title: Infertility and pregnancy in women with polycystic ovary syndrome.
abstract: 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. At this time the couple should be evaluated for factors that may contribute to infertility and this should include semen analysis. However, for many, anovulation is likely to be the cause of infertility and 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, would suggest that treatment should be individualized. After a brief overview of factors relating to infertility, this paper outlines treatments available for ovulation induction in women with PCOS and 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, and indications for in vitro fertilization and laparoscopic ovarian diathermy outlined. Pregnancy outcome in this patient population is also discussed.
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Medical School, Houston, TX, USA. shahla.nader-eftekhari@uth.tmc.edu
authors.forename: S
authors.initials: S
authors.lastname: Nader
mesh_terms: D002996:Clomiphene / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use; D006801:Humans; D017588:Hyperandrogenism / Q000150:complications; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D007329:Insulin Antagonists / Q000627:therapeutic use; D007333:Insulin Resistance; D010060:Ovulation / Q000502:physiology; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011247:Pregnancy; D011256:Pregnancy Outcome
chemical_list: D005300:Fertility Agents, Female; D007329:Insulin Antagonists; D002996:Clomiphene; D005640:Follicle Stimulating Hormone