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Not ovulating (anovulation) is found in 15% of women with infertility. Of those, 50% will be diagnosed with polycystic ovary syndrome (PCOS), see below. Measuring progesterone levels 7 days after ovulation tests for ovulation. The progesterone level should be greater than 3ng/mL. An ultrasound can also be used to see if the follicle sack has released the embryo has collapsed to form the corpus luteum.

Weight plays an important role in ovulation in both western and Chinese medicine. A minimum level of body fat is needed to maintain normal ovulation. This minimum level is around 22% of body weight. Excessive weight loss affects GnRH levels, reverting the body to a pubescent form. This is often caused by women exercising too much or dieting.

In Chinese medicine, both of these aspects weaken the body. qi, blood, yin and jing. As levels of qi, blood, yin and jing decrease, there isn't enough vital substance in the body to make the egg grow and mature. The body, starved and in survival mode, prioritises the body's resources into daily needs and not fertility.

It can take several months of treatment including a new, appropriate diet, reduced energy expenditure, acupuncture and Chinese herbs to bring the body back into good health and better fertility.