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			Concern Treatment Pregnancy Experiences Concern Evaluating Your Fertility Understanding Fertility Maximise Your Fertility Infertility: An Introduction Infertility in Females Impact of Age Ovulatory Classification of Disorders Clinical Features of Disorders Possible Causes of Disorders Lack of Ovulation Irregular Ovulation Polycystic Ovary Disease Inadequate Luteal Phase Prolactin Disorders Anatomical Chromosomal Disorders Other Causes (Idiopathic) Infertility in Males Implications of Infertility Questions to Ask Your Doctor		WHO Classification of Ovulatory Disorders    In 1968, Insler and collaborators proposed a treatment orientated classification of patients with cycle disorders. This classification has been modified and adopted by the World Health Organisation and is currently used in many centres. The WHO classification system uses three parameters to assign patients to groups: Level of endogeneous prolactin. Level of endogenous gonadotropins (LH and FSH). Level of endogenous oestrogens.        A flow chart illustrating how the test parameters are used to assign patients to the various groups is shown in the figure and the diagnosis and description of each group is summarised in the table that follows. WHO classification of anovulatory states WHO classification system for ovulatory disorders Group Diagnosis Description I Hypothalamic-pituitary failure Amenorrhoeic women with no evidence of endogenous oestrogen production; non-elevated prolactin levels, low FSH levels (hypogonadotrophic hypogonadism), and no detectable space-occupying lesion in the hypothalamic-pituitary region. II Hypothalamic- pituitary dysfunction Women with a variety of menstrual cycle disturbances (e.g. lutealphase insufficiency, anovulatory cycles, anovulatory polycystic ovary syndrome, and amenorrhoea) with evidence of endogenous oestrogen production, and normal prolactin and FSH levels. III Ovarian failure Amenorrhoeic women with no evidence of ovarian production and with elevated FSH levels, but non-elevated prolactin levels. IV Congenital or acquired genital tract disorder Amenorrhoeic women who do not respond with withdrawal bleeding to repeated courses of oestrogen administration. V Hyperprolactinaemic infertile women with a space-occupying lesions in the hypothalamic pituitary region Women with a variety of menstrual cycle disturbances (e.g. luteal phase insufficiency, anovulatory cycles, or amenorrhoea) with elevated prolactin levels and evidence of a space-occupying lesion in the hypothalamic-pituitary region. VI Hyperprolactinaemic infertile women with no detectable space occupying lesion in the hypothalamic- pituitary region Same as group V women except that there is no evidence of a space-occupying lesion. VII Amenorrhoeic women with non-elevated prolactin levels and evidence of a space-occupying lesion in the hypothalamic-pituitary region Women with low endogenous oestrogen production, normal or low prolactin and FSH levels. About 97% of anovulating patients are classified into WHO Group II and the remainder of the anovulating patients are classified into Group I. These two groups represent patients who are most likely to benefit from gonadotropin therapy to restore ovulation. Classification systems such as the WHO Classification of ovulatory disorders help to ensure that the best treatment is selected for specific patients. Another benefit is that classification systems permit comparison of the results of clinical studies and drug trials at different centres and even in different countries, by ensuring that identical groups of patients have been treated at each centre. This is of great value in, for example, psychiatric illnesses which, in the absence of strict diagnostic criteria, can be diagnosed quite differently in different countries. It is important to remember that although classification systems provide a useful guide to therapy, the treatment of anovulatory infertility will be selected by the doctor after consideration of the history, physical examination and diagnostic test results in the individual woman.
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