The use of drugs to stimulate the development of follicles in the ovaries to undergo ovulation, such as clomiphene, various preparations containing follicle stimulating hormone (FSH), and human chorionic gonadotropin (hCG). The two main situations for it are: in the treatment of infertility due to anovulation typically when there is oligomenorrhea or amenorrhea; and for superovulation in assisted conception (e.g. in vitro fertilisation and gamete intrafallopian transfer)

"Anorexia" means a profound loss of appetite, followed by loss of weight; "nervosa" means that there is a nervous or mental basis for the state, in this case a belief by the person affected, and contrary to the perception of others, that she (very rarely he) is overweight. She stops eating, may induce vomiting, and uses laxatives to keep the intestines empty and the stomach flat. The menstrual periods stop (there is amenorrhea for two reasons: the weight loss and the underlying mental disturbance, both of which cause hypothalamic anovulation. Medical complications from induced vomiting and laxative abuse can be serious, occasionally fatal. Treatment, which includes psychological and psychiatric counseling, is difficult and is not always completely accomplished. It's a condition chiefly of adolescent girls; the younger the patient the better the chance of cure. For fertility, ovulation induction as often required.

An inexpensive way of detecting ovulation through the effect progesterone has on the hypothalamus, increasing the body's temperature a few tenths of a degree. Best recorded using a BBT thermometer (with a smaller scale than thermometers used to record fevers or high temperatures) first thing in the morning before rising, and preferably in the vagina for accuracy. Day 1 of the chart is the first morning when there is menstruation (a period). Commonly there's a dip in the temperature just before the sustained rise that indicates that ovulation has occurred (a "biphasic chart"). The chart typically records the days you are menstruating, when you have sex and when you're aware of mucus and ovulation pain. Best used to document: (1) the presence and length of the luteal phase, especially if clomiphene is being used for ovulation induction; and (2) the timing of symptoms such as premenstrual spotting. Not as good for predicting ovulation as LH-testing in urine.

imilar to bromocriptine, but more potent and with fewer side effects; used once or twice weekly to lower production of prolactin in hyperprolactinemia. Not yet approved for infertility treatment, but no adverse fetal effects have been reported when used for ovulation induction.

A follicle is "recruited" at two distinct stages of development. Early or continuous recruitment refers to the ongoing, continuous recruitment of primordial follicles to start their growth and become antral follicles, a process that is independent of major hormones, starts before birth and ends when there are no follicles left, this taking place around the time of menopause. Cyclical recruitment refers to the much later recruitment of medium-sized tertiary follicles into the ovarian cycle due to a temporary elevation of follicle stimulating hormone, which occurs at the end of each luteal phase, thus initiating a new follicular phase; the group of "recruits" susceptible to this late recruitment is called a cohort. Time-wise for a particular follicle, the two episodes of recruitment occur 8 months apart: in other words, it takes 8 months for a follicle to grow from its resting state before it can have a chance of making estrogen and then undergoing ovulation. Not all early-recruited follicles undergo later cyclical recruitment: some are lost through early atresia, many reach the stage at which they could be cyclically recruited at a stage when FSH is low (most stages of the ovarian cycle) and undergo atresia then. Readers will appreciate that ovulation induction, including intentional superovulation, can have no effect on the rate at which follicles are used up in ovaries or on the age at which menopause will occur (the different recruitment points involved are 8 months apart, with the early recruitment point governing the rate eggs are used up and the late recruitment point deciding how many follicles can respond to provide useable eggs.

(hCG) A gonadotropin produced by the placenta in pregnancy (specifically it's produced by the trophoblast of the chorionic villi); the hormone measured in performing a pregnancy test. The generic (no frills') name for Pregnyl and Profasi, which are preparations of hCG obtained by extracting it from the urine of pregnant women, and Ovidrel, which is made by recombinant gene technology. Mimics the action of luteinising hormone (LH), but has a very much longer duration of action -- and this gives hCG considerable advantages over LH in clinical use. Given as an injection to lead to ovulation from a mature follicle 38 hours after the injection; or to stimulate ongoing function of the corpus luteum, particularly its production of progesterone. So it is typically given after a course of follicle stimulating hormone (FSH) in assisted conception (IVF or GIFT) programs and ovulation induction programs 36 hours before the expected time of egg retrieval (or before having sex or IUI), and then sometimes in further, smaller doses to support the luteal phase that follows. Sometimes used with clomiphene. Ovarian monitoring is needed for its correct use with FSH or with clomiphene. hCG treatment can precipitate the ovarian hyperstimulation syndrome (OHSS).

