A Review of First Line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome

doi:10.3390/medsci7090095

Review

. 2019 Sep 10;7(9):95.

doi: 10.3390/medsci7090095.

A Review of First Line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome

Michael Costello¹, Rhonda Garad², Roger Hart³, Hayden Homer⁴, Louise Johnson⁵, Cailin Jordan⁶, Edgar Mocanu⁷, Jie Qiao⁸, Luk Rombauts⁹, Helena J Teede¹⁰, Eszter Vanky¹¹, Christos Venetis¹², William Ledger¹³

Affiliations

¹ University of New South Wales, High St, Kensington, Sydney, NSW 2033, 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, UK. 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, Dublin D02 YN77, 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 National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash University, Melbourne, VIC 3168, Australia. helena.teede@monash.edu.
¹¹ Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 1517 Trondheim, Norway. eszter.vanky@ntnu.no.
¹² University of New South Wales, High St, Kensington, Sydney, NSW 2033, Australia. c.venetis@unsw.edu.au.
¹³ University of New South Wales, High St, Kensington, Sydney, NSW 2033, Australia. w.ledger@unsw.edu.au.

PMID: 31510088
PMCID: PMC6780967
DOI: 10.3390/medsci7090095

Review

A Review of First Line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome

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

. 2019 Sep 10;7(9):95.

doi: 10.3390/medsci7090095.

Authors

Affiliations

¹ University of New South Wales, High St, Kensington, Sydney, NSW 2033, 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, UK. 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, Dublin D02 YN77, 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 National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash University, Melbourne, VIC 3168, Australia. helena.teede@monash.edu.
¹¹ Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 1517 Trondheim, Norway. eszter.vanky@ntnu.no.
¹² University of New South Wales, High St, Kensington, Sydney, NSW 2033, Australia. c.venetis@unsw.edu.au.
¹³ University of New South Wales, High St, Kensington, Sydney, NSW 2033, Australia. w.ledger@unsw.edu.au.

PMID: 31510088
PMCID: PMC6780967
DOI: 10.3390/medsci7090095

Abstract

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility in women of reproductive age. Lifestyle change is considered the first line treatment for the management of infertile anovulatory women with PCOS, and weight loss for those who are overweight or obese. First line medical ovulation induction therapy to improve fertility outcomes is letrozole, whilst other less efficacious ovulation induction agents, such as clomiphene citrate, metformin, and metformin combined with clomiphene citrate, may also be considered. Metformin combined with clomiphene citrate is more effective than clomiphene citrate alone. In obese women with PCOS, clomiphene citrate could be used in preference to metformin alone whilst clomiphene citrate could be added to metformin alone in order to improve reproductive outcome in all women with PCOS. Gonadotrophins, which are more effective than clomiphene citrate in therapy naïve women with PCOS, can be considered a first line therapy in the presence of ultrasound monitoring, following counselling on the cost and the potential risk of multiple pregnancy.

Keywords: infertility; ovulation induction; polycystic ovary syndrome; treatment.

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Conflict of interest statement

The authors declare no conflict of interest.

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References

1. Teede H., Deeks A., Moran L. Polycystic ovary syndrome: A complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med. 2010;8:41. doi: 10.1186/1741-7015-8-41. - DOI - PMC - PubMed
1. Group REA-SPCW Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS) Hum. Reprod. 2004;19:41–47. doi: 10.1093/humrep/deh098. - DOI - PubMed
1. Homburg R. Management of infertility and prevention of ovarian hyperstimulation in women with polycystic ovary syndrome. Best Pract. Res. Clin. Obstet. Gynaecol. 2004;18:773–788. doi: 10.1016/j.bpobgyn.2004.05.006. - DOI - PubMed
1. Costello M.F., Misso M.L., Wong J., Hart R., Rombauts L., Melder A., Norman R.J., Teede H.J. The treatment of infertility in polycystic ovary syndrome: A brief update. Aust. N. Z. J. Obstet. Gynaecol. 2012;52:400–403. doi: 10.1111/j.1479-828X.2012.01448.x. - DOI - PubMed
1. Walls M.L., Hunter T., Ryan J.P., Keelan J.A., Nathan E., Hart R.J. In vitro maturation as an alternative to standard in vitro fertilization for patients diagnosed with polycystic ovaries: A comparative analysis of fresh, frozen and cumulative cycle outcomes. Hum. Reprod. 2015;30:88–96. doi: 10.1093/humrep/deu248. - DOI - PubMed

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[1] Teede H., Deeks A., Moran L. Polycystic ovary syndrome: A complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med. 2010;8:41. doi: 10.1186/1741-7015-8-41. - DOI - PMC - PubMed

[2] Teede H., Deeks A., Moran L. Polycystic ovary syndrome: A complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med. 2010;8:41. doi: 10.1186/1741-7015-8-41. - DOI - PMC - PubMed

[3] Group REA-SPCW Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS) Hum. Reprod. 2004;19:41–47. doi: 10.1093/humrep/deh098. - DOI - PubMed

[4] Group REA-SPCW Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS) Hum. Reprod. 2004;19:41–47. doi: 10.1093/humrep/deh098. - DOI - PubMed

[5] Homburg R. Management of infertility and prevention of ovarian hyperstimulation in women with polycystic ovary syndrome. Best Pract. Res. Clin. Obstet. Gynaecol. 2004;18:773–788. doi: 10.1016/j.bpobgyn.2004.05.006. - DOI - PubMed

[6] Homburg R. Management of infertility and prevention of ovarian hyperstimulation in women with polycystic ovary syndrome. Best Pract. Res. Clin. Obstet. Gynaecol. 2004;18:773–788. doi: 10.1016/j.bpobgyn.2004.05.006. - DOI - PubMed

[7] Costello M.F., Misso M.L., Wong J., Hart R., Rombauts L., Melder A., Norman R.J., Teede H.J. The treatment of infertility in polycystic ovary syndrome: A brief update. Aust. N. Z. J. Obstet. Gynaecol. 2012;52:400–403. doi: 10.1111/j.1479-828X.2012.01448.x. - DOI - PubMed

[8] Costello M.F., Misso M.L., Wong J., Hart R., Rombauts L., Melder A., Norman R.J., Teede H.J. The treatment of infertility in polycystic ovary syndrome: A brief update. Aust. N. Z. J. Obstet. Gynaecol. 2012;52:400–403. doi: 10.1111/j.1479-828X.2012.01448.x. - DOI - PubMed

[9] Walls M.L., Hunter T., Ryan J.P., Keelan J.A., Nathan E., Hart R.J. In vitro maturation as an alternative to standard in vitro fertilization for patients diagnosed with polycystic ovaries: A comparative analysis of fresh, frozen and cumulative cycle outcomes. Hum. Reprod. 2015;30:88–96. doi: 10.1093/humrep/deu248. - DOI - PubMed

[10] Walls M.L., Hunter T., Ryan J.P., Keelan J.A., Nathan E., Hart R.J. In vitro maturation as an alternative to standard in vitro fertilization for patients diagnosed with polycystic ovaries: A comparative analysis of fresh, frozen and cumulative cycle outcomes. Hum. Reprod. 2015;30:88–96. doi: 10.1093/humrep/deu248. - DOI - PubMed

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A Review of First Line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome

Affiliations

A Review of First Line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome

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