Am I Actually Ovulating? What Most Women Don't Know About Their Fertility

Fertility awareness and reproductive health

Understanding your ovulation cycle

Many women assume they are ovulating just because they get regular periods but this isn't always true. Ovulation is essential for conception and overall hormonal health, yet up to 40% of infertility cases in women stem from ovulation problems (25% in the US).

Inspired by Dr. Cynthia Onuoha-Brown, PharmD, a clinical pharmacologist and integrative fertility expert in the WOVA network who specializes in supplement safety, medication interactions, and fertility support for women with PCOS and ovulatory challenges, we answer the most common questions to help you understand what's really going on inside your cycle.

❓ What is the number 1 cause of infertility for women?

The leading cause of infertility in women is ovulatory dysfunction, meaning problems with releasing eggs regularly. Ovulatory dysfunction accounts for roughly 25 to 40% of female infertility cases worldwide. Ovulatory disorders are one of the three most common causes of infertility in the US, alongside male factor, tubal disease, and unexplained infertility.

Within this group, Polycystic Ovary Syndrome (PCOS) is the most common cause. PCOS affects about 6 to 13% of women of reproductive age globally and often leads to irregular or absent ovulation.

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❓ Are lack of ovulation and PCOS the same? Do they go together?

Not exactly. Both “PCOS” and “anovulation” are central to female infertility, but they are not the same thing. Anovulation (lack of ovulation) is the main direct cause of female infertility, and PCOS is the most common underlying condition that causes anovulation. In other words, PCOS is the leading cause of anovulatory infertility.

• Lack of ovulation (anovulation) means you are not releasing an egg in a cycle.

• PCOS is a specific hormonal disorder and the most common reason for ovulatory dysfunction, responsible for about 70% of anovulation cases, but not all anovulation is due to PCOS.

Other causes of ovulatory problems include thyroid issues, stress, high prolactin levels, low body weight, and early ovarian aging.

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❓ Do all women know if they are ovulating? Can you have regular periods and still not ovulate or have PCOS?

No, many women don't realize they are not ovulating. You can have regular bleeding and still not ovulate. This is called anovulatory bleeding.

Also, many women with "silent PCOS" have no obvious symptoms like acne or excess hair growth and may even have regular periods, yet they do not ovulate consistently.

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❓ If you have a lack of ovulation, do you automatically have PCOS?

No. While PCOS is the most frequent cause, not all ovulation issues are caused by PCOS. Other causes include thyroid dysfunction, stress, low body weight, hormonal imbalances, or diminished ovarian reserve.

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❓ How common is "silent PCOS" or undiagnosed lack of ovulation?

Studies suggest that 50–70% of women with PCOS remain undiagnosed, often because they don't have classic symptoms like irregular periods or obvious signs of high androgens.

More broadly, chronic anovulation affects a significant portion of reproductive-age women, though occasional anovulatory cycles can happen to most women at some point. Many women may have irregular or absent ovulation without realizing it, especially if they still experience some form of bleeding.

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❓ How do you know if you're not ovulating if everything else looks normal? What's the easiest way to find out?

There are several ways to track ovulation:

• Ovulation Predictor Kits (OPKs) detect the LH surge before ovulation but don't guarantee egg release.

• Basal Body Temperature (BBT) tracking shows a post-ovulation temperature rise, confirming ovulation after the fact.

• Cervical mucus monitoring helps predict fertile days.

• Progesterone blood tests about 7 days after suspected ovulation confirm ovulation clinically.

• Ultrasound monitoring in clinics can directly track follicle growth and egg release but is less common.

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❓ Can you ovulate some months and not others?

Yes, it's common to ovulate irregularly, for example, ovulating one cycle but missing the next. This can be due to stress, hormonal fluctuations, PCOS, age, or lifestyle factors.

That's why tracking ovulation over multiple cycles is important, especially if you're trying to conceive or want a clearer understanding of your reproductive health.

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❓ What about the other causes of female infertility besides ovulatory dysfunction?

If ovulation issues cause about 25–40% of infertility, the other causes include:

• Tubal factors (blocked or damaged fallopian tubes) — 20–30%

• Endometriosis — 10–15% of all infertility cases, though it affects 24–50% of women who have infertility

• Uterine or cervical factors — 5–10%

• Diminished ovarian reserve/age-related decline — 10–20%

• Unexplained infertility (no identifiable cause despite testing) — 20–30%

Note these categories can overlap.

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✅ Final takeaways:

• Ovulatory dysfunction is the leading cause of female infertility, with PCOS being the most common culprit.

• You can have regular periods but still not ovulate, and you may not know it.

• Not all lack of ovulation means you have PCOS. There are many other causes.

• Many women with PCOS are undiagnosed, and many women with ovulatory issues go unaware.

• Tracking ovulation through kits, temperature, mucus, or blood tests can give you clearer answers.

• Ovulation can vary cycle to cycle as it's not always consistent.

• Other infertility causes include tubal damage, endometriosis, uterine issues, ovarian reserve decline, and unexplained cases. Male infertility contributes for the over 30-50% of the cases.

• The most common causes of infertility are ovulatory dysfunction, male factor infertility, and tubal disease.

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Understanding ovulation is key to taking control of your reproductive health. If you're curious about your cycle or suspect you might not be ovulating regularly, talk to a healthcare expert or explore resources like WOVA for personalized support.

References

1. Carson SA, Kallen AN. Diagnosis and management of infertility: a review. JAMA. 2021;326(1):65-76. doi:10.1001/jama.2021.4788

2. Bellver J, Rodríguez-Tabernero L, Robles A, et al. Polycystic ovary syndrome throughout a woman’s life. J Assist Reprod Genet. 2018;35(1):25-39. doi:10.1007/s10815-017-1076-6

3. Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. A prospective study of the prevalence of polycystic ovary syndrome in unselected women from the southeastern United States. J Clin Endocrinol Metab. 1998;83(9):3078-3082. doi:10.1210/jcem.83.9.5090