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Koo and Na: The infertility treatment related with polycystic ovary syndrome
Recent Clinical Review
Korean Journal of Obstetrics and Gynecology

Korean Journal of Obstetrics and Gynecology 2010; 53(10): 869-880.

Published online: 31 October 2010

DOI: https://doi.org/10.5468/kjog.2010.53.10.869

The infertility treatment related with polycystic ovary syndrome

Yun Hee Koo, M.D., Yong Jin Na, M.D.

Department of Obstetrics and Gynecology, Pusan National University College of Medicine, Busan, Korea.

Corresponding author (yjna@pusan.ac.kr)

Received 15 July 2010       Revised 28 August 2010       Accepted 20 September 2010

Copyright © 2010 Korean Society of Obstetrics and Gynecology

Abstract

The treatment of infertile women with polycystic ovary syndrome (PCOS) has not yet been established. Before any intervention is initiated, lifestyle modification with diet and exercise leading to weight loss should be emphasized in overweight women. The recommended first-line treatment for ovulation induction remains clomiphene citrate. If clomiphene citrate use fails to result in ovulation or pregnancy, the recommended second-line intervention is exogenous gonadotropins. The use of exogenous gonadotropins is related to an increased risk for multiple pregnancies, and, therefore, intense ovarian response monitoring is required. Laparoscopic ovarian surgery is an alternative to gonadotropin therapy because this surgery is as effective as gonadotropin in pregnancy rate or live birth rate. However, the surgery may require additional ovulation induction drug and should be performed by well-trained surgeon, its use solely to induce ovulation is unwarranted. Recommended third-line treatment is in vitro fertilization (IVF). IVF reduces the risk of multiple pregnancies by using single-embryo transfer in women with PCOS. The use of metformin alone as first-line infertility therapy or in combination with clomiphene is surrounded by controversies. Aromatase inhibitors appear to be as effective as clomiphene citrate for induction of ovulation, but the drug is currently not approved for treatment of infertility. Further studies should demonstrate the efficacy and long term safety.

Keywords: Polycystic ovary syndrome, Infertility treatment, Clomiphene

Figures and Tables

Fig. 1
Cumulative pregnancy rate resulting in singleton live birth of a consecutive series of 240 normogonadotrophic anovulatory infertile women undergoing classic ovulation induction (clomiphene citrate as first-line, followed by follicle-stimulating hormone as second-line therapy).
kjog-53-869-g001
Fig. 2
Results from the meta-analysis of the randomized, controlled trials of laparoscopic ovarian surgery versus gonadotropins for (A) live-birth rate and (B) multiple pregnancy rate. Notes: Test for heterogeneity: chi-square=0.35, df=1 (P=0.55), I2=0%. Test for overall effect: Z=0.14 (P=0.89). CI: confidence interval.
kjog-53-869-g002
Table 1
Revised diagnostic criteria of polycystic ovary syndrome
kjog-53-869-i001

Note: Thorough documentation of applied diagnostic criteria should be done (and described in research papers) for future evaluation.

Table 2
Randomized trial from the National Institutes of Health Reproductive Medicine Network
kjog-53-869-i002

*P<0.001.

†P<0.001 (combination vs clomiphene citrate [CC]).

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