Korean J Obstet Gynecol.  2010 Oct;53(10):869-880. 10.5468/kjog.2010.53.10.869.

The infertility treatment related with polycystic ovary syndrome

• Koo YH
• Na YJ

• KMID: 1453751
• DOI: http://doi.org/10.5468/kjog.2010.53.10.869

Abstract

The treatment of infertile women with polycystic ovary syndrome (PCOS) has not yet been established. Before any intervention is initiated, lifestyle modification with diet and exercise leading to weight loss should be emphasized in overweight women. The recommended first-line treatment for ovulation induction remains clomiphene citrate. If clomiphene citrate use fails to result in ovulation or pregnancy, the recommended second-line intervention is exogenous gonadotropins. The use of exogenous gonadotropins is related to an increased risk for multiple pregnancies, and, therefore, intense ovarian response monitoring is required. Laparoscopic ovarian surgery is an alternative to gonadotropin therapy because this surgery is as effective as gonadotropin in pregnancy rate or live birth rate. However, the surgery may require additional ovulation induction drug and should be performed by well-trained surgeon, its use solely to induce ovulation is unwarranted. Recommended third-line treatment is in vitro fertilization (IVF). IVF reduces the risk of multiple pregnancies by using single-embryo transfer in women with PCOS. The use of metformin alone as first-line infertility therapy or in combination with clomiphene is surrounded by controversies. Aromatase inhibitors appear to be as effective as clomiphene citrate for induction of ovulation, but the drug is currently not approved for treatment of infertility. Further studies should demonstrate the efficacy and long term safety.

Keyword

Polycystic ovary syndrome; Infertility treatment; Clomiphene

MeSH Terms

Aromatase Inhibitors
Clomiphene
Diet
Female
Fertilization in Vitro
Gonadotropins
Humans
Infertility
Life Style
Live Birth
Metformin
Overweight
Ovulation
Ovulation Induction
Polycystic Ovary Syndrome
Pregnancy
Pregnancy Rate
Pregnancy, Multiple
Weight Loss
Aromatase Inhibitors
Clomiphene
Gonadotropins
Metformin

Figure

• 

  Fig. 1 Cumulative pregnancy rate resulting in singleton live birth of a consecutive series of 240 normogonadotrophic anovulatory infertile women undergoing classic ovulation induction (clomiphene citrate as first-line, followed by follicle-stimulating hormone as second-line therapy).

• 

  Fig. 2 Results from the meta-analysis of the randomized, controlled trials of laparoscopic ovarian surgery versus gonadotropins for (A) live-birth rate and (B) multiple pregnancy rate. Notes: Test for heterogeneity: chi-square=0.35, df=1 (P=0.55), I2=0%. Test for overall effect: Z=0.14 (P=0.89). CI: confidence interval.

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