title: Treatment strategies for the infertile polycystic ovary syndrome patient.
abstract: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Infertility is a prevalent presenting feature of PCOS, and approximately 75% of these women suffer infertility due to anovulation. Lifestyle modification is considered the first-line treatment and is associated with improved endocrine profile. Clomiphene citrate (CC) should be considered as the first line pharmacologic therapy for ovulation induction. In women who are CC resistant, second-line treatment should be considered, as adding metformin, laparoscopic ovarian drilling or treatment with gonadotropins. In CC treatment failure, Letrozole could be an alternative or treatment with gonadotropins. IVF is considered the third-line treatment; the 'short', antagonist-based protocol is the preferred option for PCOS patients, as it is associated with lower risk of developing ovarian hyperstimulation syndrome (specifically by using a gonadotropin--releasing hormone agonist as ovulation trigger), but with comparable outcomes as the long protocol.
authors.affiliation: Department of Obstetrics & Gynecology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Samer
authors.initials: S
authors.lastname: Tannus
authors.affiliation: Department of Obstetrics & Gynecology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Yechiel Z
authors.initials: YZ
authors.lastname: Burke
authors.affiliation: Department of Obstetrics & Gynecology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Shahar
authors.initials: S
authors.lastname: Kol
mesh_terms: D000858:Anovulation / Q000628:therapy; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002996:Clomiphene / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D010535:Laparoscopy / Q000379:methods; D000077289:Letrozole; D008019:Life Style; D008687:Metformin / Q000627:therapeutic use; D009570:Nitriles / Q000627:therapeutic use; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy*; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D005300:Fertility Agents, Female; D009570:Nitriles; D014230:Triazoles; D002996:Clomiphene; D000077289:Letrozole; D008687:Metformin
keywords: IVF; clomiphene citrate; gonadotropins; laparoscopic ovarian drilling; letrozole; metformin; polycystic ovary syndrome