title: Ovulation induction in polycystic ovary syndrome: Current options.
abstract: There are a variety of effective treatment options to induce ovulation in women with polycystic ovary syndrome (PCOS). The most effective treatments are primarily reproductive and target the hypothalamic-pituitary-ovarian (HPO) axis. Letrozole, an aromatase inhibitor, is headed toward replacing clomiphene, a selective estrogen receptor modulator, as the first-choice option. Metabolic treatments likely work indirectly through the HPO axis. Many metabolic treatments have shown initial promise and later failed (troglitozone or d-chiro-inositol) or disappointed (metformin); further studies are needed of newer agents to treat type 2 diabetes. Weight loss interventions, lifestyle related, through obesity drugs or through bariatric surgery have shown mixed results on pregnancy outcomes. With both reproductive and metabolic treatments, combination therapies (such as metformin and clomiphene together) may offer greater benefit to distinct subgroups of patients.
authors.affiliation: Department of Obstetrics and Gynecology and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA. Electronic address: RSL1@PSU.EDU.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Legro
mesh_terms: D000858:Anovulation / Q000209:etiology / Q000628:therapy*; D019440:Anti-Obesity Agents / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D050110:Bariatric Surgery; D002996:Clomiphene / Q000627:therapeutic use; D004035:Diet Therapy; D005081:Exercise Therapy; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D007294:Inositol / Q000627:therapeutic use; D007333:Insulin Resistance; D000077289:Letrozole; D008687:Metformin / Q000627:therapeutic use; D009570:Nitriles / Q000627:therapeutic use; D009765:Obesity / Q000150:complications / Q000628:therapy; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000628:therapy*; D011247:Pregnancy; D018873:Pregnancy Rate; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use*; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D019440:Anti-Obesity Agents; D047072:Aromatase Inhibitors; D005300:Fertility Agents, Female; D007004:Hypoglycemic Agents; D009570:Nitriles; D020845:Selective Estrogen Receptor Modulators; D014230:Triazoles; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D007294:Inositol; D000077289:Letrozole; D005640:Follicle Stimulating Hormone; D008687:Metformin
keywords: clinical trials; hyperandrogenism; infertility; insulin resistance