Etiology of anovulation or oligo ovulation-How to establish the cause??

The five  common causes of anovulation as suggested by WHO are A) WHO Group-I: - HP Failure ( FSH will be low alongwith amenorrhoea), B) WHO Group-II: HP dysfunction e.g., PCOS:- evidenced by normal E 2 , normal FSH . As a matter of fact about 90%of anovulation are  of this type –clinically represented by oligo ameno, and rarely ameno, C) WHO Group –III - Primary Ov failure. POF, Natural menopause, Turners syn. Symp are : Ameno, Low E2, high FSH-A better marker will be low AMH than low FSH accompanied by .. Hot flushes. Quite often in cases of WHO Group III-the cause remains uncertain--D) WHO Group-IV- Hyperprolactinaemia.(PRL level will have to be twice the upper limit). E) WHO group-V:- Outflow Tract Obstruction. FSH is Normal, No PCT neither withdrawal bleeding with combined E & P; Usually Primary ameno, Rarely Anchorman’s Syndrome.