Treatment of Infertility in Polycystic Ovary Syndrome

Abstract

A review. Women with polycystic ovary syndrome (PCOS) suffer infertility primarily because of chronic anovulation, the basis for which has not been completely established. Fundamental to the problem is decreased FSH secretion and arrest of follicle growth at the midantral stage of development. As a result, treatment methods that result in increased FSH release are assocd. with ovulatory responses in many individuals. In particular, clomiphene citrate has proven to be an effective means of ovulation induction. Failure to respond to clomiphene has led to the use of gonadotropin therapy with good results. However, the benefit of gonadotropin use is balanced against the increased risk for ovarian hyperstimulation syndrome. Insulin resistance is a common feature of PCOS and treatment with insulin-lowering drugs has provided an effective alternative for individuals that are clomiphene-resistant and reluctant to advance to gonadotropin therapy. Ovulatory responses to metformin and thiazolidinediones have been variable, as judged by published studies, although in general, they appear to be at least as effective as clomiphene citrate. Whether the combination of an insulin-lowering drug and clomiphene citrate holds greater benefit compared with either method alone remains to be established. [on SciFinder(R)]