Infertility treatment for women with polycystic ovary syndrome (PCOS)

Women with polycystic ovary syndrome (PCOS) do not ovulate regularly and often have difficulty becoming pregnant. Although the medicine clomiphene (Clomid) is commonly used to stimulate ovulation, it doesn't work for some women with PCOS. This is because PCOS ovulation problems are linked to an imbalance of multiple body systems. Often other treatment measures can restore balance to the body's metabolism and hormone system, making ovulation medicine unnecessary (or more effective if it is used).1

  • Before considering medicine to stimulate ovulation, overweight women with polycystic ovary syndrome are advised to lower their body mass index (BMI) with diet and exercise. Even a modest weight reduction can trigger ovulation in women with PCOS.2
  • If weight loss does not help start ovulation, clomiphene is usually tried first, sometimes combined with a steroid. About 50% to 70% of women with PCOS will ovulate after they are treated with clomiphene.1
  • If clomiphene does not start ovulation, it may be combined with another medicine, such as metformin, to start ovulation. Combining the two treatments may make it more likely that clomiphene will trigger ovulation in women with PCOS.
  • Women who do not ovulate with a combination of medicines are sometimes treated with gonadotropins, which are similar to the hormones the body produces to start ovulation. During this type of treatment, a woman must have daily monitoring of egg follicle development, using blood tests and ultrasound, to prevent ovarian hyperstimulation syndrome.
  • If clomiphene does not work, your doctor may try a medicine called letrozole. Letrozole is thought to harm the fetus if it is used during pregnancy. Talk to your doctor about being sure you are not pregnant before taking this drug.

Laparoscopic ovarian surgery such as ovarian drilling (partial destruction of an ovary, which can trigger ovulation) or in vitro fertilization (IVF) are sometimes used for women with PCOS who have tried weight loss and fertility medicine, but still are not ovulating.2 For more information, see the topic Polycystic Ovary Syndrome (PCOS).

Citations

  1. Haas DA, et al. (2003). Effects of metformin on body mass index, menstrual cyclicity, and ovulation induction in women with polycystic ovary syndrome. Fertility and Sterility, 79(3): 469–481.
  2. American College of Obstetricians and Gynecologists (2002, reaffirmed 2006). Management of infertility caused by ovulatory dysfunction. ACOG Practice Bulletin No. 34. Obstetrics and Gynecology, 99(2): 347–358.

Last Updated: March 21, 2008

Author: Bets Davis, MFA & Sandy Jocoy, RN

Medical Review: Sarah Marshall, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology

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