Ovulation induction in women with polycystic ovary syndrome

Konstantinos Georgopoulos1, Georgios Mastorakos2, Dimitrios G. Goulis3, Eleni Kousta1

1MSc Programme «Research on Female Reproduction» Athens University Medical School &
Midwifery Department, T.E.I. of Athens, Athens
2Endocrine Unit, “Aretaieion” Hospital, Medical School, National and Kapodistrian University of
Athens, Athens, Greece
3Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical
School, Aristotle University of Thessaloniki, Greece

ABSTRACT
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy-affecting women of reproductive age. It is also the most common cause of anovulatory infertility. The aim of this review is to provide a summary of current literature on the management of anovulatory PCOS. The treatment of infertile women with PCOS is surrounded by many controversies. Management includes lifestyle modification, pharmacotherapy (including clomiphene citrate (CC), metformin, gonadotropins, aromatase inhibitors),
as well as laparoscopic surgery. Weight loss and exercise have been proven effective in restoring ovulatory cycles and achieving pregnancy in overweight and obese women with PCOS and should be the first-line option for these women. CC is the first and the most used agent for inducing ovulation in women with PCOS. About 65-80% of PCOS women ovulate under CC, whereas the others are defined CC-resistant. In women who are CC resistant or fail to conceive, second-line treatment should be considered. Metformin plus CC should be considered as an effective option in CC -resistant PCOS. The use of exogenous gonadotropins is considered as second-line therapy, but it is associated with increased chances for multiple pregnancy and a high risk of ovarian hyper-stimulation syndrome and, therefore, intense monitoring of ovarian response is
required. Aromatase inhibitors may be an effective alternative treatment for ovulation induction, however lack of experience and side effects are limiting factors for using these agents. Laparoscopic ovarian drilling has been used as a surgical treatment for ovulation in women with PCOS, although more studies are needed to determine the effectiveness of this treatment. Ovulation induction in women with PCOS should
be individualized with regard to weight, treatment efficacy and patient preferences with the aim of achieving mono-ovulation and subsequently the birth of a singleton baby.
Keywords: polycystic ovary syndrome (PCOS), ovulation induction, lifestyle modification, clomiphene citrate, metformin, gonadotrophins, aromatase inhibitors, laparoscopic ovarian drilling

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