Infertility Treatment for Women With PCOS

Topic Overview

Women with polycystic ovary syndrome (PCOS) do not ovulate regularly. They often have trouble getting pregnant. The medicine clomiphene (such as Clomid) is commonly used to stimulate ovulation. But it doesn't work for some women who have PCOS. This is because many body systems are involved in PCOS ovulation problems. Often other treatment can restore balance to the body's metabolism and hormone system, so that ovulation medicine is not needed (or works better if it is used).

• Before considering medicine to stimulate ovulation, overweight women with polycystic ovary syndrome should try to lower their body mass index (BMI) with diet and exercise. Even a modest weight loss may trigger ovulation.
• If weight loss does not help start ovulation, clomiphene is usually tried first.
• If clomiphene does not start ovulation, it may be combined with another medicine, such as metformin. Combining the two treatments may make it more likely that clomiphene will trigger ovulation.
• Women who do not ovulate with a combination of medicines are sometimes treated with gonadotropins. These are similar to the hormones the body produces to start ovulation. During this type of treatment, a woman must have daily monitoring of egg follicle development to prevent ovarian hyperstimulation syndrome. The monitoring requires blood tests and ultrasound.
• If clomiphene does not work, your doctor may try a medicine called letrozole. Letrozole may harm the fetus if it is used while you are pregnant. Talk to your doctor about making sure you are not pregnant before you take this drug.

Laparoscopic ovarian surgery or in vitro fertilization (IVF) is sometimes used for women with PCOS who have tried weight loss and medicine, but still are not ovulating. (A surgery sometimes used is ovarian drilling. This involves partial destruction of an ovary, which can trigger ovulation.) ^{footnote 1}