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Updated: Jan 31, 2026

Fertility Preservation in Patients with Severe Ovarian Dysfunction
Published on: March 25, 2021
Hypothalamic-Pituitary-Ovarian Axis Disorders Impacting Female Fertility
Sasha Mikhael1,2, Advaita Punjala-Patel3, Larisa Gavrilova-Jordan4,5
1Division of Reproductive Endocrinology Infertility and Genetics, Augusta University, Medical College of Georgia, Augusta, GA 30912, USA. smikhael@augusta.edu.
Abstract:
The hypothalamic-pituitary-ovarian (HPO) axis is a tightly regulated system controlling female reproduction. HPO axis dysfunction leading to ovulation disorders can be classified into three categories defined by the World Health Organization (WHO). Group I ovulation disorders involve hypothalamic failure characterized as hypogonadotropic hypogonadism. Group II disorders display a eugonadal state commonly associated with a wide range of endocrinopathies. Finally, group III constitutes hypergonadotropic hypogonadism secondary to depleted ovarian function. Optimal evaluation and management of these disorders is based on a careful analysis tailored to each patient. This article reviews ovulation disorders based on pathophysiologic mechanisms, evaluation principles, and currently available management options.
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