Ovulation induction in the nonestrogenized patient

Women with nonestrogenized amenorrhea comprise a wide array of clinical problems. Identification and correction of the underlying pathologic process is the most appropriate approach to ovulation induction. Patients with central nervous system (CNS) or hypothalamic amenorrhea are treated with pulsatile gonadotropin-releasing hormone (GnRH) when it is not possible to correct the underlying causes of these disorders. Gonadotropin therapy is needed for pituitary-related amenorrhea after conservative therapy is unsuccessful. However, ovarian hyperstimulation and multiple pregnancies are risks of gonadotropin therapy. The outcome is poor for ovarian failure or gonadotropin-resistant ovaries. An occasional pregnancy is established, but oocyte donation or adoption should be an early consideration. Women with nonestrogenized amenorrhea and a low or normal follicle-stimulating hormone (FSH) level can expect high ovulation and pregnancy rates with gonadotropin therapy when more conservative means are unsuccessful: Treatment is not likely to benefit those with elevated FSH levels.