Treatment should be based on diagnosis of<unk> . Treatment varies based on the 4 most common causes of<unk> : polycystic ovarian syndrome (PCOS), hypogonadotropic hypogonadism (HA), primary ovarian insufficiency (POI), and hyperprolactinemia. Importantly, semen analysis should be carried out of the XY partner to exclude severe XY factors before managing anovulatory subfertility. Overall, in healthy individuals with<unk> , ovulatory disorders may be favorably influenced by a healthy diet such as a higher consumption of monounsaturated fats rather than trans fats, vegetable rather than animal protein sources, high fat dairy, multivitamins, and iron from plants and supplements. Treatment for polycystic ovarian syndrome (PCOS) Treatment for management of<unk>  due to PCOS is multifaceted, including weight reduction, ovulation induction agents, insulin-sensitizing agents, gonadotrophins and ovarian drilling. In PCOS patients with overweight or obesity, weight loss is first line treatment. Studies show a reduction in weight as little of 5% by caloric restriction and increased physical activity can re-establish spontaneously ovulation and improve response to ovulation induction therapy if initiated. Weight loss also generally results in improved menstrual regularity and pregnancy rates in women with PCOS. It is well recognized that insulin resistance can be part of the sequelae of PCOS and if present, contribute to<unk> . Metformin, a biguanide, is a common insulin sensitizer often given to treat women with PCOS. No other insulin sensitizers have evidence of effective and safe use of fertility treatment. Previously, metformin was recommended as treatment for<unk>  in polycystic ovary syndrome, but in the largest trial to date, comparing clomiphene with metformin, clomiphene was more effective than metformin alone. Following this study, the ESHRE/ASRM-sponsored A consensus workshop does not recommend metformin for ovulation stimulation. Subsequent randomized studies have confirmed the lack of evidence for adding metformin to clomiphene. Ovulation induction The main ovulation induction medications include: *Antiestrogen, causing an inhibition of the negative feedback of estrogen on the pituitary gland, resulting in an increase in secretion of follicle-stimulating hormone. Medications in use for this effect are mainly clomifene citrate and tamoxifen (both being selective estrogen-receptor modulators), as well as letrozole (an aromatase inhibitor. *Follicle-stimulating hormone (FSH), directly stimulating the ovaries. In women with<unk> , it may be an alternative after 7 - 12 attempted cycles of pituitary feedback regimens (as evidenced by clomifene citrate), since the latter ones are less expensive and more easy to control. Treatment for hypogonadotropic hypogonadism (HA) In women with hypogonadotropic hypogonadism suspicious for functional hypothalamic amenorrhea, treatment should be centered around weight gain, reducing intensity and frequency of exercise, and stress reduction with psychotherapy or counseling. Athletes and women with anorexia can have reduced GnRH pulsing due to hypothalamic dysfunction due to increased energy requirements without their needs being met calorically and severely reduced caloric intake, respectively. If<unk>  persists following lifestyle modifications, ovulation can be induced with pulsatile gonadotrophin-releasing hormone (GnRH) or gonadotrophin (FSH & LH) administration. Treatment for primary ovarian insufficiency (POI) For women with POI that desire pregnancy, ovulation induction strategies should be avoided and assisted reproduction, such as in vitro fertilization (IVF) with donor oocytes, should be offered. Treatment for hyperprolactinemia: For anovulatory women with hyperprolactinemia without symptoms, they can forgo treatment and continue with close follow up and medical observation. If symptoms of hyperprolactinemia are present, dopamine agonists, such as bromocriptine, are first line treatment which act by inhibiting production of prolactin by the pituitary and can shrink a prolactin-secretin lesion (i.e. prolactinoma) if present. In rare cases, endoscopic transnasal transsphenoidal surgery and radiotherapy, may be required to resect and shrink a prolactinoma if greater than 10 mm in size. Importantly, individuals should be able to conceive following normalization of serum prolactin levels and shrinking or removal of the tumor. Other treatments Corticosteroids (usually found in anti-inflammatory drugs) can be used to treat<unk>  if it is caused by an overproduction of male hormones by the adrenal glands. Corticosteroids are usually used to reduce the production of testosterone.
Anovulation
Anovulatory cycle
Gonadotropin-resistant ovary syndrome
Lactational amenorrhea
Polycystic ovary syndrome
Exercise amenorrhoea
Progestin-induced virilization
Primary ovarian insufficiency