II. History: Evaluation of Anovulation
- Confirm Anovulation
- See Ovulation
- See Anovulatory Bleeding
- Plot Menstrual Cycle pattern
-
Pituitary Adenoma history
- Galactorrhea
- Visual changes
- Hyperandrogenism history (e.g. Hirsutism, HAIR-AN)
- Lifestyle factors (e.g. emotional stress)
- Weight change (excessive gain or loss)
- Exposure to Teratogens
III. Examination
- Hyperandrogenism (e.g. Polycystic Ovary Syndrome)
- Assess for syndromes
- Altered Sense of Smell
- Altered Breast development
- Assess for Pituitary Adenomas
- Pelvic exam
- Evaluate for pelvic mass
- Cervical Mucus (increased amount or thickness)
- Hormonal effects
IV. Differential Diagnosis
- See Infertility and Infertility Causes
- Pregnancy
- Menopause or Premature Ovarian Failure
V. Labs
- See Ovulation
- Day 3 FSH, LH, Estradiol
- Day 21 Progesterone
- Consider Day 25 Endometrial Biopsy
- Will show no secretory effect in Anovulation
- Consider Testosterone and DHEA levels if Virilization
- Consider 17-Hydroxyprogesterone
VI. Management: Inducing Ovulation for Fertility
- Treat specific underlying diseases
- Thyroid disease
- Pituitary Adenoma
- Clomiphene Citrate (Clomid) alone
- If no Ovulation with Clomiphene
- Consider 8 day course of Clomid
- Consider with HCG if no Ovulation occurs
- HCG 10,000 units IM or 250 mcg SC
- Monitor follicle with Ultrasound
- Give when follicle 20 mm
- Monitor follicle on days 10-12
- Anticipate 2 mm/day growth
- Consider with Metformin (Polycystic ovarian syndrome)
- Consider with Glucocorticoids (adrenal hyperfunction)
- Indicated for adrenal suppression
- Obtain AM Cortisol for baseline
- Dosing: Prednisone 10 mg or Dexamethasone 500 mcg
- Protocol
- Cycle for days 3-7 with Clomid or
- Continuous Glucocorticoid alone
- Consider with Gonadotropins (e.g. Parlodel)
- Clomid given 1-2 amps IM or SC and
- Gonadotropin given on day 9-10
- Consider Progesterone
- Indicated in Luteal Phase defect
Images: Related links to external sites (from Bing)
Related Studies
| 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, ﾊｲﾗﾝﾌｾﾞﾝ, 排卵不全 |
| Swedish | Utebliven ägglossning |
| Czech | anovulace, Anovulace, Selhání ovulace |
| Finnish | Anovulaatio |
| Russian | ANOVULIATSIIA, АНОВУЛЯЦИЯ |
| Croatian | ANOVULACIJSKI CIKLUS |
| Polish | Cykl anowulacyjny, Brak jajeczkowania, Cykl bez owulacji, Cykle bezowulacyjne |
| Hungarian | Anovulatio, Ovulatio elmaradása |
| Norwegian | Anovulasjon, Manglende eggløsning |
