Caues if anovulatory infertility ?? What kind of Anovulation ??Anovulation is present in 40% cases of Female subfertility . If so then our primary duty is to assess the cause of anovulation and plan tr accordingly . The WHO have categorized anovulatory disorders in 3 chief kinds but in clinical practice we often follow 5 types of anovulation , Such five causes of anovulation A) WHO Group-I: - HP Failure (Low gonadotrophins with 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 is of this type –clinically represented by oligo ameno, and rarely ameno, C) WHO Group III:- Primary Ov failure. POF, Natural menopause , Turners syn. Clinically exhibited by ameno, Low E2, High FSH-A better marker will be low AMH than low FSH... Hot flushes. This are called as Primary Ov failure. Unfortunately in most 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) Group-V:- Outflow Tract Obstruction. FSH is Normal, No withdrawal bleed after Prog Challenge test. , neither withdrawal bleeding with combined E & P; Usually Primary ameno, Rarely Ashermans Syndrome
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