Chronic anovulation is an important cause of infertility, accounting for approximately 20% of all causes. Men should have had a semen analysis and women should have had the basic infertility work-up including an assessment of tubal patency. In 1973 the World Health Organization published a simple classification of anovulation, namely, WHO I, II and III. WHO I patients are characterized by a history of amenorrhea. WHO II is characterized by a history of oligomenorrhea, although there may be some with amenorrhea. Central obesity is a cardinal feature of women with polycystic ovary syndrome (PCOS) with an increased waist-hip ratio. WHO III is characterized by oligoamenorrhea, and may present with menopausal symptoms, such as hot flushes, night sweats, and vaginal dryness. This chapter presents the treatment for WHO I, II, and III patients. The treatment involves lifestyle modification, aromatase inhibitors, insulin-sensitizing drugs, and hyperprolactinemia.

This chapter describes five sequential medical steps to successful implantation and reviews the evidence supporting their efficacy and safety. The steps are: selection and preparation of the patient, optimizing the ovarian stimulation protocol, analysing the need of adjuvant medical therapies, embryo transfer and management of the luteal phase. Aspirin, nitric oxide donors, aromatase inhibitors, ascorbic acid, glucocorticoids and insulin-sensitizing drugs are the commonly used adjuvant drugs. Luteal phase length can be restored by stimulating the corpora lutea with human chorionic gonadotropin (hCG) (luteal phase support) or supplementation with progesterone. Improving embryo implantation continues to pose a major challenge to clinicians. While much progress has been made in technical aspects of in vitro fertilization (IVF) treatment to optimize embryo quality and stimulation regimens, it is becoming increasingly clear that patient-related factors may be just as important or more important in determining the chance of success of treatment.