• Interval between vaginal bleeding > 35 days
• Patient typically ovulates, but less often than is typical
• Weak predictor of infertility

• Interval between vaginal bleeding > 6 months
• Patient may only rarely ovulate
• Strong predictor of infertility

• Endometriosis
• Low sperm counts or motility
• Structural problems with the uterus or fallopian tubes
• Antibodies to sperm or eggs
• The inability of sperm to penetrate or survive in the cervical mucus
• An unexplained fertility problem

• Causes antiestrogenic effect @ hypothalamus: stimulates FSH and LH production
• Initiate treatment on day 3-5 post spontaneous or MPA-induced withdrawal bleed -- this makes sure they are not pregnancy
• Increase dose by 50 mg per cycle if ovulation does not occur
• Makes women crazy (highly sexual, emotional) due to fluctuations in estrogen

• Obesity
• Amenorrhea prior to treatment
• Increased ovarian volume
• Hyperandrogenemia
• Older age (weak predictor)

Prevention and Treatment of Symptoms

• NSAIDs (big doses)
• Oral contraceptives
• GnRH antagonists
• Gonadotropic inhibitor (Danazol)

Treatment of Endometriosis Infertility

• Surgery
• No drug therapy will treat endometriosis-induced infertility

Infertile

Unsuccessful in becoming pregnant after a prolonged period (usually a year) of determined attempts of heterosexual intercourse without contraception

Sterile

Incapable of producing offspring

Clomiphene Citrate (CC)

↓

Gonadotropins: FSH + CC

↓

In vitro Fertilization + CC, + FSH

Metformin should be considered if CC fails, Metformin should be used in pts with signs and symptom of PCOS

• Ovaries
• Fallopian Tubes
• Outer Surface of Uterus
• Uterine Ligaments