(hPG) A mixture of follicle stimulating hormone (FSH) and luteinising hormone (LH) extracted directly from pituitary glands obtained at autopsies; not used in Australia or elsewhere since 1986, when it was shown that Creutzfeldt-Jakob disease (CJD), a deadly form of dementia, had been transmitted from its use, presumably due to contaminating and infected brain tissue. Before 1986 it had been used mostly for ovulation induction in women with amenorrhea (absent periods) for which other hormones or drugs had not been effective, although sporadic instances of its use for in vitro fertilisation are known in Australia. No new cases of CJD have been reported among former users of hPG since the early 1990s.

(LH) The hormone, or gonadotropin, produced by the pituitary gland to cause, in women, ovulation of a mature follicle in the ovary, resulting in formation of the corpus luteum; in men, stimulates the production of testosterone by the Leydig cells of the testis. Suppressed by GnRH-agonists and GnRH-antagonists, so that (for ovulation induction) an injection of human chorionic gonadotropin (hCG), which acts the same way, has a predictable time course of action. A small amount of LH is essential for normal function of the tertiary follicle and the corpus luteum. Recombinant LH is under development by Serono as Luveris, but its clinical role in place of hCG is not yet established.

Oral anti-diabetic drug that improves many aspects of the polycystic ovary syndrome, including lowering of androgens, serum LH, insulin levels and weight, in combination with a low calorie diet; improves development of ovarian follicles and ovulation, as well as responsiveness to clomiphene or gonadotropins if ovulation induction or in vitro fertilisation is necessary.

(OHSS) A complication of ovulation induction with, usually, follicle stimulating hormone, especially in cycles of superovulation for assisted conception, when it is intended to retrieve more than one egg. The ovaries become large, they can be painful, and there is excessive fluid released into the abdomen (the peritoneal cavity). Either removing this fluid or the occurrence of vomiting can cause dehydration, thickening of the blood and, occasionally, a serious thrombosis, such as a stroke. Death has been reported. Moderate to severe OHSS is treated in hospital, with administration of fluid intravenously, sometimes including albumin.

Measurement of estradiol in blood serum. Used especially for monitoring the development of ovarian follicles in assisted conception, usually together with transvaginal ultrasound. The cycle might be a natural one or, more usually, when there is ovulation induction or superovulation. The result should be available within 4 hours of the test for this purpose.

Measurement of progesterone in serum. Often measured to check the occurrence of prior ovulation. Used to infer the onset of ovulation in ovulation induction or assisted conception programs, and attaches extra significance to an apparently raised serum LH in judging the onset of the LH surge during monitoring. The result should be available within 4 hours for these purposes. Abbr. serum P4.

Ultrasound imaging of the pelvic organs for diagnosing abnormalities of (particularly) the uterus and the ovaries; for monitoring the development of ovarian follicles with ovulation induction and assisted conception programs; and for following the course of early pregnancy. Among the pioneers were Dr Karl Popp, who used a mechanical sector scanner vaginally in Hamburg in 1984, and Dr John Anderson, who used the first vaginal linear array scanner at Sydney IVF in 1985, leading to its widespread use subsequently in Australia and the US.

(VEGF) A growth factor (or local hormone) needed for new blood vessels to form in, for example, the corpus luteum, as it turns into an efficient hormone-producing gland making and releasing progesterone about a week after ovulation. Because such new blood vessels are rather leaky, excess VEGF from multiple corpora lutea during ovulation induction or superovulation using gonadotropins can be associated with new blood vessels trying to form in the general peritoneal cavity, leakage of fluid from which causes fluid to build up in the abdomen, a potentially dangerous condition known as the ovarian hyperstimulation syndrome. VEGF is also important in the formation of the placenta, so mutations of VEGF or its target proteins can cause recurrent miscarriage.