Can you get pregnant when you’re not ovulating?
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Created with Hector Chapa, MD, FACOG, Clinical Assistant Professor of Obstetrics and Gynecology, USA
Can you get pregnant when you’re not ovulating? The short answer is possibly; the long answer involves a deeper look into the biological process that is ovulation as well as knowledge of what and when the fertile window is and an understanding of your own unique menstrual cycle.
Many women have spent years doing everything they can to avoid getting pregnant, but now the time has come when they would welcome it and they find that it is not as straightforward as they were led to believe.
Whilst 85% of couples who are having regular unprotected sex will conceive within 12 months many are looking for ways to optimize their chances and speed up the process. But, whether you’re hoping to improve your chances of getting pregnant or are actively trying to avoid it, understanding the science behind how conception happens will help.
While it may appear simple—an egg meets a sperm—the reality is a complex series of events involving the brain, sex hormones, and reproductive system. So, if you want to know the answer to “when am I most fertile?”, “can I get pregnant if I’m not ovulating?”, or “how do I know if I’m ovulating?”, then read on.
Understanding ovulation
To answer the question “can you get pregnant when you’re not ovulating?”,’ we need to first take a look at what ovulation is.
Ovulation happens when an ovary releases an egg. Once released, the egg travels down the fallopian tube, where it can survive for up to 24 hours. It is here, in the fallopian tube, that it can be fertilized by a sperm cell.
Fertilization of the egg is most likely to happen when there are already live sperm cells waiting in the fallopian tube and they join together in the first four to six hours after ovulation.
The science behind ovulation
The average menstrual cycle is 28 days long; day one is the first day of your period. The cycle is divided into two phases, the follicular phase and the luteal phase, with ovulation separating the two.
During the follicular phase, an area in the brain known as the hypothalamus secretes the gonadotropin-releasing hormone (GnRH). This triggers the pituitary gland, also found in the brain, to release the follicle-stimulating hormone (FSH). The release of FSH causes the follicles in one ovary to mature. Follicles are sacs in the ovaries that contain an egg. One of the maturing follicles will become a “dominant follicle” and start to secrete the hormone estrogen as it develops. The rising level of estrogen stimulates the hypothalamus to release even more GnRH, which in turn induces the pituitary gland to release a surge of luteinizing hormone (LH). This LH surge triggers the dominant follicle to release a now mature egg, and ovulation occurs.
The luteal phase occurs after ovulation. During this phase, the follicle that released the egg turns into a structure called the corpus luteum. The corpus luteum is essential because it produces progesterone, a hormone that thickens the uterine lining to support a potential pregnancy
The phase ends when either the corpus luteum is fertilized by a sperm cell or dies. If the corpus luteum dies, it triggers the uterus lining to shed, resulting in your period and the start of the next cycle (Holesh et al 12).
What is the fertile window?
The ”fertile window” is the period of time during the menstrual cycle where it is possible to get pregnant. Understanding when your fertile window is can increase your chances of conceiving.
Studies have shown that the fertile window is a six-day timeframe that runs from the five days before ovulation to the day of ovulation. To successfully conceive, living sperm needs to be waiting in the fallopian tube as the egg descends through it. The fertile window has been calculated using the knowledge that sperm can survive in a woman’s body for up to five days and an egg for up to 24 hours. Even though it is possible to conceive by having sex on any of the days in the fertile window, the odds are greatest if unprotected sex occurs two to three days before the egg is released.
If you want to know when your fertile window is, you need to know what day you will ovulate. This can be difficult to accurately predict, even for women with regular 28 day cycles.
Clinical guidelines often state that the fertile window is between days 9-14 of a regular 28-day cycle. This assumes that ovulation occurs exactly 14 days before the start of the next period, which for the average woman is day 14 of her cycle.
However, recent studies have found that this information may not be entirely correct. According to studies by Wilcox and Bull, only a small percentage of women were found to ovulate exactly 14 days before the next menses. For many of them, their fertile windows were earlier than predicted.
The results of these studies tell us that it is difficult to predict when ovulation will occur using only cycle length as a guide. Keeping a menstrual diary to track the signs and symptoms of ovulation, such as basal body temperature and cervical discharge, or using over-the-counter ovulation kits can help you predict your fertile window more accurately.
