Treating infertility in women with polycystic ovarian syndrome: a review

This study reviewed treatment options for infertility in women with polycystic ovarian syndrome (PCOS). 

Polycystic ovarian syndrome (PCOS) is a common condition in women. Women with PCOS may not ovulate regularly. This can lead to fertility issues. Infertility can be treated medically and/or surgically. Medical treatment involves taking drugs to stimulate ovulation. This is called ovarian induction (OI). Surgery can also be an option. Laparoscopic ovarian drilling (LOD) is one of these options. A review of treatment options can help inform PCOS patients of the best option for them. 

This study performed an analysis of 44 reviews on PCOS treatment. These reviews included data on the medical and surgical treatment of PCOS. Fertility outcomes included ovulation rate (OR), live birth rate (LBR) and pregnancy rate (PR).  

4 drugs or drug types were reviewed for OI. Letrozole (Femara) was associated with higher LBR, OR and PR than clomiphene citrate (CC; Clomid). CC is another drug used for OI. Patients with resistance to CC have better fertility outcomes with letrozole and metformin (Glucophage). Metformin is a drug to treat insulin resistance (IR). IR is common in PCOS. CC had higher LBR, OR and PR than metformin alone. CC had better FOs than LOD. Gonadotrophins (GDTs) had higher LBR, PR, and OR in patients resistant to CC. This was in combination with metformin. GDTs were associated with lower fertility outcomes compared to letrozole. 

Metformin was associated with higher LBR and PR when combined with in vitro fertilization (IVF). Taking metformin during pregnancy was associated with higher LBR. Other insulin-sensitizing drugs were also reviewed. These included inositol and n-acetyl cysteine (NAC). NAC and inositol had improved outcomes compared to metformin in some studies. 

LOD was associated with lower LBR than CC + metformin and GDTs. LOD had better FOs in women with a body mass index (BMI; a measurement of body weight in relation to height) under 25 kg/m². 

This study reviewed treatment options for infertility in women with PCOS.

If you have any concerns regarding infertility please consult with your physician.