A Review of Second- and Third-line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome

Michael F Costello¹, Rhonda M Garad², Roger Hart³, Hayden Homer⁴, Louise Johnson⁵, Cailin Jordan⁶, Edgar Mocanu⁷, Jie Qiao⁸, Luk Rombauts⁹, Helena J Teede^{10

11

12

13}, Eszter Vanky¹⁴, Christos A Venetis¹⁵, William L Ledger¹⁶

Affiliations

¹ University of New South Wales, High St. Kensington, Sydney, NSW 2052, Australia. mfcostello@unsw.edu.au.
² Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University and Monash Health, Melbourne, VIC 3168, Australia. rhonda.garad@monash.edu.
³ Division of Obstetrics and Gynaecology, The University of Western Australia, University of Western Australia, Crawley, WA 6008, Australia. roger.hart@uwa.edu.au.
⁴ Christopher Chen Oocyte Biology Research Laboratory, UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia. h.homer@uq.edu.au.
⁵ Victorian Assisted Reproductive Treatment Authority, Melbourne, VIC 3000, Australia. LJohnson@varta.org.au.
⁶ Genea Hollywood Fertility, Wembley 6014, Australia. Cailin.Jordan@genea.com.au.
⁷ Royal College of Surgeons, Rotunda Hospital, D02 YN77 Dublin, Ireland. emocanu@rcsi.ie.
⁸ Department of Obstetrics and Gynaecology, Medical Center for Human Reproduction, Peking University Third Hospital, Beijing 100191, China. jie.qiao@263.net.
⁹ Department of Obstetrics and Gynaecology, Monash University, Melbourne 3168, Australia. luk.rombauts@monash.edu.
¹⁰ Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University and Monash Health, Melbourne, VIC 3168, Australia. helena.teede@monash.edu.
¹¹ National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash University, Melbourne 3168, VIC, Australia. helena.teede@monash.edu.
¹² National Health and Medical Research Council Centre for Research Excellence in PCOS, University of Adelaide, Adelaide 5006, SA, Australia. helena.teede@monash.edu.
¹³ University of New South Wales, Sydney 2033, NSW, Australia. helena.teede@monash.edu.
¹⁴ Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 1517 Trondheim, Norway. eszter.vanky@ntnu.no.
¹⁵ University of New South Wales, High St. Kensington, Sydney, NSW 2052, Australia. c.venetis@unsw.edu.au.
¹⁶ University of New South Wales, High St. Kensington, Sydney, NSW 2052, Australia. w.ledger@unsw.edu.au.

PMID: 31247909
PMCID: PMC6681353
DOI: 10.3390/medsci7070075

Review

A Review of Second- and Third-line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome

Michael F Costello et al. Med Sci (Basel). 2019.

. 2019 Jun 26;7(7):75.

doi: 10.3390/medsci7070075.

Authors

Affiliations

¹ University of New South Wales, High St. Kensington, Sydney, NSW 2052, Australia. mfcostello@unsw.edu.au.
² Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University and Monash Health, Melbourne, VIC 3168, Australia. rhonda.garad@monash.edu.
³ Division of Obstetrics and Gynaecology, The University of Western Australia, University of Western Australia, Crawley, WA 6008, Australia. roger.hart@uwa.edu.au.
⁴ Christopher Chen Oocyte Biology Research Laboratory, UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia. h.homer@uq.edu.au.
⁵ Victorian Assisted Reproductive Treatment Authority, Melbourne, VIC 3000, Australia. LJohnson@varta.org.au.
⁶ Genea Hollywood Fertility, Wembley 6014, Australia. Cailin.Jordan@genea.com.au.
⁷ Royal College of Surgeons, Rotunda Hospital, D02 YN77 Dublin, Ireland. emocanu@rcsi.ie.
⁸ Department of Obstetrics and Gynaecology, Medical Center for Human Reproduction, Peking University Third Hospital, Beijing 100191, China. jie.qiao@263.net.
⁹ Department of Obstetrics and Gynaecology, Monash University, Melbourne 3168, Australia. luk.rombauts@monash.edu.
¹⁰ Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University and Monash Health, Melbourne, VIC 3168, Australia. helena.teede@monash.edu.
¹¹ National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash University, Melbourne 3168, VIC, Australia. helena.teede@monash.edu.
¹² National Health and Medical Research Council Centre for Research Excellence in PCOS, University of Adelaide, Adelaide 5006, SA, Australia. helena.teede@monash.edu.
¹³ University of New South Wales, Sydney 2033, NSW, Australia. helena.teede@monash.edu.
¹⁴ Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 1517 Trondheim, Norway. eszter.vanky@ntnu.no.
¹⁵ University of New South Wales, High St. Kensington, Sydney, NSW 2052, Australia. c.venetis@unsw.edu.au.
¹⁶ University of New South Wales, High St. Kensington, Sydney, NSW 2052, Australia. w.ledger@unsw.edu.au.

PMID: 31247909
PMCID: PMC6681353
DOI: 10.3390/medsci7070075

Abstract

In clomiphene-citrate-resistant anovulatory women with polycystic ovary syndrome (PCOS) and no other infertility factors, either metformin combined with clomiphene citrate or gonadotrophins could be used as a second-line pharmacological therapy, although gonadotrophins are more effective. Gonadotrophins could also be used as a second-line pharmacological therapy in anovulatory women with PCOS and clomiphene-citrate-failure. Laparoscopic ovarian surgery can also be used as a second-line therapy for ovulation induction in anovulatory women with clomiphene-citrate-resistant PCOS and no other infertility factors. The usefulness of letrozole as a second-line pharmacological treatment for ovulation induction in clomiphene-citrate-resistant women with PCOS requires further research. In terms of improving fertility, both pharmacological anti-obesity agents and bariatric surgery should be considered an experimental therapy in anovulatory women with PCOS and no other infertility factors. Where first- or second-line ovulation induction therapies have failed, in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) could be offered as a third-line therapy in women with PCOS in the absence of an absolute indication for IVF/ICSI. For women with PCOS undergoing IVF/ICSI treatment, the gonadotropin-releasing hormone (GnRH) antagonist protocol is preferred and an elective frozen embryo transfer strategy could be considered. In assisted conception units with sufficient expertise, in-vitro maturation (IVM) of oocytes could be offered to women with PCOS.

Keywords: IVF; IVM; assisted reproductive technology; infertility; polycystic ovary syndrome; surgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

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A Review of Second- and Third-line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome

Affiliations

A Review of Second- and Third-line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

LinkOut - more resources

Full Text Sources