Induction of ovulation is primarily used for treatment of infertility in anovulatory women. Long-term management of anovulatory states may result in incidental or intended establishment of regular ovulation when fertility is not a goal, for example, when insulin-enhancing agents or dopamine agonists are administered to women with polycystic ovary syndrome (PCOS) or hyperprolactinemia, respectively. This chapter will focus specifically on induction of ovulation for women who desire restoration of ovulation for the purpose of becoming pregnant.
Induction of ovulation for fertility treatment should be undertaken with awareness of other potential fertility factors affecting the likelihood of conception. Most important among these are tubal patency and semen quality, and ideally these should be evaluated prior to therapy. This is certainly true in the case of treatments entailing substantial cost and disruption for the patient such as administration of gonadotropins. In practice, when the history is convincing that the male and tubal factors are very likely normal, and treatment is of lesser intensity and cost, evaluation of male and tubal factors may be delayed until after a few cycles of successful ovulation have occurred without conception.