Determination of pathophysiological mechanisms in subjects with amenorrhoea and their value in predicting ovulation induction therapy.

A scheme of investigation to determine the pathophysiological mechanisms in 142 women with amenorrhoea is described together with the results of a selective ovulation induction programme. Initial screening tests were performed to identify patients with conditions which were unlikely to respond to any form of treatment (e.g. primary ovarian failure) or in whom other well defined absolute causes of infertility were present. The site of defect within the hypothalamic-pituitary-ovarian axis was then determined by a series of dynamic test procedures. On the basis of these results ovulation induction treatment was selected and given for six treatment cycles. Ovulation was induced in 89.2% of 556 treatment cycles and 60.2% of 125 patients treated for up to six cycles conceived. The rationale and benefits of such an investigative protocol are discussed.