Management Options for Infertile Women with Polycystic Ovary Syndrome

Abstract

Polycystic ovary syndrome (PCOS) is a heterogenous condition affecting 5–10% of women at reproductive age. It is the most common cause of anovulatory infertility, characterized by hyperandrogenism and arrested follicle development, and is frequently associated with metabolic features such as insulin resistance and obesity. The diagnosis of PCOS, based on the Rotterdam criteria (2003), can be made when at least two of the following three main features are met: oligo-ovulation and/or anovulation, hyperandrogenism (clinical and/or biochemical), and polycystic ovarian morphology at ultrasound examination. Several approaches to ovulation induction have been proposed in women with PCOS. These approaches vary in efficacy, treatment duration, cost, and patient compliance. Management includes lifestyle changes, pharmacotherapy (metformin, clomiphene citrate, letrozole, gonadotropins, inositol), laparoscopic surgery (ovarian drilling), and assisted reproductive techniques, usually in vitro fertilization (see Figure 1). Clinical decisions in PCOS anovulatory patients are currently supported by a recently published international evidence-based guideline that provides 166 recommendations to help clinicians in the diagnosis and management of PCOS and to guide clinical practice.