Ovulation induction in normogonadotropic anovulation (PCOS).
Treatment of normogonadotropic anovulatory infertility (World Health Organization class 2, or WHO2) is by induction of ovulation using clomiphene citrate (CC), followed by follicle-stimulating hormone (FSH) in cases of treatment failure. Not all patients will become ovulatory or will conceive with this treatment. Others, exhibiting multifollicular instead of monofollicular development, may encounter complications such as ovarian hyperstimulation and multiple pregnancy. Recently introduced alternative treatment interventions-such as insulin-sensitizing drugs, aromatase inhibitors, or laparoscopic electrocautery of the ovaries-may offer the possibility of improving the efficacy of the classical ovulation induction algorithm. Based on initial patient characteristics, it may be possible to identify specific patient subgroups with altered chances of success or complications while using one of these interventions. Regarding CC and FSH ovulation induction, this has been performed using multivariate prediction models. This approach may enable us to improve safety, cost-effectiveness, and patient convenience in future ovulation induction.
van Santbrink
Evert J P
EJ
Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus Medical Center, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. e.vansantbrink@erasmusmc.nl
Fauser
Bart C J M
BC
D000858:Anovulation / Q000188:drug therapy*; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D002996:Clomiphene / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004564:Electrocoagulation; D005260:Female; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D010535:Laparoscopy; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy*; D011247:Pregnancy; D018873:Pregnancy Rate; D015431:Weight Loss
D047072:Aromatase Inhibitors; D007004:Hypoglycemic Agents; D002996:Clomiphene; D005640:Follicle Stimulating Hormone