Induction of ovulation

Abstract

Anovulatory infertility comprises about one-quarter of patients attending an infertility clinic. Management should be directed at determining the diagnosis, excluding other fertility problems and initiating ovulation induction therapies. Once the cause of anovulation has been corrected, good cumulative conception rates may be achieved, whether with pulsatile gonadotrophin-releasing hormone for hypogonadotrophic hypogonadism, dopamine agonists for hyperprolactinaemia or anti-oestrogen therapy for polycystic ovary syndrome. Polycystic ovary syndrome is the hardest condition to manage because of the additional metabolic problems, frequent obesity and sensitivity of the ovaries to stimulation, all of which increase risks of ovarian hyperstimulation syndrome and multiple pregnancy. Clomiphene-resistant cases of polycystic ovary syndrome can be managed with gonadotrophin therapy or laparoscopic ovarian diathermy. Treatment should be in specialist reproductive medicine clinics with adequate access to ultrasound monitoring of therapy in order to minimize the risks.