Abstract
Background: Disruption of ovulation occurs in different types of clinical infertility. The World Health Organization (WHO) has provided a classification of ovulation disorders. This review focuses on WHO group 2 anovulation. Methods: Searches were performed in Medline/PubMed and EMBASE. Each subject summary was presented to the European Society of Human Reproduction and Embryology (ESHRE) Workshop Group, where omissions or disagreements were resolved by discussion. Results: Disorders resulting in ovulatory disturbances are a relatively common cause of infertility. They occur most frequently in the context of WHO group 2 anovulation as reflected, for example, in the polycystic ovary syndrome (PCOS). The aetiology of PCOS remains unclear but evidence exists for a multifactorial origin with a genetic predisposition. Women with PCOS show an increased time to pregnancy but their eventual family size is not necessarily reduced. Also their frequency of miscarriage does not appear increased. Clomiphene citrate is still the first-line treatment in subfertile anovulatory patients with PCOS, with gonadotrophins and laparoscopic ovarian surgery as second-line options. Aromatase inhibitors show promising results. Conclusions: Long-term health risks in patients with WHO group 2 anovulation demand their general health be monitored, even after their reproductive needs have been fulfilled. Metabolic and cardiovascular risk prevention in women with PCOS should start as early as possible. It is not easy to analyse the possible role of PCOS, independent of obesity, metabolic syndrome, insulin resistance and diabetes, on long-term health.
| Original language | English |
|---|---|
| Article number | dms019 |
| Journal | Human Reproduction Update |
| Volume | 18 |
| Issue number | 5 |
| Pages (from-to) | 586-599 |
| Number of pages | 14 |
| ISSN | 1355-4786 |
| DOIs | |
| Publication status | Published - 01.09.2012 |
Funding
The meeting was organized by the European Society of Human Reproduction and Embryology with an unrestricted educational grant from Institut Biochimique S.A. (Switzerland). P.G. Crosignani has done consulting work for Bayer-Schering, IBSA and Merck-Serono. A Glasier has done consulting work for HRA-Pharma, Paris, France. B.C. Tarlatzis: Merck Serono has received unrestricted research grants, travel grants and honorarium from Merck Sherp & Dohme; unrestricted research grants, travel grants and honorarium from IBSA & Ferring Travel grants; and honororia from B.C.J.M. Fauser has received fees and grant support from the following companies (in alphabetic order); Andromed, Ardana, Auxogyn, Ferring, Genovum, Merck (MSD), Merck Serono, Organon, Pantharei Bioscience, PregLem, Schering, Schering Plough, Serono, Uteron Pharma, Watson Pharmaceuticals and Wyeth. J.L.H. Evers works in a department that received unrestricted research grants from Merck Sharp & Dohme and Ferring B.V. No other conflicts of interest have been disclosed.
