ABSTRACT
Treatment of anovulatory infertility aims at restoring normal ovarian physiology, that is, mono-follicular growth and mono-ovulation. First-line ovulation induction treatment with anti-estrogen clomiphene citrate (CC) has the advantage of a high response rate and low costs as well as minor side effects and complications. In case of clomiphene-resistant anovulation (CRA) or failure to conceive (CRF), secondline treatment to induce ovulation consists of daily administration of exogenous FSH. To enhance the ovarian sensitivity for FSH stimulation, laparoscopic electrocoagulation of the ovaries (LEO, Chapter 18) and the use of insulin sensitizers (i.e., Metformin, Chapter 17) are proposed. These modalities are utilized in patients after CRA and may be combined with the use of CC or FSH. Although effective, treatment with CC and FSH is complicated by the limited control of ovarian response due to large inter-and intrapatient variability. Development of prediction models taking into account individual patient characteristics may be a step forward in optimizing the decision-making process in the treatment of normogonadotropic anovulation, resulting in a more patient-tailored treatment.
