WHO classification of anovulation ??

 

Classification of Anovulation.

 

Class I :- Hypothalamic/ Pit cause including PRL disorder which cause diminished GnRH pulse, In this Class I anovulation there will be e.g. Serum E2, FSH & LH will be low. This is 5-10% of all anovulatory disorders. Besides PRL disorders, Kallmann’s syn, (cong deficiency of GnTH deficiency). Sheehan’s syndrome, Idiopathic GnRH deficiency, Stress, Exercise-induced amenorrhea, Pit. Tumours,

 

WHO Class II Anovulatory Disorders:- Normogonadotrophic Normo-gonadal anovulation though in some cases LH may be raise, This class represents about 75% of all anovulatory   disorders. Majority will respond to CC/ Anastrazole.

WHO Class III:- Hypergonadotropic:- Hypergonadotropic Hypo oestrogenic : Accounts for 10% of all anovulation- Elevated FSH, LH, low E2, Mostly are cases of Primary Ov insufficiency. & Gonadal Dysgenesis. There are cases of Fragile X permutations carriers, and very rarely in some cases you will be Ovarian resistance.-in this case there is mutation in the receptor of FSH receptors present on the surfaces of ovarian follicle. In some cases, however there may be circulating ovarian antibodies, either against FSH receptors or FSH itself. (Poor response with stimulation).What is Primary Ovarian Insuffiency? There is accelerated follicles loss. Therefore the ovarian follicle pool is diminished at an early age.

Class III: anovulatory women don not respond to OI, hence are the candidates for egg donation.

UNEXPLAINED INFERTILITY.

When to declare? 1) Normal semen   2) Normal ovulatory      3) Tubal patency-assessed. & No cavitary distortion of uterus.

 

What optimum treatment for UI? Ideally for last three decades the OI & IUI was the standard TR protocol. But time and aging it has been evidenced that this procedure yields=ds only 7-9& per cycle. So modern data shoes that if such UI cases are directly planned FOR ivf THEN SUCCESS RATE WILL BE QUITE HIGH IN THE RANGE OF > 30% PER CYCLE.

In fact cumulative data reveals the success rate of 17% in CC-FSH –IUI, 21% for CC-IUI but as high as 50% for IVF. This more trues for elderly women those who are > 38yrs.

Male Factor Infertile

Normal semen is now Density is 15 million/ ml, 40% motility, 4% morphology. In such case Mild Male Factor Subfertility relevance of IUI if density is 10-15 million ml.

Less than 10 million. / ml density-better to refer to IVF.