Can you get pregnant outside of the fertile window?
Generally speaking, for conception to be possible, sex has to occur within the fertile window. However, because it is so difficult to accurately pinpoint the day of ovulation, many women may conceive much earlier or later than they thought was possible.
The Wilcox study found that women had at least a 10% chance of being in their fertile window each day from day 6 to 21, even if they have regular 28 day cycles. In fact, it found that only 30% of women have a fertile window that falls exactly between days 10-17 of their cycle, which is when clinical guidelines say it should occur.
The Bull study looked at over 600,000 ovulatory cycles and found that the day that you ovulate and the length of time between ovulation and your next period varies a lot, both between women as well as for the same woman from month to month. Things like your BMI, age, ethnicity, stress levels, and lifestyle can all have an effect on your cycle length.
These studies highlight how difficult it is to predict when your fertile window is and, therefore, what days in your cycle you could fall pregnant.
Additionally, some evidence has been found to suggest that on rare occasions, sperm can survive inside the female body for up to seven days. This means that, for a small number of people, conception could be possible outside of the 6 day fertile window and from earlier in the cycle than previously thought.
Femia offers the most accurate tool for determining ovulation and fertile days
Can you get pregnant if you’re not ovulating?
You might be asking yourself, “can I get pregnant if I’m not ovulating?” and the answer is no. It is not possible to get pregnant if you do not ovulate during a cycle, as this means that your ovaries have not released an egg to be fertilized.
Anovulation is the medical term for not ovulating. Not being able to ovulate is the cause of infertility in 30% of cases.
Ovulation can range in severity from month to month. A study by DeVilbiss found that anovulatory cycles, a cycle where no egg is released, are common. However, this kind of infrequent anovulation does not significantly delay you getting pregnant.
Some women, however, can suffer from chronic anovulation. This means that they do not release an egg during the majority of their cycles and consequently will find it much more difficult to get pregnant naturally.
What causes anovulation?
Anovulation is usually caused by a hormonal imbalance. There are several hormones that need to work together in order for your ovaries to release a healthy egg. If any of these are out of balance, it can stop you ovulating.
Several different medical conditions as well as lifestyle factors can affect the balance of these hormones.
The International Federation of Gynecology and Obstetrics (FIGO) recently grouped the causes of anovulation into four different categories.
Type 1: Hypothalamus
This is when the hypothalamus does not produce enough GnRH. A number of conditions and lifestyle factors can cause this such as low body weight, excessive exercise, or high levels of stress.
Type 2: Pituitary gland
This is when the pituitary gland does not secrete enough LH and FSH. This is most commonly caused by pituitary failure due to head injuries, autoimmune or inflammatory disorders, or benign pituitary tumors.
Type 3: Ovarian
Even if your hormone levels are ok, the ovaries can fail to release an egg due to several reasons. Premature menopause, previous radiotherapy or chemotherapy damaging the ovaries, autoimmune conditions, or genetic conditions like Turners syndrome can all cause ovarian failure.
Type 4: Polycystic ovary syndrome (PCOS)
This is the most common cause of anovulation, and accounts for 70% of cases.
In PCOS, the ovaries produce too much androgen. Androgens are a group of sex hormones and include the hormone testosterone. Women normally have low levels of testosterone, but those who suffer from PCOS can have much higher levels than normal. High testosterone levels can cause the ovaries to produce small, immature follicles that don’t respond to normal levels of FSH. This means that a dominant follicle is less likely to develop, and without a dominant follicle, you cannot ovulate.
It is possible to suffer from PCOS and have no symptoms. However, many women will experience one or more of the following:
- Difficulty getting pregnant
- Excessive hair growth on the body (hirsutism)
- Irregular menstrual cycles that are typically longer than normal
- Weight gain
- Acne or oily skin
- Thinning hair
Ultrasound imaging of women with PCOS will show several small, underdeveloped follicles in the ovaries. But, despite the name, they are not actually cysts.
How do you know if you're not ovulating?
It can be difficult to know for certain whether or not you’re ovulating; however, if you suffer from any of the following symptoms, you should discuss them with your healthcare provider:
- Irregular menstrual cycles, either very long or very short
- Amenorrhea (No periods)
- Very heavy or very light periods
- Inability to get pregnant
How do you treat anovulation?
