Disorders of timely oocyte (egg) production are the most common causes of female infertility. These disorders range from anovulation, oligo-ovulation, ovarian aging. Anovulation and oligo-ovulation are typically associated with cessation of regular menstrual cycles or increased length between tow menstrual periods greater than 35 days. Many diseases are associated with anovulation and infertility.
Anovulatory disorders are approached as classified by World Health Organization.
WHO Group 1: Hypogonadotropic hypogonadism or hypothalamic amenorrhea: Causes related with central nervous system, stress, eating disorders, exercised induced ovulatory dysfunction are included in this category. About 35% of adult-onset anovulation may be related with dysfunction of hypothalamus, the region of brain controlling reproductive events, 15% of them may be related to pituitary diseases such as small adenomas of the pituitary gland located just below hypothalamus secreting excessive milk hormone, prolactin. Apart from detailed history and physical examination and hormonal tests, the work-up may include MRI scan of the hypothalamus and pituitary region of the brain. If the life stressors, eating disorders or strenuous exercise are the culprits life style interventions may result in high success rates in conception after all other causes like male factor were ruled out.
WHO Group 2: Normoestrogenic or hyperandrogenic anovulation: This group includes women with polycystic ovary syndrome. These patients should also be screened for other casues of increased male hormones and also for metabolic disorders associated with the condition such as lipid profile abnormnalities and diabetes. After assessment the management for subfertility may include life style modifications, ovulation induction agents like clomiphene citrate (Clomid) tablet or in some cases injectible gonadotropin preparations. Individual decisions may be made for an outpatient surgical procedure to enhance ovulation (ovarian drilling) or some case may need IVF if cannot succeed in conceiving with other methods.
WHO Group 3: Hypergonadotropic hypogonadism or premature ovarian failure (POF). May present as diminished ovarian reserve initially. It is called as POF when menapuasal state occurs before 40 years of age which requires certain test to assure general well-being of the patients. Most realistic chance to conceive for otherwise healthy patients with POF would be through egg donation.