title: Evidence-based lifestyle and pharmacological management of infertility in women with polycystic ovary syndrome.
abstract: Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder in women of reproductive age and by far the most common cause of anovulatory infertility. Lifestyle change alone, and not in combination with pharmacological ovulation induction such as clomifene citrate or metformin, is generally considered the first-line treatment for the management of infertile anovulatory women with PCOS who are overweight or obese. Clomifene citrate should be considered as a first-line pharmacological therapy to improve fertility outcomes. Second-line medical treatments may include ovulation induction with gonadotropins (in clomifene citrate-resistant or clomifene citrate failure women) or laparoscopic ovarian drilling (in clomifene citrate-resistant women) or possibly with metformin combined with clomifene citrate (in clomifene citrate-resistant women). There is currently insufficient evidence to recommend aromatase inhibitors over that of clomifene citrate in infertile anovulatory women with PCOS in general or specifically in therapy-naive or clomifene citrate-resistant women with PCOS.
authors.affiliation: School of Women's & Children's Health, Division of Obstetrics & Gynaecology, University of New South Wales, Level 1 Women's Health Institute, Royal Hospital for Women, Locked Bag 2000, Randwick, Sydney, NSW 2031, Australia. mfcostello@unsw.edu.au
authors.forename: Michael F
authors.initials: MF
authors.lastname: Costello
authors.forename: William L
authors.initials: WL
authors.lastname: Ledger
mesh_terms: D004359:Drug Therapy, Combination; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D006062:Gonadotropins / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007247:Infertility, Female / Q000150:complications* / Q000628:therapy*; D008019:Life Style; D009765:Obesity / Q000150:complications; D011085:Polycystic Ovary Syndrome / Q000150:complications* / Q000188:drug therapy
chemical_list: D004965:Estrogen Antagonists; D005300:Fertility Agents, Female; D006062:Gonadotropins; D007004:Hypoglycemic Agents