ABSTRACT
This chapter describes a systematic approach to women whose periods are absent or infrequent, the World Health Organization Types of ovulation disorders, treatment of ovulatory disorders, and the effectiveness of those treatments. Gonadotrophin therapy is used to prepare women for treatment with intercourse only, with intrauterine insemination, with in vitro fertilisation, and with in vitro fertilization combined with intracytoplasmic sperm injection. The manufacturers withdrew them for commercial reasons about 10 years ago, something very regrettable, and the only option is to use exogenous gonadotrophins to stimulate ovulation. Induction of ovulation with gonadotrophins can be achieved with or without a gonadotrophin-releasing hormone (GnRH) agonist. GnRH antagonists act by receptor blockage, competitively inhibiting gonadotroph cells and immediately suppressing gonadotrophin secretion. The rising levels of oestradiol also trigger the hypothalamus, and then the pituitary, to reduce pulsatility frequency of GnRH secretion, leading to high levels of Luteinising hormone (LH) production, recognisable as the LH surge.
