Late ovulation: causes, impact on fertility and the role of IVF

Late ovulation, often linked to hormonal imbalances or PCOS, can complicate conception but solutions like ovarian stimulation or IVF can help achieve pregnancy.

Ovulation and menstrual cycle

In women with a 28-day cycle, ovulation usually occurs around the 14th day. This regularity facilitates monitoring ovulation and planning pregnancy. The maximum probability of conception is on the day of ovulation and the five days preceding it.

What is late ovulation

Ovulation is considered late when it occurs after the 21st day of the menstrual cycle. Today, in many women, the cycle exceeds the typical 28 days: only 10% of women ovulate strictly on the 14th day. The normal cycle length varies between 21 and 35 days, and these variations do not always indicate fertility issues. However, irregular ovulation makes it more difficult to determine the optimal time for conception.

Late ovulation is especially common in polycystic ovary syndrome (PCOS), where ovulation can be irregular or absent.

Causes of late ovulation

1. Medication use. Certain medications, including antidepressants, chemotherapy, thyroid hormones, and steroids, can inhibit ovulation.

2. Breastfeeding. During breastfeeding, hormonal levels change, which can lead to irregular or absent periods and ovulation.

3. PCOS. A chronic endocrine disorder characterized by excess androgens, irregular periods, and disrupted ovulation.

4. Thyroid disorders. Both hyperthyroidism and hypothyroidism can affect the regularity of ovulation.

5. Stress. Chronic stress disrupts the production of reproductive hormones, making ovulation processes more difficult.

How does late ovulation affect conception?

Late ovulation can complicate identifying the fertile window, reducing the chances of conception. However, with proper cycle monitoring, millions of women succeed in becoming pregnant even with irregular ovulation.

After release, the ovum remains viable for 12 to 24 hours, and sperm can survive in the woman's body for up to five days. Therefore, conception is possible both on the day of ovulation and a few days afterward.

Ovulation monitoring methods

• Observation of cervical mucus. It becomes transparent, elastic, and slippery during the ovulation period.
• Changes in the cervix. During fertile days, it is soft, high, and open.
• Ovulation tests. They detect the release of luteinizing hormone (LH), which occurs before ovulation.

Treatment for late ovulation

The treatment depends on the cause and includes both lifestyle modifications and medication:

• Anti-estrogens (e.g., clomiphene) to stimulate ovulation;
• Gonadotropins to induce ovulation when there is no response to basic treatment;
• Reducing insulin resistance in cases of PCOS (e.g., metformin).

If medication is ineffective, surgical interventions may be considered, such as ovarian coagulation via laparoscopy in cases of PCOS.

Ovary stimulation is performed under ultrasound monitoring. When the follicle reaches the desired size, human chorionic gonadotropin (hCG) is injected to induce ovulation. This increases the risk of multiple pregnancies (up to 30%).

Late ovulation and IVF

Late ovulation is a common reason for resorting to in vitro fertilization (IVF). In cases of irregular ovulation, precisely identifying the optimal moment for conception is difficult, while IVF allows for controlled management of this process with high accuracy.

During IVF, ovulation is artificially triggered using hormonal preparations. This enables precise monitoring of ovule maturation and retrieval at the optimal time. However, if the ovaries respond weakly or with delay, protocol modifications or additional stimulation may be necessary.

IVF with egg donation

When ovarian stimulation in the patient is ineffective (for example, due to reduced ovarian reserve), donor eggs are used. In this case, the donor's ovulation is separately controlled and the recipient's body is prepared for embryo transfer. Late ovulation factor is irrelevant here.

IVF with double donation

If donor eggs and sperm are required, the patient's ovulation is completely excluded from the process. The main task then is to prepare the endometrium and synchronize the cycle. This approach is particularly indicated in cases of severe infertility or premature ovarian exhaustion.

Thus, late ovulation is not an obstacle to successful conception thanks to modern assisted reproductive technologies.

When to see a doctor

If you have irregular periods, difficulty conceiving, or suspect an hormonal imbalance, it is important to consult a gynecologist in a timely manner. At the Natuvitro medical center, you will benefit from a comprehensive diagnosis, a personalized treatment plan, and support at all stages of your pregnancy planning.

You can make an appointment by phone or via the form available on our center's website.