ACOG technical bulletin. Managing the anovulatory state: medical induction of ovulation. Number 197--September 1994 (replaces no. 120, September 1988). Committee on Technical Bulletins of the American College of Obstetricians and Gynecologists.

With proper diagnosis and selection of treatment, ovulation induction is an option for anovulatory women. Specialized skills, knowledge, and resources, as well as patient and physician commitment, are requisite to the appropriate application of these modalities. Patients should be provided with information, support, and access to the health care team to maximize success. Current therapeutic options include the use of clomiphene citrate, bromocriptine, gonadotropins, and GnRH. Importantly, each and every one of these agents is best applied only in the appropriate clinical circumstances in keeping with the patient's individual needs. Whereas clomiphene citrate is particularly suited for the management of women with normal levels of FSH and prolactin and adequate levels of estrogen, gonadotropin therapy may be applied to both women with low levels of estrogen and gonadotropins as well as those with normal levels. Bromocriptine is only applicable for hyperprolactinemic women. Gonadotropin-releasing hormone therapy is best suited for circumstances characterized by low gonadotropin and estrogen levels as an alternative to gonadotropin therapy (assuming intact pituitary gonadotropin reserve).