How to Release 2 Eggs During Ovulation Naturally

 By OBGYN Dr. Kenosha Gleaton

While researchers and healthcare providers have a good understanding of what a normal menstrual cycle looks like, variations occur from time to time. Some people fall outside of the 24-38 day range, experience bleeding in between periods, have anovulatory cycles, and some may even ovulate more than once in a cycle. [1] Let’s talk more about hyperovulation.

What Is Hyperovulation?

Ovulation is the release of a mature egg, which occurs once a month in most people assigned female at birth (AFAB) of reproductive age. In the majority of cases, one ovary will release one egg around day 14 of the menstrual cycle when LH levels peak (which can be measured using an ovulation test kit). [2] However, researchers have discovered that in some cases more than one egg can be released during one menstrual cycle. This is known as hyperovulation, sometimes referred to as multiple ovulation. [3] 

How Does Hyperovulation Work?

Ovulation is the process of an ovary releasing a mature egg. Each ovary contains 1-2 million primordial follicles, which are small sacs that contain an immature egg. Hormones like FSH encourage follicle development, which leads to the growth of these eggs, one of which will eventually be released when LH levels surge. [2] During hyperovulation, more than one egg matures and is released, typically one egg from each ovary. [3] If both eggs are fertilized, it leads to fraternal twins. [3] 

What Causes Hyperovulation?

There are a few factors that can lead to hyperovulation, including age, genetics, and medications. [2-6]

Age

Age seems to be the primary factor responsible for increased ovulation. The older someone gets, the more difficult it is for the body to inhibit FSH levels, which encourage the growth and development of the ovarian follicles. [2] 

Genetics

Ever notice how twins seem to run in the family? According to some studies, genetics may play a role in how frequently or likely someone is to experience multiple ovulation. [4] Research shows fraternal twin women give birth to twins at a rate of one per 60 births, compared to the general population having twins in about one per 250 pregnancies. [5-6]

Medications

Certain medications can also impact your menstrual cycle, hormone levels, and ovulation. For example, getting off of birth control has the potential to cause a surge in FSH production, which can lead to the development of more than one egg. [7] This isn’t guaranteed to happen every time, but is a possibility. Some fertility medications are also used to stimulate the ovaries to produce multiple mature eggs in one cycle. These are known as ovulation induction medications and come in the form of tablets and injections. [8] 

How to Increase Your Chances of Hyperovulation

Can you encourage your body to ovulate more than once a month? Believe it or not, one study found that about 20% of study participants had at least one cycle where hyperovulation occurred. [3] There’s no way to guarantee that you will release more than one egg in a cycle, but here are some factors that may increase your chances of hyperovulation. 

Ovulation Induction Medications

If you do decide to go the induction route, a healthcare provider can talk to you more about what options are right for you. Medications like clomiphene or gonadotropins can stimulate the ovaries and encourage the release of multiple eggs. [8] It is important to note that ovulation induction medications may only be suitable for some people, such as those who have irregular cycles or don’t ovulate regularly. Ovulation induction medications also come with some health risks you should be aware of. [8] 

Stopping Hormonal Birth Control

As already mentioned, coming off of hormonal contraceptives like the birth control pill may cause a spike in FSH production, leading to overstimulation of the ovaries and the release of more than one egg. [7] There is no way to guarantee that this will work for you, but research shows that this is a possibility. Note that there are risks and side effects associated with stopping and starting hormonal medications suddenly. You should always consult a provider before changing your medication routine. 

Myoinositol

Myoinositol is a naturally occurring sugar that has antioxidant properties. There is quite a bit of research surrounding the use of inositol for improving IVF outcomes, supporting female fertility, and encouraging ovulation in certain groups of people, such as those with PCOS. [9-10] Clinical trials have found that inositol increases the rate of spontaneous ovulation in certain groups. [11] This is not to say that inositol will cause hyperovulation or guarantee that ovulation will occur, but there is a strong association between the use of inositol and cycle regularity. If you’re interested in menstrual cycle supplements like inositol, you should speak with your healthcare provider. 

Other factors that may affect your chances of hyperovulation include weight, height, breastfeeding, age, race/ethnicity, and genetics. [2-6] 

Risks of Hyperovulation to Keep in Mind

Releasing more than one egg in a cycle may sound like the ideal way to encourage pregnancy, but there are some risks to keep in mind. For one, a twin pregnancy does come with increased risks of preterm birth, prenatal death, intrauterine growth restriction, preeclampsia, and more. [12] Plenty of people will have healthy twin pregnancies, but it’s important to be aware of the risks. 

