title: Mono-ovulation in women with polycystic ovary syndrome: a clinical review on ovulation induction.
abstract: Polycystic ovary syndrome (PCOS) affects 5-10% of women of reproductive age and is the most common cause of anovulatory infertility. The treatment approaches to ovulation induction vary in efficacy, treatment duration and patient friendliness. The aim was to determine the most efficient, evidence-based method to achieve mono-ovulation in women diagnosed with PCOS. Publications in English providing information on treatment, efficacy and complication rates were included until September 2015. Systematic reviews, meta-analyses and randomized controlled trials were favoured over cohort and retrospective studies. Clomiphene citrate is recommended as primary treatment for PCOS-related infertility. It induces ovulation in three out of four patients, the risk of multiple pregnancies is modest and the treatment is simple and inexpensive. Gonadotrophins are highly efficient in a low-dose step-up regimen. Ovulation rates are improved by lifestyle interventions in overweight women. Metformin may improve the menstrual cycle within 1-3 months, but does not improve the live birth rate. Letrozole is effective for ovulation induction, but is an off-label drug in many countries. Ovulation induction in women with PCOS should be individualized with regard to weight, treatment efficacy and patient preferences with the aim of achieving mono-ovulation and subsequently the birth of a singleton baby.
authors.affiliation: Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. Electronic address: kathrine.birch.petersen@regionh.dk.
authors.forename: Kathrine
authors.initials: K
authors.lastname: Birch Petersen
authors.affiliation: Department of Gynecology/Obstetrics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
authors.forename: Nina Gros
authors.initials: NG
authors.lastname: Pedersen
authors.affiliation: Fertility Clinic and Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
authors.forename: Anette Tønnes
authors.initials: AT
authors.lastname: Pedersen
authors.affiliation: Department of Gynecology/Obstetrics, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark.
authors.forename: Mette Petri
authors.initials: MP
authors.lastname: Lauritsen
authors.affiliation: Fertility Clinic and Department of Gynecology/Obstetrics, Holbæk Hospital, Copenhagen University Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark.
authors.forename: Nina
authors.initials: N
authors.lastname: la Cour Freiesleben
mesh_terms: D000328:Adult; D000858:Anovulation / Q000188:drug therapy; D001835:Body Weight; D002996:Clomiphene / Q000627:therapeutic use; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D006062:Gonadotropins / Q000097:blood; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy; D000077289:Letrozole; D008019:Life Style; D008687:Metformin / Q000737:chemistry / Q000627:therapeutic use; D009570:Nitriles / Q000737:chemistry; D050177:Overweight; D010060:Ovulation; D010062:Ovulation Induction / Q000379:methods*; D061214:Patient Safety; D011085:Polycystic Ovary Syndrome / Q000150:complications* / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies; D014230:Triazoles / Q000737:chemistry
chemical_list: D005300:Fertility Agents, Female; D006062:Gonadotropins; D009570:Nitriles; D014230:Triazoles; D002996:Clomiphene; D000077289:Letrozole; D008687:Metformin
keywords: BMI; PCOS; assisted reproduction; clomiphene citrate; infertility