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
WHO Group-I: - HP Failure (Low gonadotrophins with
amenorrhoea),
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,
WHO
Group III:- Primary Ov failure. POF. The clinical examples are Natural menopause , Turners syn. Such are exhibited
by 1) ameno,2) Low E2,3) High FSH-4) Low AMH which is a better marker than low FSH...5)
Hot flushes. This are called as Primary
Ov failure. Unfortunately in most cases of WHO Group III-the cause remains
uncertain and many believe that such type of loss of ovarian reserve is
autoimmune type.
WHO Group-IV- Hyperprolactinaemia.(PRL level will have to be twice the upper limit).
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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