Anovulation – one of the most common causes of infertility – is here given a thorough review, with classification of the different subtypes, how they are diagnosed, how they are treated, and the possible complications and outcomes involved. This is a comprehensive evidence-based summary from an international expert team, with guidelines for daily practice clearly stated and summarized for your convenience.
Physiology of the menstrual cycle: Understanding the principles of ovarian stimulation. Classification of anovulation. Causes of anovulation: WHO class 1. Causes of anovulation: WHO class 2, non-PCOs. Causes of anovulation: WHO class 2; Polycystic Ovary Syndrome. Causes of anovulation: WHO class 3. Other endocrine disorders causing anovulation: Congenital Adrenal Hyperplasia. Other endocrine disorders: Thyroid disorders. Other endocrine disorders: Prolactinomas. Genetics of anovulation. Diagnostics of anovulation. Ovulation induction versus controlled ovarian hyperstimulation. Monitoring of ovulation induction cycles. Treatment of WHO 1: GnRH or gonadotropins?. Treatment of WHO 2: Clomiphene citrate. Treatment of WHO 2: Aromatase inhibitors. Treatment of WHO 2: Insulin sensitizers. Treatment of WHO 2: Laparoscopic electrocautery of the ovaries. Treatment of WHO 2: Gonadotropins and the role of GnRH agonists and antagonists. Treatment of WHO 2: Lifestyle modifications. Treatment of WHO 3. How to define success in ovulation induction. Complications of ovarian stimulation: Multifollicular development. Complications of ovarian stimulation: Ovarian Hyperstimulation Syndrome. Complications of ovarian stimulation: Multiple pregnancies. Long-term complications of anovulation. Predicting outcome of treating anovulation. Future prospectives. Summary: Level of evidence of statements. Summary: Strength of grade of recommendations.