If you are attempting to stimulate ovulation using fertility drugs like clomiphene or gonadotropins, there are additional risks and side effects to be aware of. These include [8]:

• Headaches
• Nausea
• Mood swings
• Hot flashes
• Breast tenderness
• Vision disturbances
• Abdominal pain
• Ovarian hyperstimulation syndrome (OHSS): a rare but serious condition that causes enlarged ovaries, abdominal pain, and fluid accumulation. 

Natalist: Supporting You In Your Journey

Research and technology are constantly developing, providing more and more insight into the menstrual cycle, ovulation, fertility, and reproduction. What we do know is that hyperovulation naturally occurs in some people on occasion, and is more likely to occur in those of a certain age, family background, weight, height, race, and those who are taking or coming off of certain medications. While it would be ideal for those TTC if ovulation occurred multiple times a month, it’s impossible to make hyperovulation occur. What you can do to increase your chances of getting pregnant is live a healthy lifestyle, track ovulation, take prenatal vitamins for women, and manage any underlying conditions. [13] If you need helpful information or products to support your journey, you know where to find us. Browse Natalist products, or keep reading the Natalist blog. → 

References:

1. Menstruation and Menstrual Problems. NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development. January 2024. https://www.nichd.nih.gov/health/topics/factsheets/menstruation
2. Holesh JE, Bass AN, Lord M. Physiology, Ovulation. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 1, 2023.
3. S.N. Beemsterboer, R. Homburg, N.A. Gorter, R. Schats, P.G.A. Hompes, C.B. Lambalk, The paradox of declining fertility but increasing twinning rates with advancing maternal age, Human Reproduction, Volume 21, Issue 6, June 2006, Pages 1531–1532, https://doi.org/10.1093/humrep/del009
4. Is the probability of having twins determined by genetics?. Medline Plus. National Library of Medicine. Accessed Jan 2024. https://medlineplus.gov/genetics/understanding/traits/twins/
5. Lazarov S, Lazarov L, Lazarov N. MULTIPLE PREGNANCY AND BIRTH: TWINS, TRIPLETS AND HIGH-ORDER MULTIPLES. OVERVIEW. Trakia Journal of Sciences. Published 2016. http://www.uni-sz.bg/tsj/Vol.14,%20N%201,%202016/S.Lazarov%20(1).pdf
6. Freeborn, PhD D. Overview of Multiple Pregnancy - Health Encyclopedia - University of Rochester Medical Center. Accessed January 2024. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contentid=P08019&contenttypeid=85
7. Jernstrom H, Knutsson M, Olsson H. Temporary increase of FSH levels in healthy, nulliparous, young women after cessation of low-dose oral contraceptive use. Contraception. 1995;52(1):51-56. doi:10.1016/0010-7824(95)00124-s
8. Sharma M, Balasundaram P. Ovulation Induction Techniques. [Updated 2023 Jun 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK574564/
9. Laganà AS, Vitagliano A, Noventa M, Ambrosini G, D’Anna R. Myo-inositol supplementation reduces the amount of gonadotropins and length of ovarian stimulation in women undergoing IVF: a systematic review and meta-analysis of randomized controlled trials. Archives of Gynecology and Obstetrics. 2018;298(4):675-684. doi:https://doi.org/10.1007/s00404-018-4861-y6.
10. Sacchinelli A, Venturella R, Lico D, et al. The Efficacy of Inositol and N-Acetyl Cysteine Administration (Ovaric HP) in Improving the Ovarian Function in Infertile Women with PCOS with or without Insulin Resistance. Obstetrics and Gynecology International. 2014;2014:1-5. doi:https://doi.org/10.1155/2014/1410208.
11. Gambioli R, Forte G, Buzzaccarini G, Unfer V, Laganà AS. Myo-Inositol as a Key Supporter of Fertility and Physiological Gestation. Pharmaceuticals (Basel). 2021;14(6):504. Published 2021 May 25. doi:10.3390/ph14060504
12. Dudenhausen JW, Maier RF. Perinatal Problems in Multiple Births. Deutsches Ärzteblatt International. 2010;107(38):663-668. doi:https://doi.org/10.3238/arztebl.2010.0663
13. Good Health Before Pregnancy: Prepregnancy Care. ACOG. FAQ056. December 2021. https://www.acog.org/womens-health/faqs/good-health-before-pregnancy-prepregnancy-care 

Dr. Kenosha Gleaton is board-certified in gynecology and obstetrics and is the Medical Advisor of Natalist. She received her MD from MUSC and completed her residency at Carolinas Medical Center in Charlotte, NC.