Open AccessOvulation induction in polycystic ovary syndrome
Author(s) -
Tanbo Tom,
Mellembakken Jan,
Bjercke Sverre,
Ring Eva,
Åbyholm Thomas,
Fedorcsak Peter
Publication year - 2018
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.13395
Subject(s) - polycystic ovary , medicine , ovulation induction , letrozole , ovarian hyperstimulation syndrome , anovulation , metformin , ovulation , aromatase inhibitor , endocrinology , aromatase , in vitro fertilisation , gynecology , hormone , pregnancy , insulin , insulin resistance , biology , breast cancer , cancer , genetics
The objective of this narrative review was to suggest a rational order of treatment choices in anovulatory women with polycystic ovary syndrome ( PCOS ), for whom a multitude of treatment options exist. In obese/overweight women with PCOS the importance of weight reduction should be stressed. Inositol, a dietary supplement with a documented effect on ovulation and without adverse effects in the doses recommended, may be suggested. Additional first‐line medical alternatives include insulin sensitizers, selective estrogen receptor modulators, and aromatase inhibitors. Of these, the aromatase inhibitor letrozole and the combination of clomiphene citrate and metformin have the highest rates of ovulation and live birth. Second‐line treatments are ovarian electrocautery and low‐dose follicle‐stimulating hormone stimulation. Controlled ovarian stimulation with in vitro fertilization, should be considered the last option as it carries a significant risk of ovarian hyperstimulation syndrome in patients with PCOS .