Effective Regimens for Ovulation Induction in Polycystic Ovary Syndrome

Abstract

A review. Several approaches have been used for ovulation induction in women with polycystic ovary syndrome (PCOS). Wt. redn. should be recommended for obese women, because even 5% wt. loss can be effective. Recent analyses still support the effectiveness of clomiphene citrate (CC) as a first-line medical therapy. Of anovulatory women with PCOS, about 70% will ovulate in response to CC, and the cumulative live birth rate is about 30%. A max. of 6 CC cycles has been recommended, but some patients may benefit from more cycles, as the cumulative pregnancy rate (PR) continues to rise after 6 cycles. Women who do not respond to a daily dose of 150 mg can be considered CC-resistant. Human gonadotropins can be used as second-line treatment, but depending on the wt. and age of the patient and practical clin. circumstances, other treatments may be more effective or easier to carry out. As many women with PCOS are insulin-resistant, it is rational to focus treatment attempts on the improvement of insulin resistance and hyperinsulinemia. Treatment with metformin alone or in combination with CC may be used, and overweight women in particular should be offered this option. Although other insulin-sensitizing agents, i.e. thiazolidinediones, seem to be effective, their safety in the treatment of PCOS is less well documented, and they cannot be recommended for women desiring pregnancy. The results of using aromatase inhibitors for ovulation induction have been promising, and they may become a useful alternative for ovulation induction. Laparoscopic ovarian drilling is an effective treatment in CC-resistant women, but being an invasive method, it should be used only for patients resistant to other ovulation induction methods. [on SciFinder(R)]