Management of anovulatory infertility

P. G. Crosignani, D. Bianchedi, A. Riccaboni, W. Vegetti

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Chronic anovulation is probably the major cause of human infertility and is essentially associated with four distinct endocrine conditions; hyperprolactinemic anovulation, hypogonadotrophic anovulation, normogonadotrophic anovulation and hypergonadotrophic anovulation. Hyperprolactinaemia and microprolactinoma are frequent findings in young women and excessive prolactin secretion impairs ovarian function causing anovulatory subfertility. Dopaminergic treatment restores ovarian function and shrinks prolacinoma. In these patients restoration of fertility with prolactin lowering drugs does not increase the incidence of multiple pregnancies or early pregnancy loss. In the vast majority of hyperprolactinemic women pregnancy is safe and could be beneficial. Cabergoline is the most effective and tolerated of the antiprolactinemic drugs. Hypogonadotrophic anovulation is frequently associated with acute or chronic emotional stress and in this case the patient should be counselled. Explanation and reassurance are the first important management steps. The use of pulsatile gonadotrophin-releasing hormone is the best strategy to induce fertility. Patients with normogonadotrophic anovulation are likely to have polycystic ovary. The most cost effective profertility treatment is the administration of an anti-oestrogen such as clomiphene or tamoxifen. The second choice therapy for patients with normogonadotrophic anovulation is ovarian stimulation with human gonadotrophin preparations. Low dose modifications give pregnancy rates lower than that with the traditional high-dose step-up protocol and intensive monitoring is required, but multiple pregnancies are less frequent. No treatment is available to enable women with hypergonadotrophic anovulation to conceive. Fertility in these patients can be promoted only by an egg donation programme.

Original languageEnglish
Pages (from-to)108-119
Number of pages12
JournalHuman Reproduction
Volume14
Issue numberSUPPL. 1
Publication statusPublished - 1999

Fingerprint

Anovulation
Infertility
Fertility
Multiple Pregnancy
Prolactin
Prolactinoma
Pregnancy
Clomiphene
Hyperprolactinemia
Ovulation Induction
Pregnancy Rate
Tamoxifen
Therapeutics
Gonadotropins
Psychological Stress
Gonadotropin-Releasing Hormone
Pharmaceutical Preparations
Ovum
Ovary
Estrogens

Keywords

  • Chronic anovulation
  • Hypergonadotrophic anovulation
  • Hyperprolactaemia
  • Hypogonadotrophic anovulation
  • Normogonadotrophic anovulation

ASJC Scopus subject areas

  • Physiology
  • Developmental Biology
  • Obstetrics and Gynaecology
  • Reproductive Medicine

Cite this

Crosignani, P. G., Bianchedi, D., Riccaboni, A., & Vegetti, W. (1999). Management of anovulatory infertility. Human Reproduction, 14(SUPPL. 1), 108-119.

Management of anovulatory infertility. / Crosignani, P. G.; Bianchedi, D.; Riccaboni, A.; Vegetti, W.

In: Human Reproduction, Vol. 14, No. SUPPL. 1, 1999, p. 108-119.

Research output: Contribution to journalArticle

Crosignani, PG, Bianchedi, D, Riccaboni, A & Vegetti, W 1999, 'Management of anovulatory infertility', Human Reproduction, vol. 14, no. SUPPL. 1, pp. 108-119.
Crosignani PG, Bianchedi D, Riccaboni A, Vegetti W. Management of anovulatory infertility. Human Reproduction. 1999;14(SUPPL. 1):108-119.
Crosignani, P. G. ; Bianchedi, D. ; Riccaboni, A. ; Vegetti, W. / Management of anovulatory infertility. In: Human Reproduction. 1999 ; Vol. 14, No. SUPPL. 1. pp. 108-119.
@article{65c1d8add4f34209b95ae725f7233a4d,
title = "Management of anovulatory infertility",
abstract = "Chronic anovulation is probably the major cause of human infertility and is essentially associated with four distinct endocrine conditions; hyperprolactinemic anovulation, hypogonadotrophic anovulation, normogonadotrophic anovulation and hypergonadotrophic anovulation. Hyperprolactinaemia and microprolactinoma are frequent findings in young women and excessive prolactin secretion impairs ovarian function causing anovulatory subfertility. Dopaminergic treatment restores ovarian function and shrinks prolacinoma. In these patients restoration of fertility with prolactin lowering drugs does not increase the incidence of multiple pregnancies or early pregnancy loss. In the vast majority of hyperprolactinemic women pregnancy is safe and could be beneficial. Cabergoline is the most effective and tolerated of the antiprolactinemic drugs. Hypogonadotrophic anovulation is frequently associated with acute or chronic emotional stress and in this case the patient should be counselled. Explanation and reassurance are the first important management steps. The use of pulsatile gonadotrophin-releasing hormone is the best strategy to induce fertility. Patients with normogonadotrophic anovulation are likely to have polycystic ovary. The most cost effective profertility treatment is the administration of an anti-oestrogen such as clomiphene or tamoxifen. The second choice therapy for patients with normogonadotrophic anovulation is ovarian stimulation with human gonadotrophin preparations. Low dose modifications give pregnancy rates lower than that with the traditional high-dose step-up protocol and intensive monitoring is required, but multiple pregnancies are less frequent. No treatment is available to enable women with hypergonadotrophic anovulation to conceive. Fertility in these patients can be promoted only by an egg donation programme.",
keywords = "Chronic anovulation, Hypergonadotrophic anovulation, Hyperprolactaemia, Hypogonadotrophic anovulation, Normogonadotrophic anovulation",
author = "Crosignani, {P. G.} and D. Bianchedi and A. Riccaboni and W. Vegetti",
year = "1999",
language = "English",
volume = "14",
pages = "108--119",
journal = "Human Reproduction",
issn = "0268-1161",
publisher = "Oxford University Press",
number = "SUPPL. 1",

