From the Guidelines
Polycystic Ovary Syndrome (PCOS) significantly impacts fertility in women, causing hormonal imbalance, ovulation disorders, and irregular menstrual cycles, which reduce the chances of natural conception. According to the American College of Obstetricians and Gynecologists (ACOG) guidelines 1, treatment for women with PCOS who wish to conceive begins with weight control and a regular exercise program, followed by medication if needed.
Key Points to Consider
- The ACOG recommends treatment with clomiphene citrate due to its effectiveness, with about 80 percent of women with PCOS ovulating and half of these patients conceiving 1.
- If clomiphene treatment fails, low-dose gonadotropin therapy is recommended to induce ovulation, as it induces a high rate of monofollicular development with a lower risk of ovarian hyperstimulation 1.
- Metformin and thiazolidinediones can improve ovulation frequency, but their effects on early pregnancy are not well known, and metformin appears to be safe, although documentation is limited 1.
Management and Treatment
- Weight control and regular exercise are essential for improving fertility in women with PCOS.
- Clomiphene citrate is the recommended medication for ovulation induction, due to its effectiveness and relatively low risk of side effects.
- Gonadotropin therapy may be considered if clomiphene treatment fails, with low-dose therapy preferred to minimize the risk of ovarian hyperstimulation.
- Assisted reproductive technologies, such as IVF, may be necessary for some women with PCOS who do not respond to medical treatment.
Improving Fertility Outcomes
- Controlling weight, improving insulin sensitivity, and regulating hormonal imbalance can significantly improve fertility outcomes in women with PCOS.
- Early diagnosis and treatment of PCOS can help reduce the risk of infertility and related complications.
- A comprehensive treatment plan, including lifestyle modifications, medication, and assisted reproductive technologies, can help women with PCOS achieve successful pregnancies.
From the Research
Impact of PCOS on Fertility
- Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder that affects women of reproductive age and is a predominant cause of infertility 2, 3, 4.
- Women with PCOS often experience anovulation, menstrual disturbances, and hyperandrogenism, which can lead to infertility 2, 3, 4.
- The management of PCOS-related infertility includes lifestyle modifications, medical treatments, and surgical options 2, 3, 4, 5.
Medical Treatments for PCOS-Related Infertility
- Clomiphene citrate is considered the first-line therapy for ovulatory infertility in women with PCOS 2, 4.
- Aromatase inhibitors can induce ovulation with results that are nearly identical to or better than those reported with clomiphene citrate 3, 4.
- Metformin is not recommended for infertility treatment in the absence of metabolic anomalies 2, 4.
- Letrozole may be considered as a new first-line medical treatment for anovulatory infertility in PCOS over clomiphene citrate 5.
Surgical Options for PCOS-Related Infertility
- Ovarian drilling by laparoscopy or by transvaginal hydrolaparoscopy is an option when medical treatment fails 4.
- In vitro fertilization (IVF) is indicated for infertile women with PCOS after unsuccessful treatment with ovulation induction agents or in women deemed high-risk of multiple gestations 6.
- IVF treatment protocols should be carefully chosen to reduce the risk of ovarian hyperstimulation syndrome in PCOS patients 6.