ABSTRACT
Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. Treatment modes available are numerous, mainly relying on ovarian stimulation with follicle-stimulating hormone (FSH), a reduction in circulating insulin concentrations and a decrease in luteinizing hormone (LH) levels as the basis of the therapeutic principles. Clomifene citrate is still the first-line treatment, and if unsuccessful is usually followed by stimulation with exogenous FSH. This should be given in a low-dose protocol, essential to avoid the otherwise prevalent complications of ovarian hyperstimulation syndrome and multiple pregnancies. The addition of a gonadotropin-releasing hormone (GnRH) analog, while very useful during in vitro fertilization/ embryo transfer (IVF/ET), adds little to ovulation induction success, whereas the position of GnRH antagonists is not yet clear. Hyperinsulinemia is the commonest contributor to the state of anovulation and its reduction, by weight loss or insulin-sensitizing agents such as metformin, will alone often restore ovulation or will improve results when used in combination with other agents. Laparoscopic ovarian diathermy is proving equally as successful as FSH for the induction of ovulation, particularly in thin patients with high LH concentrations. Aromatase inhibitors are presently being examined and may replace clomifene in the future. When all else has failed, IVF/ET produces excellent results. The aim of ovulation induction therapy should be to correct the underlying disturbance and achieve safe, repeated unifollicular ovulation in order to achieve the livebirth of singleton babies. There are today very few women suffering from anovulatory infertility associated with PCOS who cannot be successfully treated.
