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Efforts to improve treatment outcome of ovulation induction are increasingly focused on patient characteristics instead of treatment characteristics. Fertility treatment for hypogonadotropic anovulation may consist of a pulsatile gonadotropin-releasing hormone (GnRH) pump or direct stimulation of the ovaries with exogenous gonadotropins (FSH and LH). Although the classical treatment sequence for normogonadotropic anovulation (WHO2) is clomiphene citrate followed by FSH, a number of new interventions are proven to be useful for these patients. Patients presenting with oligo- or amenorrhea due to hyperprolactinemia may be effectively treated with dopamine agonists. Antiestrogens are first-line treatment options in normogonadotropic anovulation. The major complication of ovulation induction is development of multiple follicles resulting in increased chances of multiple pregnancy and ovarian hyperstimulation syndrome (OHSS). New compounds or strategies such as insulin sensitizers, aromatase inhibitors, and laparoscopic ovarian electrocautery (LEO) should be compared to traditional compounds in patient subgroups with various characteristics.
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