Treatments for infertility resulting from PCOS

Treatments for Infertility Resulting from Polycystic Ovary Syndrome (PCOS)

02/17/2013 12:15 PM EST

Source: National Institute of Child Health and Human Development -
Related MedlinePlus Pages: Female Infertility, Polycystic Ovary Syndrome

Treatments for infertility resulting from PCOS

 

In most cases, fertility problems in women with PCOS result from the absence of ovulation (anovulation), but anovulation may not be the only reason for these problems. Before beginning treatment for infertility possibly related to PCOS, be sure that your health care provider rules out other causes.¹
Lifestyle changes, such as losing weight, can trigger body changes that facilitate conception in women with PCOS.^2,3 Your health care provider may recommend that you try weight loss and other lifestyle changes before trying any medications to see if fertility returns and pregnancy occurs naturally. Research shows that lifestyle changes can help restore ovulation and improve pregnancy rates among women with PCOS.^4,5 In one study of 11 women with PCOS who had menstrual dysfunction and lost more than 5% of their initial weight, nine either became pregnant or had their menstrual cycles become more regular.⁶
If you have PCOS-related infertility, your health care provider may prescribe one of the following medications to help you get pregnant:

• Clomiphene (pronounced KLOM-uh-feen), or clomiphene citrate
  • This is the most common treatment for infertility in women with PCOS.⁷ The American College of Obstetricians and Gynecologists (ACOG) recommends that clomiphene should be the primary medication for PCOS patients with infertility.
    
  • Clomiphene indirectly causes eggs to mature and be released.⁸
    
  • Women treated with clomiphene are more likely to have twins or triplets than women who get pregnant naturally. One in 10 women who conceive with the aid of clomiphene will have a multiple pregnancy, most commonly twins.⁹
  
  
  
• Metformin (pronounced met-FAWR-min)
  • Although this insulin-sensitizing drug is normally used to treat diabetes, it may also be used as an adjunct to increase or regulate ovulation in women with PCOS.
    
  • Metformin can be used alone¹⁰ or used with clomiphene when clomiphene alone is not successful.^11,12
    
  • Evidence shows that metformin—both alone and in combination with clomiphene—increases ovulation, but it does not increase the rate of pregnancy.¹³
    
  • Metformin is not approved by the FDA for treating PCOS-related infertility.
  
  
  
  
• Letrozole (pronounced LET-roh-zohl)
  • This drug transiently slows estrogen production and causes the body to make more follicle-stimulating hormone (FSH), a hormone needed for ovulation.¹⁴
    
  • Letrozole is as effective as clomiphene in causing ovulation,¹⁵ but it is still not known whether it improves pregnancy and live-birth rates.¹⁶
    
  • The NICHD currently is doing studies to compare the safety and effectiveness of letrozole with clomiphene for treating infertility related to PCOS.
    
  • Studies of letrozole in animals have shown that it causes birth defects if used during pregnancy, but there have been no studies of this drug in pregnant women.^17,18
  
  
  
  

If you do not get pregnant with these first-line medications, your health care provider may suggest one of the following treatments:^19,20

• Gonadotropins (pronounced goh-nad-uh-TROH-pins)
  • These hormones, given as shots, cause ovulation.
    
  • This treatment is costly and has a higher risk of multiple pregnancies than does treatment with clomiphene.²¹
    
  • Your health care provider may need to use frequent laboratory tests and ultrasound exams to watch how your body responds to this treatment.²²
  
  
  
• Ovarian drilling
  • This surgery may increase the chance of ovulation²³ and may be considered if lifestyle changes and medications have been used without success.
    
  • In ovarian drilling the surgeon makes a small cut in your abdomen and inserts a long, thin tool called a laparoscope (pronounced LAP-er-uh-skohp). The surgeon then uses a needle with electric current to puncture and destroy a small part of the ovary. The surgery leads to lower androgen levels, which may improve ovulation.
    
  • This surgery may be less costly than treatment with gonadotropin,²⁴ and it does not seem to increase the risk of multiple pregnancies.²⁵ However, it does carry the risk of scarring the ovaries.²⁶
    
  • This treatment is not recommended by all professional societies. It is unclear whether the process is more effective than medications for treating PCOS infertility.
  
  
  
  

If you do not get pregnant with the treatments listed above, your health care provider may suggest in vitro fertilization, or IVF.²⁷ In this procedure, sperm and an egg are placed in a dish outside the body, in which fertilization occurs. Then a doctor places the fertilized egg into the uterus. IVF may offer women with PCOS the best chance of getting pregnant, and it may give health care providers better control over the risk of multiple births. But it can be expensive and may not be covered by health care insurance.²⁸

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1. American Society for Reproductive Medicine. (2011). Frequently asked questions about infertility. Retrieved December 22, 2011, from http://www.reproductivefacts.org/awards/index.aspx?id=3012 [top]
   
2. ACOG. (2011). Polycystic ovary syndrome. Retrieved May 10, 2012, from http://www.acog.org/~/media/For%20Patients/faq121.pdf?dmc=1&ts=20120510T1116545699 (PDF - 273 KB) [top]
   
