Ovulation disorders: Part II. Anovulation associated with normal estrogen.

PURPOSE: To present various types of anovulatory states associated with normal estrogen and various treatment options.

METHODS

Evaluation and treatment of various conditions including polycystic ovarian syndrome, hyperprolactinemia, congenital adrenal hyperplasia are discussed as are methods to prevent certain complications of these therapies.

RESULTS

Clomiphene citrate seems equally effective to gonadotropins at least for the first three cycles but has a frequent complication of adversely affecting the cervical mucus so intrauterine insemination is frequently needed. Glucocorticoid therapy and insulin receptor drugs can exert a primary or more commonly an ancillary benefit when used in combination with other follicle maturing drugs. Complications, e.g., adverse cervical mucus, luteinized unruptured follicle (LUF) syndrome, premature luteinization, luteal phase deficiency and treatment options are presented.

CONCLUSIONS

Vaginal progesterone can correct luteal phase problems, human chorionic gonadotropin (hCG) and follicle stimulation hormone (FSH) and gonadotropin releasing hormone (GnRH) agonists can help LUF syndrome and GnRH agonists and antagonists can help the complication of premature luteinization.