Ovulation induction.
Anovulation, a common cause of female infertility, is a highly curable condition. Presented here is a simple treatment-orientated diagnostic scheme. Anovulatory women with low endogenous oestradiol and follicle stimulating hormone (FSH) are treated with either pulsatile gonadotrophin releasing hormone (GnRH) or gonadotropins, and women with eu-oestrogenic anovulation (mostly with polycystic ovarian syndrome; PCOS) have first-line treatment with clomiphene citrate (CC), possibly with metformin. If CC fails, FSH is administered using a chronic low-dose protocol with small incremental dose rises. A comparison of urinary with recombinant and pure FSH with luteinising hormone (LH) containing gonadotropins is made. Recombinant products are purer and more convenient for use but are expensive. LH content has little impact except in hypogonadotropic hypogonadism or severe pituitary suppression with GnRH analogues. Aromatase inhibitors, recombinant LH and long-acting FSH may find a future place in the armamentarium.
Homburg
Roy
R
Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Free University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. r.homburg@vumc.nl
D000858:Anovulation / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006966:Hyperprolactinemia / Q000097:blood / Q000150:complications; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000502:physiology; D007247:Infertility, Female / Q000188:drug therapy* / Q000503:physiopathology; D010060:Ovulation / Q000187:drug effects* / Q000502:physiology; D010900:Pituitary Diseases / Q000150:complications; D016649:Primary Ovarian Insufficiency / Q000503:physiopathology