Some of the factors that interfere with the woman’s ability to conceive are those related to ovulatory dysfunction. The reproductive hormones play an important role in the treatment of ovulatory problems. Some women do not have ovulatory cycles (anovulation); others have irregular cycles (oligo-ovulation). These two conditions are not the main problem but a mere manifestation or symptom of another condition of greater significance. The conditions are quite diverse and may include problems with the central nervous system, endocrine system or problems within the developing follicles or ovary.

Hypothalamic-Pituitary Problems. Failure to ovulate may be due in part to little or no stimulation coming from the pituitary gland. Insufficient LH and FSH to stimulate any follicles in the ovaries to maturity result in oligo-ovulation or anovulation. Treatment consists of either stimulating the pituitary gland to release LH and FSH by means of GnRH stimulation (see GnRH treatment) or to simply replace the missing LH and FSH by administering it directly (see gonadotropin stimulation).

Ovarian Failure. In other conditions, women fail to ovulate because there are not enough follicles in their ovaries. If this happens before the age of 40, the condition is called "Premature Ovarian Failure" or POF. Prior chemotherapy or radiation therapy while treating cancer, removal of the ovaries, genetic abnormalities, or patient specific factors are some of the conditions which result in depletion of the egg supply at a young age. In some cases, there is usually no obvious explanation and these women are believed to have exhausted their supply of oocytes at a young age for apparently no reason. When few or no oocytes are left in the ovaries the patients are no longer candidates for ovulation induction and they will benefit more from donor oocytes.

Ovarian Cysts and Chronic Anovulation. Most women who fail to ovulate regularly have a normally functional pituitary gland and sufficient follicles containing oocytes in the ovaries. However, the problem apparently is related to the stimulatory effect of gonadotropins released by the pituitary or to the way the ovaries respond to the hormones. This is the case of the Poly-Cystic Ovarian Syndrome (PCOS) which is a condition characterized by the lack of ovulation including multiple small follicles within the ovary which are visible on ultrasound and abnormal levels of blood testosterone, LH and FSH. The cause for this disorder is poorly understood. Apparently there is a lack of FSH stimulation to ensure proper follicular development to maturity. Treatment of this condition depends on adding injectable FSH to maintain proper follicular development or giving Clomiphene Citrate to stimulate FSH release resulting in normal ovulation.