Ovulatory disorders in infertility

Question 1

WHO definition of ovulatory disorders

Answer 1

• Group I: hypothalamic pituitary failure (hypothalamic amenorrhoea or hypogonadotrophic hypogonadism).
• Group II: hypothalamic-pituitary-ovarian dysfunction (predominately polycystic ovary syndrome).
• Group III: ovarian failure.

Question 2

Group I ovulatory disorders to increase chance of pregnancy

Answer 2

• Increasing their body weight if they have a BMI of less than 19
• Moderating exercise levels if they undertake high levels of exercise
• Pulsatile administration of gonadotrophin-releasing hormone or gonadotrophins with luteinising hormone activity to induce ovulation

Question 3

Group II ovulatory disorders receiving ovarian stimulation

Answer 3

• Clomifene citrate: ultrasound monitoring during at least the first cycle of treatment; no more than 6/12
• Metformin
• A combination of the above.

Question 4

Group II ovulatory disorders resistant to clomid

Answer 4

• Laparoscopic ovarian drilling
• Combined treatment with clomifene citrate and metformin if not already offered as first-line treatment
• Gonadotrophins with ovarian monitoring