obstetrics – Normal and Problem Pregnancies, 3rd ed.,  1996 Churchill Livingstone, Inc.

19. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse  Station, N.J., 1999. Chapter 251.

20. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse  Station, N.J., 1999. Chapter 250.

21. Ignaz P Semmelweiss: “Die Aetiologie, der Begriff und die  Prophylaxis des Kindbettfiebers” (“Etiology, the Understanding and  Prophylaxis of Childbed Fever”). Vienna (Austria), 1861.

22. Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th  ed., 1998 Mosby-Year Book, Inc.

23. Mandell: Principles and Practice of Infectious Diseases, 5th ed.,  2000 Churchill Livingstone, Inc.

24. Horner NK et al. J Am Diet Assoc Nov-2000; 100(11): 1368-1380.

25. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

26. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

27. Dr. John R. Lee, David Zava and Virginia Hopkins: “What your doctor may not tell you about breast cancer – How hormone balance can help save your life”, Wellness Central, Hachette Book Group USA, 2005. On page 253 and 254 he describes how progesterone can be used as a cream to treat estrogen dominance.

Last modified: March 19, 2023

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.