Clinical Review

Anovulation

BMJ 2003; 327 doi: http://dx.doi.org/10.1136/bmj.327.7414.546 (Published 04 September 2003) Cite this as: BMJ 2003;327:546
  1. Diana Hamilton Fairley,
  2. Alison Taylor

    Introduction

    Disorders of ovulation account for about 30% of infertility and often present with irregular periods (oligomenorrhoea) or an absence of periods (amenorrhoea). Many of the treatments are simple and effective, so couples may need only limited contact with doctors. This makes it easier for a couple to maintain a private loving relationship than in the stressful, more technological environment of assisted conception. However, not all causes of anovulation are amenable to treatment by ovulation induction. Anovulation can sometimes be treated with medical or surgical induction, but it is the cause of the anovulation that will determine whether ovulation induction is possible. The various options are discussed later in this article.

    Causes suitable for ovulation induction

    Hypothalamic-pituitary causes

    Hypogonadotrophic hypogonadism is characterised by a selective failure of the pituitary gland to produce luteinising hormone and follicle stimulating hormone. The commonest cause is excessive exercise, being underweight, or both. Women who have a low body mass index (weight (kg)/(height (m)2)) (for example, < 20) or who exercise excessively—for example, gymnasts, marathon runners, ballerinas—may develop amenorrhoea because of a physiological reduction in the hypothalamic production of gonadotrophin releasing hormone. Women who are underweight for their height when they get pregnant are more likely to have “small for dates” babies; and children of women who have eating disorders are more likely to be admitted to hospital with failure to thrive.

    Sheehan's syndrome (panhypopituitarism), caused by infarction of the anterior pituitary venous complex (usually after massive postpartum haemorrhage or trauma), and Kallman's syndrome (amenorrhoea with anosmia caused by congenital lack of hypothalamic production of gonadotrophin releasing hormone) are rare. Children treated for a craniopharyngioma or some forms of leukaemia may have hypogonadotrophic hypogonadism secondary to cerebral irradiation, which may affect the hypothalamus or the pituitary.

    View this table:

    Causes of anovulation suitable for ovulation induction treatment

    Hyperprolactinaemia is usually caused by a pituitary microadenoma. …

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