Modern approaches to the diagnosis and management of anovulation

Any disruption of the delicate interactions of the hypothalamic pituitary ovarian axis, which must operate within precise quantitative limits and accurate temporal sequences, may lead to anovulation. Although empirical use of ovulation-inducing regimens has yielded positive results in some cases, a cost-effective therapy can only be achieved following a limited but intelligent work-up of the patient and a logical ovulation-induction protocol. The first step in this process is a thorough understanding of interactions of the hypothalamic-pituitary-ovarian axis and folliculogenesis. Furthermore, it necessitates understanding of the environmental conditions permitting the successful implantation of the conceptus. We shall briefly review the regulation of follicular development, suggest algorithms for diagnosis, and propose therapeutic alternatives.