Management strategies for ovulation induction in women with polycystic ovary syndrome and known clomifene citrate resistance.
OBJECTIVE
Clomifene citrate is the first and the most used agent for inducing ovulation in patients affected by polycystic ovary syndrome (PCOS). About 60-85% of PCOS women ovulated under clomifene citrate, whereas the others were defined clomifene citrate-resistant. The purpose of the current review will be to describe treatment strategies to induce ovulation in infertile PCOS patients with clomifene citrate resistance.


RESULTS
Clomifene citrate and metformin association are a valid option for inducing ovulation in clomifene citrate-resistant PCOS patients. Surgical ovulation induction by laparoscopic ovarian drilling should be reserved to well selected cases. Excellent preliminary results are obtained using new drug formulations, such as aromatase inhibitors.


CONCLUSIONS
In clomifene citrate-resistant PCOS patients, clomifene citrate and metformin combination and laparoscopic ovarian drilling, in selected cases, should be considered before gonadotropin administration. The efficacy of the other treatments must be confirmed in future well designed studies.
Palomba
Stefano
S
Department of Gynecology and Obstetrics, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy. stefanopalomba@tin.it
Falbo
Angela
A
Zullo
Fulvio
F
D000111:Acetylcysteine / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001971:Bromocriptine / Q000627:therapeutic use; D002996:Clomiphene / Q000627:therapeutic use*; D003907:Dexamethasone / Q000627:therapeutic use; D004351:Drug Resistance; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D016166:Free Radical Scavengers / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use; D006062:Gonadotropins / Q000627:therapeutic use; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D010535:Laparoscopy; D008687:Metformin / Q000627:therapeutic use; D009271:Naltrexone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D015282:Octreotide / Q000627:therapeutic use; D010053:Ovary / Q000601:surgery; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000150:complications*
D018931:Antineoplastic Agents, Hormonal; D047072:Aromatase Inhibitors; D005300:Fertility Agents, Female; D016166:Free Radical Scavengers; D005938:Glucocorticoids; D006062:Gonadotropins; D006727:Hormone Antagonists; D007004:Hypoglycemic Agents; D009292:Narcotic Antagonists; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D001971:Bromocriptine; D009271:Naltrexone; D003907:Dexamethasone; D008687:Metformin; D015282:Octreotide; D000111:Acetylcysteine