Why you are ovulating late (or not at all)
Can I even get pregnant if I’m ovulating after day 14? What does it all mean? How do I know what is causing these issues and, more importantly, what can you do about it? Those are the things that I’m going to talk about in this video, so keep watching to learn more.
My name is Dr. Marc Sklar, also known as The Fertility Expert, and welcome to Fertility TV, your YouTube channel dedicated to helping you get pregnant. I’ve been helping couples get pregnant for over 18 years, whether it’s in my online fertility programs or right here in sunny San Diego at my clinics. This question about ovulation is one that always gets asked, so we’re going to dive deeper today into this topic so that you can understand what ovulation timing is all about, why it’s important, why you’re having a disruption to your ovulation timing, and what you can do about it.
To know if you’re not ovulating at all or if you’re ovulating late, we have to talk about what the appropriate timing for ovulation is. So first let’s talk about what a regular cycle should look like and when ovulation should happen. A normal cycle should be about 28 days. We do have a little window, about 26 to 30 days I’m cool with, and if that’s happening, you should be ovulating around day 14. Now, this expectation that we have to ovulate right on day 14, that’s not necessarily the case. You can ovulate a bit early, let’s say on day 13 or day 12. You can also ovulate a bit late: day 15, 16, even upwards of 17 or 18. Really, there is that window of time and that’s your fertile window, when you’re ovulating, that window of time that you’re ovulating. But we get this misunderstanding that we have to be ovulating on day 14, and that’s not necessarily the case.
One of the most important pieces of ovulation is knowing when you’re ovulating. So for many of you, you might not even be aware of or know when you’re ovulating. That is probably a bigger issue. So as long as you’re ovulating in that window and, more importantly again, you know when you’re ovulating so that you can time intercourse appropriately, you do have a period of time or a window of time where ovulation can occur and still be considered normal or healthy. On top of this, just because you’re operating maybe a smidge early or a little bit later than day 14 doesn’t necessarily mean that you can’t get pregnant either. Because as long as you know when you’re ovulating and you can time intercourse appropriately, you should be able to get pregnant with ovulating outside of that day 14 timeline, as long as it’s in within that window of time that I just described.
How do you know if you’re ovulating? So here are some key ways to track. First and foremost, one of my favorite ways is BBT charting, basal body temperature charting. This is really valuable because it shows your temperature fluctuations throughout your whole cycle, which means you are tracking all cycle and you can see when you ovulate, when your hormones shift, and when they rise, and the length of your cycle. It will clear things up for you dramatically. The other nice thing about BB T charting is that you can overlay it with what’s called OPK, ovulation predictor kits, when you get that LH surge so that you can see, does it match up? Does the surge match up with what my basal temperatures are telling me? I have several videos on this topic about BBT charting, about tracking ovulation. You can check those out right over here if you want to learn more about those methods.
But there are a couple other ways, new ways, in this day and age due to technology and advancements in technology, that I think can also benefit you and you’re going to understand why they’re important in just a little bit when I start getting into the causes of late ovulation or no ovulation. You understand why these methods are really important, and the reason why I like them is because they actually can allow you to track multiple hormones like LH, estradiol, and progesterone throughout your cycle so you can see when things are shifting, how they’re shifting, and why that’s happening. So those are really valuable.
I do like to use these with the BBT charting, but these are new methods and the two ovulation kits that I like are called Oova and Mira. We’re going to leave the links for both of those in the description below so you can check them out. They are very similar, but they do test some slightly different hormones so you can see which one is more important for you, and then pick the one that’s appropriate for you as well.
So there are actually seven main reasons why you might not be ovulating at all or ovulating late. Now, this doesn’t mean that these are the only reasons; these are the seven most common reasons that I see clinically that I think you’re going to be able to relate to and then start to actually use on your fertility journey. So let’s get into talking about these different causes. I’m going to say this in order of what I find to be the more common reasons why.
