Management of disorders of ovulation

This review article evaluates the management of disorders of ovulation by first examining the specific conditions covering hypothalamic disorders, polycystic ovary syndrome and hyperprolactinaemia. Treatment options for disorders of ovulation depend on the clinical presentation, the underlying cause and the woman's wishes. Those who seek fertility require treatment to induce ovulation, and this treatment should be offered in conjunction with assessment of other factors relevant to fertility, including semen analysis and the exclusion of pelvic pathology. The uses of clomiphene citrate, gonadotrophins, gonadotrophin releasing hormone (GnRH), metformin, laparoscopic surgery and in vitro fertilization (IVF) are discussed. Ovulation should not be induced in women who do not wish to conceive. These women usually seek a diagnosis and cycle control. This is best achieved using cyclical progestogens or an oestrogen-progestogen pill, and treatment choice depends on the woman's oestrogen status and her contraceptive needs. The final section concentrates on adverse outcomes of induction ovulation including multiple pregnancy, ovarian hyperstimulation syndrome (OHSS) and ovarian carcinoma.