Abstract | 19th Annual International Conference for Restorative Reproductive Medicine

Najmabadi S1  Stanford J2

s.najmabadi@utah.edu
Shahpar Najmabadi
1,2Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah. 
Author Affiliations
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Title

Characteristics of anovulatory cycles among fertile and subfertile women

Background
Studies of women of reproductive age without subfertility have noted incidence of anovulatory cycles in the range of 3-10%, depending on the woman’s age, and the biomarker used to identify ovulation. Presumably, women with subfertility have higher incidence of anovulatory cycles, although data are limited. Clinically, it can be useful to understand cycle characteristics associated with anovulation.

Objectives
In this study we aimed to 1) describe the proportion of anovulatory cycles in fertile and subfertile women; 2) compare total cycle length, and days and intensity of menstrual and non-menstrual bleeding between ovulatory and anovulatory cycles, adjusted for age.

Methods
This study is a secondary data analysis, combining data from four cohorts of women, followed for 1-3 years. Using the Creighton Model FertilityCare system charts, women recorded vaginal bleeding and mucus discharge daily. We used the peak day of cervical mucus as the estimated day of ovulation and the last day of the follicular phase. We used generalized linear mixed models stratified by cycle ovulatory status and age to describe menstrual cycle parameters, including cycle length, and characteristics of menstrual and non-menstrual bleeding.

Results
Ovulation was assessed in 4477 cycles of 771 women (581 presumably fertile women with 3324 cycles, 74.5% under 30 years old; and 190 subfertile women with 1153 cycles, 37.9% under 30 years old). Overall, 5.00% of cycles (n=224) were anovulatory: 3.5% of cycles of fertile women (n=115), and 9.5% (n=109) cycles of subfertile women.
Among nonconception cycles (4235), overall cycle length was 30.73 days (95% CI 30.32, 31.15). Among ovulatory cycles, younger women (<30) had significantly longer cycles compared to older women (31.22 days [95% CI 30.71, 31.72] versus (29.57 days [95% CI 28.89, 30.25], p=0.0002). Among anovulatory cycles, there was not a significant difference in cycle length by woman age (p=0.5641). Both short (35 days) were more frequent among anovulatory cycles (7.05% versus 1.06%, and 19.23% versus 10.25%, respectively).
Additional analyses are being done to look at characteristics and menstrual and non-menstrual bleeding in ovulatory vs. anovulatory cycles.

Limitations and strengths
The presence or absence of a cervical mucus peak is highly correlated with the presence or absence of ovulation, but it is not completely sensitive or specific. Ovulatory cycles may still have defects or abnormalities of ovulation that would not be identified by this analysis. However, cervical mucus has been shown to be a reliable marker of ovulation, and the large number of women and cycles with standardized daily observations of cervical mucus and bleeding increases the reliability of our findings.

Conclusions
Anovulatory cycles are about 3 times more common for women with subfertility than in women with presumably normal fertility. Anovulatory cycles are more likely to be unusually short or unusually long compared to ovulatory cycles, adjusting for woman’s age.