The first most common reason why we might have an ovulation issue, late ovulation or no ovulation is elevated testosterone, because your androgen levels are elevated. Actually, the most common cause for elevated androgens or testosterone is PCOS, polycystic ovarian syndrome. I’m not going to get into PCOS today in this video because I have tons of other videos on this topic. Again, if you want to learn more about PCOS, if you feel like you have PCOS or just want to get an understanding for it, I’m going to leave those videos linked in the description below as well. But testosterone or elevated testosterone specifically can be a cause for an ovulation or irregular or late ovulation. Increased testosterone actually disrupts your ovulatory cycle and, again, it’s mostly found in PCOS or polycystic ovarian syndrome women, but there are times where I do find it without a diagnosis and official diagnosis of PCOS. So we do want to rule this out.
While I’m talking about testosterone, and I’m about to talk about a bunch of other hormones, I do want to remind you all, this is exactly why testing is so important and not just a little bit of testing; everything, testing all your hormones. Many of you have never actually had your testosterone checked or your androgens like DHEA, and that can be really, really important. So as we start talking about other hormones as well that can cause a disruption with your cycles and with ovulation, I want to shed the light again on how important it is for all of you to get all your hormones tested so that you can have clear answers. So if you haven’t had testosterone tested already, I encourage you to go ahead and do that now.
The second cause for irregular cycles, irregular ovulation, late ovulation is elevated cortisol levels. So I actually debated putting this number one, but instead I put testosterone number one, because PCOS is so common and it’s actually the most common endocrine disorder for women. But cortisol ran a close second, I have to tell you. So cortisol is a stress hormone and it rises when we have increased stress. Now, that’s okay for a short period of time, but if we have ongoing stress and we can’t come down for that, then our cortisol level has a hard time coming down. Now your cortisol level also shifts throughout the day. It starts higher in the beginning of the day, and as it’s time to go to bed that level comes down appropriately because it’s time for your body to wind down, relax, and go to sleep. So you can have different points in the day where your cortisol level is elevated, or you can have just elevated cortisol levels overall.
Now, what we’re trying to express here is how important stress is. Stress can impact so many different health conditions, so many different fertility or reproductive issues, but specifically here, it’s going to disrupt your hormones and it’s going to disrupt your hormones so much so that it throws off ovulation. This is super common, very common in PCOS women, but outside of PCOS as well. The most common question I ask anybody when they tell me, “My ovulation is late,” or “I didn’t ovulate this month,” or “My cycles are irregular this month,” is what is going on with your stress levels and how long have those been going on? That’s how often I see this and that’s how common it is to disrupt your ovulatory cycle.
Now, stress doesn’t just come in emotional stress. It can also come from physical stress, so we have to evaluate all aspects of stress. Are you emotionally stressed? Are you freaking out, anxious, depressed because of whatever’s going on in your life, or are you also physically stressed? Are you not getting enough proper nutrition? Are you exercising too much? Did you have some sort of traumatic event that happened and hurt you physically? There’s different types of stress and we need to get away from just looking at emotional stress as the only type and really take a step back and understand that there’s other aspects and understand how they are impacting your fertility as well.
Now, why does stress impact your ability to ovulate regularly? Well, when we’re under stress, that takes priority. Your body recognizes that that’s the most important thing that needs to be regulated because it can disrupt so many different things and affect so many different systems that your body says, “This is priority number one, so we have to take a step back. We have to regulate what’s going on.” So what gets pushed by the wayside? Your reproductive system. This being pushed by the wayside, the reproductive system really impacts your body’s ability to create and regulate your sex hormones. That’s right. That’s FSH, LH, estradiol. These are the most important hormones that your body needs for fertility and so when you’re under stress and your adrenals release cortisol, they send a signal to your pituitary, and what hormones are also produced in your pituitary? LH, FSH, testosterone, prolactin … we’re going to get into all of those in just a minute … and that can throw off your ovulation.
So stress is the second cause, could be the first cause for many of you, and I want you all to start to look at that and understand how it’s impacting your fertility. By the way, you can test for cortisol levels. So you can do a simple blood test, but my preference is actually a DUTCH test so you can see a full cortisol rhythm so that you understand what your levels are at what time of the day and how that’s impacting your body, your health, and your fertility.