Firstly, your healthcare provider will need to run some tests to confirm that you’re not ovulating and find out why. The treatment available depends on what is causing the anovulation. For many, the main treatment includes fertility drugs. These work by replacing the natural hormone that is affected, such as FSH or LH, to stimulate ovulation.
Does not having a period mean you’re not ovulating?
In certain circumstances, some women may not have a period (amenorrhea) or may have irregular periods but still be ovulating and, therefore, still get pregnant. Without consulting your healthcare provider and undergoing the necessary tests, you cannot know for certain whether or not you can get pregnant.
Any concerns about your menstrual cycle, including irregular menstruation or a new change in your menstrual cycle, should be discussed with your healthcare provider.
The bottom line
In order to have a shot at getting pregnant, two things need to happen. Firstly, your ovaries need to release a healthy egg into your womb; secondly, live sperm needs to be waiting in the fallopian tube as the egg descends through it.
The fertile window is the period of time when unprotected sex can lead to pregnancy. Whilst the fertile window is six days long, your chances of conceiving are best if you have sex two to three days before ovulation. Although it can be difficult to accurately predict when you will ovulate, there are methods that can help to narrow down your fertile window.
Anovulation is when you don’t release an egg during the menstrual cycle and therefore can’t get pregnant. It is usually caused by a hormonal imbalance and symptoms include not having a period, irregular periods, or periods that are very heavy or very light. While occasional anovulation is common, it’s a good idea to consult with your healthcare provider if you are still unable to get pregnant after more than a year of trying.
References
- Bouchard, Thomas P., et al. ‘Achieving Pregnancy Using Primary Care Interventions to Identify the Fertile Window’. Frontiers in Medicine, vol. 4, Jan. 2018, p. 250. PubMed Central, https://doi.org/10.3389/fmed.2017.00250.
- Bull, Jonathan R., et al. ‘Real-World Menstrual Cycle Characteristics of More than 600,000 Menstrual Cycles’. Npj Digital Medicine, vol. 2, no. 1, Aug. 2019, pp. 1–8. www.nature.com, https://doi.org/10.1038/s41746-019-0152-7.
- ‘Can I Get Pregnant Just after My Period Has Finished?’ Nhs.Uk, 27 June 2018, https://www.nhs.uk/common-health-questions/pregnancy/can-i-get-pregnant-just-after-my-period-has-finished/.
- DeVilbiss, Elizabeth A., et al. ‘Sporadic Anovulation Is Not an Important Determinant of Becoming Pregnant and Time to Pregnancy among Eumenorrheic Women: A Simulation Study’. Paediatric and Perinatal Epidemiology, vol. 35, no. 1, Jan. 2021, pp. 143–52. PubMed Central, https://doi.org/10.1111/ppe.12692.
- ‘Female Infertility-Female Infertility – Symptoms & Causes’. Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/female-infertility/symptoms-causes/syc-20354308. Accessed 13 May 2024.
- Hamilton-Fairley, Diana, and Alison Taylor. ‘Anovulation’. BMJ : British Medical Journal, vol. 327, no. 7414, Sept. 2003, pp. 546–49. PubMed Central, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC192851/.
- Holesh, Julie E., et al. ‘Physiology, Ovulation’. StatPearls, StatPearls Publishing, 2024. PubMed, http://www.ncbi.nlm.nih.gov/books/NBK441996/.
- Munro, Malcolm G., et al. ‘The FIGO Ovulatory Disorders Classification System’. International Journal of Gynecology & Obstetrics, vol. 159, no. 1, Oct. 2022, pp. 1–20. DOI.org (Crossref), https://doi.org/10.1002/ijgo.14331.
- Pregnancy – Identifying Fertile Days: MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/article/007015.htm. Accessed 13 May 2024.
- ‘Signs You’re Ovulating (besides Taking a Test)’. Mayo Clinic, https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/expert-answers/ovulation-signs/faq-20058000. Accessed 13 May 2024.
- Wilcox, Allen J., et al. ‘The Timing of the “Fertile Window” in the Menstrual Cycle: Day Specific Estimates from a Prospective Study’. BMJ, vol. 321, no. 7271, Nov. 2000, pp. 1259–62. www.bmj.com, https://doi.org/10.1136/bmj.321.7271.1259.
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