Ovulation induction in polycystic ovary syndrome.
Management of polycystic ovary syndrome (PCOS) usually spans a woman's reproductive years. While treatment of androgenic symptoms is often a primary concern, periodically, the regimen has to be modified because of a desire for pregnancy. As these women are usually anovulatory, ovulation induction is generally required. The premise on which ovulation induction in PCOS is based is two-fold: increasing ovarian exposure to follicle stimulating hormone (FSH) and/or correcting hormonal derangements. Potential differences in pathogenesis, evidenced clinically by phenotypic diversity, suggest that treatment should be individualized. This paper is an overview of treatments available and also provides a critical appraisal of management options. These options include the use of clomiphene citrate, insulin sensitizers, and the combination. Protocols for ovulation induction with FSH injections are outlined and the relative risks of multiple gestation and severe ovarian hyperstimulation syndrome of these various protocols discussed. The use of aromatase inhibitors and the occasional use of glucocorticoids are briefly reviewed. Finally, the role of laparoscopic ovarian diathermy in the management of anovulatory infertility in PCOS is outlined.
Nader
S
S
Department of Obstetrics and Gynecology, University of Texas Medical School, Houston, TX 77030, USA. shahla.nader-eftekhari@uth.tmc.edu
D000328:Adult; D000858:Anovulation / Q000628:therapy; D047072:Aromatase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D015992:Body Mass Index; D002996:Clomiphene / Q000008:administration & dosage / Q000627:therapeutic use; D003972:Diathermy; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage / Q000627:therapeutic use; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage / Q000627:therapeutic use; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D017588:Hyperandrogenism; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007333:Insulin Resistance; D010535:Laparoscopy; D000077289:Letrozole; D008687:Metformin / Q000008:administration & dosage / Q000627:therapeutic use; D009570:Nitriles / Q000008:administration & dosage / Q000627:therapeutic use; D010062:Ovulation Induction / Q000379:methods; D010641:Phenotype; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy / Q000235:genetics / Q000503:physiopathology / Q000628:therapy*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D014230:Triazoles / Q000008:administration & dosage / Q000627:therapeutic use
D047072:Aromatase Inhibitors; D005300:Fertility Agents, Female; D005938:Glucocorticoids; D007004:Hypoglycemic Agents; D009570:Nitriles; D014230:Triazoles; D002996:Clomiphene; D000077289:Letrozole; D005640:Follicle Stimulating Hormone; D008687:Metformin