The third cause is also hormone-related. This is FSH, follicle, stimulating hormone, and by this I mean that your FSH is actually too low. I know many of you are thinking like, “What do you mean too low?” We only talk about FSH when it’s too high, but I have seen times when FSH is too low. I don’t really like to see an under five. So if you’re having an FSH under five, we need to start to get an understanding for why that’s happening. Now, again, we talked about FSH being produced in the pituitary. So we just talked about a reason why it could be the stress that’s impacting it, but this is important because if FSH is too low then it’s going to take too long to increase, to develop that follicle, to mature that follicle for ovulation. If that takes too long, then it takes too long for estrogen to rise towards ovulation. The signal doesn’t get sent to your body, to increase your LH or luteinizing hormone, which is your ovulation hormone. So then ovulation gets delayed or skipped because of that. So we need to find out why that’s happening and start to correct that.
What are the main reasons why your pituitary can be impacted causing your FSH to be lower? Well, the first one is birth control pills. I know, another reason why we need to be careful with birth control pills. So birth control has been used for quite some time, but one of the impacts that it can yield is a low FSH because of its impact on the pituitary gland to regulate that so that you don’t ovulate. Long-term use can cause that. Also, fertility hormones; long-term use of fertility hormones can unnecessarily lower your FSH by impacting your pituitary; and other medications. So we do need to take a good history. You need to look back at your medication use if you’re having low levels of FSH so that we can understand where that’s coming from and so we also know how to move forward.
The fourth because is prolactin, another hormone. So prolactin is the hormone that increases or rises when you are lactating or producing breast milk. So if you’re breastfeeding a newborn, that hormone, it’s important for that level to be elevated because you need to create more breast milk for the baby, so that happens appropriately. But let’s say you are a year into it or you just finished breastfeeding. Your prolactin levels may stay elevated because your body’s used to breastfeeding and it doesn’t recognize that it needs to come down, so that might need some support. So that’s the first reason why your prolactin levels can be elevated.
The other reason that your prolactin levels can be elevated, although it’s nothing to worry about because most often it’s benign, is a small cyst on your pituitary or what’s called a benign tumor on your pituitary, which can also raise your prolactin levels. Now, when your prolactin levels are elevated, it suppresses ovulation. Remember, many of you, if you’ve had a child and you are breastfeeding, you didn’t menstruate, right? Well, why didn’t you menstruate? Because your prolactin levels were elevated, it suppressed ovulation. It controlled those other hormones, because you didn’t need to create another baby, you had to take care of a baby. So your body thinks if your prolactin is elevated, it thinks that you’re nursing and it doesn’t want to have a regular cycle so it suppresses ovulation.
The last reason why you might have the elevated prolactin levels is low dopamine, and this is a neurotransmitter. One of the ways to impact this is actually to have more joy, more happiness in your life. So get off your butt, go do things you enjoy doing. Stop doing the things that you hate to do. Let’s impact that dopamine properly in a positive light and bring more happiness and joy into your life.
Number five is your thyroid. We can’t talk about hormones and your fertility without talking about your thyroid. You’ve heard me talk about this many, many times, and ovulatory issues, irregular ovulation, or no ovulation is no different in this situation, thyroid has to be looked at. We could have a disruption to your ovulation whether you have hypothyroid, your TSH is elevated; or hyperthyroid, your TSH is too low. The first thing to recognize as we’re talking about your thyroid is that your TSH, your thyroid stimulating hormone, is actually produced in the what? Pituitary. We’ve talked about pituitary issues already today in this video, and TSH is no different. Your thyroid stimulating hormone is going to be impacted by anything that impacts or affects your pituitary such as cortisol and stress or other hormones. So that can be a cause for elevated or too low TSH levels.
