Do doctors use progesterone to help women with Polycystic Ovary Syndrome (PCOS) get pregnant?

From the Guidelines

Doctors do not typically use progesterone as a first-line treatment to help women with PCOS get pregnant, but rather use it to support the uterine lining after ovulation has been induced with other medications. The primary treatment for women with PCOS who have irregular or absent ovulation usually includes medications like clomiphene citrate to stimulate ovulation, as recommended by the American College of Obstetricians and Gynecologists (ACOG) based on good and consistent scientific evidence 1. According to the ACOG guidelines, about 80 percent of women with PCOS ovulate and one half of these patients conceive when treated with clomiphene citrate 1.

If clomiphene treatment fails, gonadotropins are often used to induce ovulation in women who have PCOS, with low-dose therapy preferred to reduce the risk of ovarian hyperstimulation 1. Progesterone supplementation may be prescribed after ovulation has been induced to support the uterine lining for embryo implantation and maintain early pregnancy. However, the use of progesterone alone will not induce ovulation in PCOS patients, which is why it's used as part of a comprehensive fertility treatment plan rather than as a standalone solution.

Some key points to consider in the treatment of PCOS patients include:

• Weight control and regular exercise as the initial treatment approach
• Use of clomiphene citrate as the first-line medication to induce ovulation
• Low-dose gonadotropin therapy if clomiphene treatment fails
• Potential use of progesterone supplementation after ovulation has been induced to support early pregnancy.

From the Research

Use of Progesterone in Women with PCOS to Aid Pregnancy

• Progesterone is a hormone that plays a crucial role in ovulation, implantation, and luteal phase support 2.
• In women with Polycystic Ovary Syndrome (PCOS), low levels of progesterone have been found in the early luteal phase, and granulosa cells from polycystic ovaries show altered progesterone production 2.
• Progesterone may be administered to PCOS patients to induce withdrawal bleeding, suppress secretion of luteinizing hormone, in ovulation induction in clomiphene citrate-resistant patients, and in luteal phase support in assisted reproduction 2.

Progesterone Administration and PCOS

• Different routes of progesterone administration have been discussed in the literature, including oral, vaginal, and injectable forms 2.
• The choice of progesterone administration route depends on the therapeutic objective, patient compliance, and the specific needs of the PCOS patient 2.
• Luteal phase support with progesterone has been shown to potentially improve pregnancy rates in women with PCOS who are undergoing ovulation induction and intrauterine insemination (OI/IUI) 3.

Ovulation Induction in PCOS Patients

• Ovulation induction is a common treatment approach for women with PCOS who are trying to conceive 4, 5.
• Various methods are used for ovulation induction, including lifestyle modifications, insulin-sensitizing agents, selective estrogen receptor modulators, aromatase inhibitors, gonadotropins, and laparoscopic ovarian drilling 4, 5.
• Gonadotropins are often used as a second-line treatment for ovulation induction in PCOS patients who do not respond to first-line treatments such as clomiphene citrate 6, 4, 5.

Pregnancy Outcomes in PCOS Patients

• Women with PCOS who become pregnant are at higher risk for pregnancy complications, such as miscarriage and gestational diabetes 4.
• Luteal phase support with progesterone may help improve pregnancy outcomes in PCOS patients by reducing the risk of miscarriage and promoting a healthy luteal phase 3.
• Further research is needed to determine the best approach to ovulation induction and luteal phase support in PCOS patients to improve pregnancy outcomes 6, 4, 3.