}

TY - JOUR

T1 - Management of anovulatory infertility

AU - Crosignani, P. G.

AU - Bianchedi, D.

AU - Riccaboni, A.

AU - Vegetti, W.

PY - 1999

Y1 - 1999

N2 - Chronic anovulation is probably the major cause of human infertility and is essentially associated with four distinct endocrine conditions; hyperprolactinemic anovulation, hypogonadotrophic anovulation, normogonadotrophic anovulation and hypergonadotrophic anovulation. Hyperprolactinaemia and microprolactinoma are frequent findings in young women and excessive prolactin secretion impairs ovarian function causing anovulatory subfertility. Dopaminergic treatment restores ovarian function and shrinks prolacinoma. In these patients restoration of fertility with prolactin lowering drugs does not increase the incidence of multiple pregnancies or early pregnancy loss. In the vast majority of hyperprolactinemic women pregnancy is safe and could be beneficial. Cabergoline is the most effective and tolerated of the antiprolactinemic drugs. Hypogonadotrophic anovulation is frequently associated with acute or chronic emotional stress and in this case the patient should be counselled. Explanation and reassurance are the first important management steps. The use of pulsatile gonadotrophin-releasing hormone is the best strategy to induce fertility. Patients with normogonadotrophic anovulation are likely to have polycystic ovary. The most cost effective profertility treatment is the administration of an anti-oestrogen such as clomiphene or tamoxifen. The second choice therapy for patients with normogonadotrophic anovulation is ovarian stimulation with human gonadotrophin preparations. Low dose modifications give pregnancy rates lower than that with the traditional high-dose step-up protocol and intensive monitoring is required, but multiple pregnancies are less frequent. No treatment is available to enable women with hypergonadotrophic anovulation to conceive. Fertility in these patients can be promoted only by an egg donation programme.

AB - Chronic anovulation is probably the major cause of human infertility and is essentially associated with four distinct endocrine conditions; hyperprolactinemic anovulation, hypogonadotrophic anovulation, normogonadotrophic anovulation and hypergonadotrophic anovulation. Hyperprolactinaemia and microprolactinoma are frequent findings in young women and excessive prolactin secretion impairs ovarian function causing anovulatory subfertility. Dopaminergic treatment restores ovarian function and shrinks prolacinoma. In these patients restoration of fertility with prolactin lowering drugs does not increase the incidence of multiple pregnancies or early pregnancy loss. In the vast majority of hyperprolactinemic women pregnancy is safe and could be beneficial. Cabergoline is the most effective and tolerated of the antiprolactinemic drugs. Hypogonadotrophic anovulation is frequently associated with acute or chronic emotional stress and in this case the patient should be counselled. Explanation and reassurance are the first important management steps. The use of pulsatile gonadotrophin-releasing hormone is the best strategy to induce fertility. Patients with normogonadotrophic anovulation are likely to have polycystic ovary. The most cost effective profertility treatment is the administration of an anti-oestrogen such as clomiphene or tamoxifen. The second choice therapy for patients with normogonadotrophic anovulation is ovarian stimulation with human gonadotrophin preparations. Low dose modifications give pregnancy rates lower than that with the traditional high-dose step-up protocol and intensive monitoring is required, but multiple pregnancies are less frequent. No treatment is available to enable women with hypergonadotrophic anovulation to conceive. Fertility in these patients can be promoted only by an egg donation programme.

KW - Chronic anovulation

KW - Hypergonadotrophic anovulation

KW - Hyperprolactaemia

KW - Hypogonadotrophic anovulation

KW - Normogonadotrophic anovulation

UR - http://www.scopus.com/inward/record.url?scp=0032879031&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032879031&partnerID=8YFLogxK

M3 - Article

VL - 14

SP - 108

EP - 119

JO - Human Reproduction

JF - Human Reproduction

SN - 0268-1161

IS - SUPPL. 1

ER -