Mono-ovulation in women with polycystic ovary syndrome: a clinical review on ovulation induction

TY - JOUR

T1 - Mono-ovulation in women with polycystic ovary syndrome

T2 - a clinical review on ovulation induction

AU - Birch Petersen, Kathrine

AU - Pedersen, Nina Gros

AU - Pedersen, Anette Tønnes

AU - Lauritsen, Mette Petri

AU - Freiesleben, Nina la Cour

N1 - Copyright © 2016 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - 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.

AB - 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.

KW - Adult

KW - Anovulation

KW - Body Weight

KW - Clomiphene

KW - Female

KW - Fertility Agents, Female

KW - Gonadotropins

KW - Humans

KW - Infertility, Female

KW - Life Style

KW - Metformin

KW - Nitriles

KW - Overweight

KW - Ovulation

KW - Ovulation Induction

KW - Patient Safety

KW - Polycystic Ovary Syndrome

KW - Randomized Controlled Trials as Topic

KW - Reproductive Techniques, Assisted

KW - Retrospective Studies

KW - Triazoles

KW - Journal Article

KW - Review

U2 - 10.1016/j.rbmo.2016.03.006

DO - 10.1016/j.rbmo.2016.03.006

M3 - Review

C2 - 27151490

SN - 1472-6483

VL - 32

SP - 563

EP - 583

JO - Reproductive BioMedicine Online

JF - Reproductive BioMedicine Online

IS - 6

ER -