Understanding and Addressing Anovulatory Infertility

Anovulation is a common and heterogenous cause of infertility with significant implications for metabolic health. Ovulatory disorders arise from disruption of the hypothalamic-pituitary-ovarian axis and are often characterized using the International Federation of Gynecology and Obstetrics hypothalamic dysfunction, pituitary dysfunction, ovarian dysfunction, and polyendocrine metabolic ovarian syndrome (PMOS) pathophysiologic framework. While many hypothalamic and pituitary causes of anovulatory infertility are treatable, primary ovarian insufficiency often requires assisted reproductive technology. In PMOS (formerly known as polycystic ovary syndrome), ovulation induction with an oral agent such as letrozole is considered first-line to reduce the risks of multiple gestation and ovarian hyperstimulation syndrome.