Induction of Ovulation

Induction of ovulation or stimulation of ovarian follicular development remains a key component of therapy in the infertility patient. Several applications exist, including restoration of ovulation in anovulatory women, ovarian superovulation (stimulating more than one mature follicle) in ovulatory women, and controlled ovarian hyperstimulation (stimulating the development of multiple dominant follicles) for assisted reproduction. Ovulation induction can be achieved through several avenues, including disruption of the negative estrogen-feedback loop, direct gonadotropin administration, inhibition of androgen conversion to estrogen, use of insulin-sensitizing agents, and laparoscopic surgical intervention. This chapter will review a brief history of these agents, the underlying scientific basis, and clinical guidelines regarding the use of different medications for the purpose of promoting follicular recruitment and ovulation. Included in this chapter is a brief overview of follicular development and ovulation, along with a description of the anatomical axes involved in this process.