II. History: Evaluation of Anovulation

  1. Confirm Anovulation
    1. See Ovulation
    2. See Anovulatory Bleeding
    3. Plot Menstrual Cycle pattern
  2. Pituitary Adenoma history
    1. Galactorrhea
    2. Visual changes
  3. Hyperandrogenism history (e.g. Hirsutism, HAIR-AN)
  4. Lifestyle factors (e.g. emotional stress)
  5. Weight change (excessive gain or loss)
  6. Exposure to Teratogens

III. Examination

  1. Hyperandrogenism (e.g. Polycystic Ovary Syndrome)
    1. Obesity
    2. Hirsutism
  2. Assess for syndromes
    1. Altered Sense of Smell
    2. Altered Breast development
  3. Assess for Pituitary Adenomas
    1. Visual Field defects
    2. Galactorrhea
  4. Pelvic exam
    1. Evaluate for pelvic mass
    2. Cervical Mucus (increased amount or thickness)
    3. Hormonal effects

IV. Differential Diagnosis

V. Labs

  1. See Ovulation
  2. Day 3 FSH, LH, Estradiol
  3. Day 21 Progesterone
  4. Consider Day 25 Endometrial Biopsy
    1. Will show no secretory effect in Anovulation
  5. Consider Testosterone and DHEA levels if Virilization
  6. Consider 17-Hydroxyprogesterone

VI. Management: Inducing Ovulation for Fertility

  1. Treat specific underlying diseases
    1. Thyroid disease
    2. Pituitary Adenoma
  2. Clomiphene Citrate (Clomid) alone
  3. If no Ovulation with Clomiphene
    1. Consider 8 day course of Clomid
    2. Consider with HCG if no Ovulation occurs
      1. HCG 10,000 units IM or 250 mcg SC
      2. Monitor follicle with Ultrasound
        1. Give when follicle 20 mm
        2. Monitor follicle on days 10-12
        3. Anticipate 2 mm/day growth
    3. Consider with Metformin (Polycystic ovarian syndrome)
    4. Consider with Glucocorticoids (adrenal hyperfunction)
      1. Indicated for adrenal suppression
      2. Obtain AM Cortisol for baseline
      3. Dosing: Prednisone 10 mg or Dexamethasone 500 mcg
      4. Protocol
        1. Cycle for days 3-7 with Clomid or
        2. Continuous Glucocorticoid alone
    5. Consider with Gonadotropins (e.g. Parlodel)
      1. Clomid given 1-2 amps IM or SC and
      2. Gonadotropin given on day 9-10
    6. Consider Progesterone
      1. Indicated in Luteal Phase defect

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Related Studies

Ontology: Anovulation (C0003128)

Definition (NCI) The absence of ovulation.(NICHD)
Definition (MSH) Suspension or cessation of OVULATION in animals or humans with follicle-containing ovaries (OVARIAN FOLLICLE). Depending on the etiology, OVULATION may be induced with appropriate therapy.
Concepts Disease or Syndrome (T047)
MSH D000858
SnomedCT 34571000
English Anovulation, Anovulations, Ovulation failure, Anovulation [Disease/Finding], ovulation failure, anovulation, Anovulation (finding), failure; ovulation, ovulation; failure
Dutch ovulatiefalen, anovulatie, ovulatie; uitblijven van, uitblijven van; ovulatie, Anovulatie, Ovulatie, an-
French Non ovulation, Anovulation
German Ausbleiben der Ovulation, Anovulation, Zyklus, anovulatorischer
Italian Mancata ovulazione, Anovulazione
Portuguese Insuficiência ovulatória, Anovulação
Spanish Fallo de la ovulación, anovulación (hallazgo), anovulación, Anovulación
Japanese 無排卵, ムハイラン, ハイランフゼン, 排卵不全
Swedish Utebliven ägglossning
Czech anovulace, Anovulace, Selhání ovulace
Finnish Anovulaatio
Polish Cykl anowulacyjny, Brak jajeczkowania, Cykl bez owulacji, Cykle bezowulacyjne
Hungarian Anovulatio, Ovulatio elmaradása
Norwegian Anovulasjon, Manglende eggløsning