Also, if your thyroid is not functioning properly, it will cause your TSH to either be too high because it needs more stimulation or too low. So we need to have a proper look at your thyroid function. Now, I mentioned three things that I often see together, and so I’m going to just mention those real quickly right now, okay? I often see PCOS, hypothyroidism, and cortisol issues or stress issues combined in many, many women. Any one of those things alone is going to disrupt ovulation and menstrual cycles, but all three together for sure will so we need to rule those out. If you’ve got one, we want to rule out the other things to make sure they’re not also impacting your fertility, ovulation, or reproductive function.
Before I get to my last two causes and points, I want to just bring up to all of you that all of these issues, all these hormones I talk about in other videos, in other ways, we always talk about stress, I’ve talked about thyroid issues, talked about PCOS, and so forth, so if you want more information on any one of those topics or the two to come, check out the rest of my YouTube channel to learn more.
So let’s get into point number six, which is anti-inflammatory medication. Anti-inflammatories like Tylenol, Advil, or any other NSAID or anything stronger, quite frankly, to reduce inflammation can disrupt ovulation and there are research studies to show this. So if you’re ongoingly taking an anti-inflammatory, you might need to talk to your doctor to understand if you should continue to take it and what you can do to address that without having to take the anti-inflammatories. There’s always things you can do to address inflammation without having to take anti-inflammatory medication. So we want you off the medication. If you’ve on it for a short period of time for whatever reason, hopefully it’s not going to impact your ovulation, but it might and that could be a reason, but sure enough, usually if you come right off of it, you’ll go right back to normal so don’t stress about that. But I am concerned about long-term use of anti-inflammatory meds so let’s get you off those and let’s find other options for you.
Last but not least, number seven, calorie restriction and over-exercise. If you are eating too little calories, you’re not eating enough nutrient-dense food, you’re not getting enough calories, you’re trying to really lose a lot of weight so you’re restricting your calorie intake, that often will throw off your ovulation and your cycles. The same thing with over-exercising. If you’re doing too much exercise, really doing some crazy exercise, you’re training for a marathon or a triathlon or anything like that, then that can throw off your cycles. We don’t want that. So if you’re doing those things, to take a step back. Bring more calories into your diet. Get on a proper diet and nutritional plan and take a step back from the crazy exercise and overdoing it. Start to do more things that are going to be relaxing and easier, and we should start to see your cycles restore to normal, and more importantly, your ovulation regulate.
So what do we do about all of these? Well, the first thing is to understand why it’s happening. So, again, testing is going to be really, really important here, especially for those first five points because we want to understand what every one of those hormones are doing and how they’re impacting your cycle, your ovulation, and your fertility. So test, don’t guess; let’s figure that out. So that’s step number one. Number two is once we know what the cause is, then we can start to create a plan around that. So if your androgens are too high, testosterone is too high, then we create a plan to lower those. If your cortisol is too high, we create a plan to lower and regulate your cortisol, and so forth. If you’re on the anti-inflammatory medication, let’s find other options for you. We talked about the exercise and diet. That’s something straightforward that you can start to manage right now, if that’s what you’re doing.
But most importantly, we need to find the cause so we can create a plan. These are things that I cover in-depth in my programs because it teaches you how to look at your hormones, how to look at your results, and then what steps you need to take to address those things. Whether you’re in my do-it-yourself program called Positive Pregnancy Method, or working with me in my private group, my Hope Fertility Coaching, any one of those programs is really going to dive deeper into these. If you want more information on those programs, then use the link in the description below. But you know what you need to be doing right now, you need to find out why. So it always starts with testing first and foremost, and then you have the information that you need to start to make change. So get to it.
I want to hear from all of you why do you think you’re ovulating late or not ovulating at all. Comment below and let me know. I also want to know what you learned from this video that you didn’t know before, so comment below and let me know. I want to hear from you. I want to know what you enjoyed and, more importantly, what you’re going through. If you like this video, give me a thumbs up. If you are not a subscriber to my YouTube channel, you need to be so hit that bell not only to subscribe but to get notified when I put out another video for all of you on your journeys. All right, everyone, until the next video. I want you all to stay safe, stay healthy, and most of all, stay fertile.