How is infertility due to PCOS treated?

Clinical research has revealed that clomiphene citrate (Clomid) is more effective than metformin in women with polycystic ovarian syndrome (PCOS) who are trying to conceive. If possible, it is best to schedule an appointment with a doctor who specializes in reproductive endocrinology for a complete evaluation. I would not delay the appointment. PCOS is a condition that may cause additional health issues such as type 2 diabetes and coronary artery disease (heart disease) if they are not addressed.

Dr. Humberto Scoccia, MD
OBGYN (Obstetrician & Gynecologist)

The most common fertility treatment for polycystic ovary syndrome (PCOS) is to use medication to make the ovaries release eggs so that sperm and egg can get together (fertilization) resulting in an embryo (fertilized egg), which can result in a pregnancy. The overall pregnancy rate with fertility medication is about 40 percent. However, some patients with PCOS do not respond to fertility medication and they require in vitro fertilization (IVF). This treatment entails stimulating the ovaries with stronger medications (injectables) and the eggs are then taken out of the ovaries so that they can be mixed with the sperm in the laboratory. The resulting embryos (fertilized eggs) are then transferred into the womb to help the patient become pregnant. The overall pregnancy rate with IVF is about 35 percent, but actual results depend on the patient’s age, other causes for the infertility, as well as egg and embryo quality.

The treatment of anovulatory infertility in women with polycystic ovary syndrome (PCOS) typically follows a sequence from lower resource intensive treatments to more resource intensive treatments. The typical sequence is:

  1. Achieve an ideal body weight
  2. Clomiphene citrate treatment—this oral medicine typically triggers ovulation
  3. Metformin—this oral diabetes medication often triggers ovulation in women with PCOS
  4. Follicle-stimulating hormone (FSH) injections—this injectable fertility medicine is very expensive and may result in twins or triplet pregnancy
  5. Laparoscopic surgical treatment of the multiple ovarian cysts
  6. In vitro fertilization (IVF)

Almost all women with PCOS and anovulatory infertility will become pregnant with one of the above treatments. Many women with PCOS will conceive naturally, especially if they optimize their health prior to attempting conception. This includes achieving an ideal body weight.

Infertility often is a consequence of polycystic ovary syndrome (PCOS). If the woman is overweight or obese, the first line of treatment is weight loss; even losing a little bit of weight may stimulate ovulation. Weight loss can also boost the effectiveness of other infertility treatments.

The second line of treatment is the ovulation-stimulating drug clomiphene citrate, which is used to treat infertile women with ovulation problems. It works by helping the pituitary gland send hormonal signals to stimulate the development of more eggs in the ovaries. Clomiphene stimulates ovulation in about 80 percent of women with PCOS, and about half of these women become pregnant.

Another option for women with PCOS who do not ovulate is letrozole, a medication Food and Drug Administration (FDA) approved for breast cancer treatment. Letrozole is sometimes used off label to induce ovulation. Some studies have shown live birth rates in obese women with PCOS who take letrozole are higher than in obese women with PCOS who take clomiphene.

If clomiphene doesn't work, healthcare providers may suggest using metformin in combination with clomiphene or injections of gonadotropins.

Treatment with gonadotropins—purified solutions of follicle-stimulating hormone (FSH) with or without luteinizing hormone (LH)—may be administered by injection. Because many women with PCOS have elevated LH, some doctors may recommend treatment with FSH alone.

Another option for women who fail to ovulate with clomiphene or metformin therapy, or who are unwilling or unable to use gonadotropins (or can't afford to use them), is a surgical procedure known as laparoscopic ovarian drilling.

During this procedure, a surgeon makes a small incision in the abdomen and inserts a laparoscope (a telescope-like instrument attached to a tiny camera). The surgeon then makes other small incisions and inserts surgical equipment that uses electrical or laser energy to burn small holes in the enlarged follicles on the surface of the ovaries. The goal of the procedure is to stimulate ovulation by reducing LH and androgen levels.

Additionally, many women who failed to ovulate with clomiphene or metformin therapy are able to ovulate with these medications after ovarian drilling. The success rates for laparoscopic ovarian drilling appear to be better for patients at or near their ideal body weight, as opposed to those who are obese.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.