Aetiology,investigation and management of ovulatory problems

Anovulatory patients typically present with infertility. They and their partners should both be seen and examined and an ovulation plan should be developed with their doctor. A diagnosis for the symptoms and signs of chronic anovulation must be made of which polycystic ovary syndrome, hypogonadotrophic hypogonadism and hyperprolactinemia are most frequent. Pre-pregnancy counselling before ovulation induction includes not only advice re weight optimisation and cessation of smoking but also advice regarding multiple pregnancy, birth defects, ovarian hyperstimulation syndrome and multiple pregnancy reduction. Empirical therapies, such as clomiphene citrate administration to infertile but ovulatory women, should not be prescribed. Clomiphene or bromocriptine treated patients who remain anovulatory and are requiring gonadotrophin releasing hormone GnRH or gonadotrophin therapies should be referred to units experienced in such care.