Anovulation is the lack of or absence of ovulation, the release of an egg from the ovary. According to the National Institute of Health, chronic anovulation accounts for around 30 percent of female infertility.

Ovulation is brought about by a cascade of various hormones involving several glands and organs. The first steps in ovulation begin when the hypothalamus, a gland in the brain secretes gonadotropin-releasing hormone (GnRH). This stimulates the pituitary gland, also found in the brain, to release Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH).

FSH stimulates the growth of follicles (a woman’s eggs) which in turn make estrogen that helps build the uterine lining. Once the estrogen reaches a certain level, an LH surge causes the ovary to release the egg (within 24-36 hours). The egg then travels down the fallopian tube towards the uterus. The egg is only viable for 12-24 hours, so sperm must meet egg during this time for conception to occur.

Common causes of anovulation:

  • Obesity: A high BMI (Body Mass Index) can cause a disruption in the hormones that create ovulation thru the conversion of androgens, like testosterone, into excess estrogen in adipose (fat) cells.
  • Low body fat/too much exercise: Can cause the pituitary gland to not produce enough FSH or LH.
  • Irregular TSH or Prolactin Levels: Prolactin inhibits GnRH and FSH, which trigger ovulation. Thyroid Stimulating Hormone (TSH), either too low or high, can impact prolactin production and lead to anovulation.
  • Stress: Stress hormones, like cortisol, can cause suppression of GnRH and therefore FSH and LH. It can also diminish sex drive.
  • PCOS: An endocrine disorder that causes irregular cycles or lack of ovulation. (Please see PCOS page)
  • Perimenopause/Low Ovarian Reserve: Decreased ovarian response to FSH and a decrease in estrogen production lead to anovulatory cycles.

Acupuncture and Chinese Medicine

In Chinese Medicine, anovulation can be caused by several different factors. Generally, we are looking at regulating and supporting Qi and blood while nourishing yin, yang and jing (essence/life and reproductive energy). We look to the liver for smooth flow of Qi and to the Kidney’s for strong reproductive energy. Both the Liver and Kidney Meridians flow over the uterus and ovaries, thereby directly impacting ovarian function.


Clinical trials showed that electro acupuncture induced regular ovulation in 38% of women. It also improved hormonal imbalances and stimulates blood flow to the ovaries to support egg growth and increase live birth rates.


Research shows that Chinese Herbal Medicine increases the ovulation rate, improves cervical mucus and is determined affective in treating infertility with anovulation.


A whole foods diet that is rich in nutrients:

  • Incorporate lots of organic fruits/vegetables
  • Consume adequate amounts of protein, either in vegetarian form or in lean meats that have not been hormonally treated.
  • Eat an adequate amount of healthy plant based fats (avoid trans-fats and more unsaturated fats). Coconut, avocado and olive oil are excellent choices. As well as organic seeds and nuts.
  • Good carbs that are high in fiber (beans/whole grains) help reduce insulin spikes.
  • Limit or eliminate dairy, especially non/low-fat dairy. Research shows that the more non-fat or low fat dairy a woman consumes, the lower the rate of pregnancy.
  • Decrease sugar and/or processed sweeteners. They disrupt blood sugar and can create insulin issues, thereby effecting ovulation.
  • Eliminate caffeine and alcohol.
  • Drink lots of water!
  • Eat foods high in B-vitamins like salmon, chickpeas, dark green leafy vegetables, eggs, sweet potatoes, lentils, raw carrots, avocados and almonds. B Vitamins have been shown to support ovulation.


  • Lowering stress and getting good exercise help regulate hormone levels. Try getting out into nature at least twice a week for a long walk and fresh air.
  • Meditation is also a good way to unwind from the day and calm the central nervous system.

written by Andrea Iwi'ula in the Bellevue office