title: Clomiphene citrate alternatives for the initial management of polycystic ovary syndrome: an evidence-based approach.
abstract: Polycystic ovary syndrome (PCOS) is a prevalent and heterogeneous condition affecting 4-8% of reproductive age women. It is the most common cause of chronic anovulation and is associated with hyperandrogenemia. Clomiphene citrate (CC) is considered as the first-line therapy for ovulation induction in these patients. Despite progress in understanding the pathophysiology of PCOS over the past 20 years, many questions persist to the extent that PCOS was described as "A Riddle Wrapped in a Mystery inside an Enigma". On the other hand, a recent publication from the Centers for Disease Control suggested that CC may be associated with an increased risk of birth defects. The purpose of this review is to critically evaluate and summarize the current literature regarding CC alternatives for the initial management of PCOS focusing specifically on the roles of weight loss and other approaches to ovulation induction as insulin-sensitizing drugs, aromatase inhibitors, minimal stimulation protocol, gonadotrophins and surgery (laparoscopic ovarian drilling). Finally, the efficacy of intrauterine insemination with CC for the initial management of PCOS will be evaluated.
authors.affiliation: Department of Obstetrics and Gynecology, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt. hatem_ah@hotmail.com
authors.forename: Hatem
authors.initials: H
authors.lastname: Abu Hashim
mesh_terms: D047072:Aromatase Inhibitors / Q000627:therapeutic use; D002996:Clomiphene / Q000008:administration & dosage / Q000627:therapeutic use*; D003972:Diathermy; D004965:Estrogen Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006062:Gonadotropins / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007333:Insulin Resistance / Q000502:physiology; D010062:Ovulation Induction / Q000379:methods; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy*; D040242:Risk Reduction Behavior; D015431:Weight Loss / Q000187:drug effects / Q000502:physiology
chemical_list: D047072:Aromatase Inhibitors; D004965:Estrogen Antagonists; D006062:Gonadotropins; D007004:Hypoglycemic Agents; D002996:Clomiphene