Management of anovulatory infertility.
Anovulatory subfertility is a heterogeneous condition with various underlying causes, which should be identified with appropriate history taking, physical examination and relevant investigations. Optimisation of body weight is essential in either underweight, overweight or obese individuals. Women with hypogonadotrophic anovulation can be treated with pulsatile gonadotrophin-releasing hormone therapy or a gonadotrophin preparation containing both follicle-stimulating hormone or luteinising hormone activities. For normogonadotrophic anovulation, clomiphene citrate should be used as first-line medical treatment. Metformin co-treatment with clomiphene citrate may be considered in a subgroup of women with polycystic ovary syndrome who are obese or clomiphene-resistant. Ovulation induction with gonadotrophin or laparoscopic ovarian drilling is the next option. Dopamine agonist is indicated for anovulation as a result of hyperprolactinaemia.
Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong.
Raymond Hang Wun
RH
Li
Ernest Hung Yu
EH
Ng
D000465:Algorithms; D000858:Anovulation / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001835:Body Weight; D018491:Dopamine Agonists / Q000627:therapeutic use; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use; D006062:Gonadotropins / Q000627:therapeutic use; D006801:Humans; D006966:Hyperprolactinemia / Q000150:complications / Q000188:drug therapy; D007006:Hypogonadism / Q000150:complications / Q000628:therapy; D007247:Infertility, Female / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D009839:Oligomenorrhea / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D010062:Ovulation Induction / Q000379:methods*
D047072:Aromatase Inhibitors; D018491:Dopamine Agonists; D004965:Estrogen Antagonists; D005300:Fertility Agents, Female; D006062:Gonadotropins; D007987:Gonadotropin-Releasing Hormone