3. Moran, L. J., Pasquali, R., Teede, H. J., Hoeger, K. M., & Norman, R. J. (2009). Treatment of obesity in polycystic ovary syndrome: A position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertility and Sterility, 92, 1966–1982. [top]
   
4. Moran, L. J., Pasquali, R., Teede, H. J., Hoeger, K. M., & Norman, R. J. (2009). Treatment of obesity in polycystic ovary syndrome: A position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertility and Sterility, 92, 1966–1982. [top]
   
5. Legro, R. S. (2007). Pregnancy considerations in women with polycystic ovary syndrome. Clinical Obstetrics and Gynecology, 50, 295–304. [top]
   
6. Kiddy, D.S., Hamilton-Fairley, D., Bush, A., Short, F., Anyaoku, V., Reed, M.J., et al. (1992). Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clinical Endocrinology (Oxford), 36, 105-111. [top]
   
7. ACOG. (2011). Polycystic ovary syndrome. Retrieved May 10, 2012, from http://www.acog.org/~/media/For%20Patients/faq121.pdf?dmc=1&ts=20120510T1116545699 (PDF - 273 KB) [top]
   
8. National Cancer Institute. (2006). Oral contraceptives and cancer risk: Questions and answers. Retrieved December 22, 2011, from http://www.cancer.gov/cancertopics/factsheet/Risk/oral-contraceptives#3 [top]
   
9. Goodarzi, M. O., Dumesic, D. A., Chazenbalk, G., & Azziz, R. (2011). Polycystic ovary syndrome: Etiology, pathogenesis and diagnosis. Nature Reviews Endocrinology, 7, 219–231. [top]
   
10. Johnson, N. (2011). Metformin is a reasonable first-line treatment option for non-obese women with infertility related to anovulatory polycystic ovary syndrome—A meta-analysis of randomised trials. Australian and New Zealand Journal of Obstetrics & Gynaecology, 51, 125–129. [top]
    
11. ACOG. (2011). Polycystic ovary syndrome. Retrieved May 10, 2012, from http://www.acog.org/~/media/For%20Patients/faq121.pdf?dmc=1&ts=20120510T1116545699 (PDF - 273 KB) [top]
    
12. Moran, L. J., Pasquali, R., Teede, H. J., Hoeger, K. M., & Norman, R. J. (2009). Treatment of obesity in polycystic ovary syndrome: A position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertility and Sterility, 92, 1966–1982. [top]
    
13. Vause, T. D., Cheung, A. P., Sierra, S., Claman, P., Graham, J., Guillemin, J. A., et al.; Society of Obstetricians and Gynecologists of Canada (2010). Ovulation induction in polycystic ovary syndrome. Journal of Obstetrics and Gynaecology Canada, 32, 495–502. [top]
    
14. U.S. Food and Drug Administration (FDA). (2000). VANIQATM (eflornithine hydrochloride) cream, 13.9%. Retrieved December 22, 2011, from http://www.accessdata.fda.gov/drugsatfda_docs/label/2000/21145lbl.pdf (PDF - 133 KB) [top]
    
15. He, D., & Jiang, F. (2011). Meta-analysis of letrozole versus clomiphene citrate in polycystic ovary syndrome. Reproductive Biomedicine Online, 23, 91–96. [top]
    
16. U.S. Food and Drug Administration (FDA). (2000). VANIQATM (eflornithine hydrochloride) cream, 13.9%. Retrieved December 22, 2011, from http://www.accessdata.fda.gov/drugsatfda_docs/label/2000/21145lbl.pdf (PDF - 133 KB) [top]
    
17. U.S. Food and Drug Administration (FDA). (2000). VANIQATM (eflornithine hydrochloride) cream, 13.9%. Retrieved December 22, 2011, from http://www.accessdata.fda.gov/drugsatfda_docs/label/2000/21145lbl.pdf (PDF - 133 KB) [top]
    
18. FDA. (2010). Femara (letrozole) tablets: Highlights of prescribing information. Retrieved December 22, 2011, from http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020726s019lbl.pdf (PDF - 456 KB) [top]
    
19. U.S. Food and Drug Administration (FDA). (2000). VANIQATM (eflornithine hydrochloride) cream, 13.9%. Retrieved December 22, 2011, from http://www.accessdata.fda.gov/drugsatfda_docs/label/2000/21145lbl.pdf (PDF - 133 KB) [top]
    
20. Legro, R. S. (2007). Pregnancy considerations in women with polycystic ovary syndrome. Clinical Obstetrics and Gynecology, 50, 295–304. [top]
    
21. Legro, R. S. (2007). Pregnancy considerations in women with polycystic ovary syndrome. Clinical Obstetrics and Gynecology, 50, 295–304. [top]
    
22. Legro, R. S. (2007). Pregnancy considerations in women with polycystic ovary syndrome. Clinical Obstetrics and Gynecology, 50, 295–304. [top]
    
23. American Society for Reproductive Medicine. (2008). Patient fact sheet: Ovarian drilling for infertility. Birmingham, AL. Retrieved December 22, 2011, from http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/OvarianDrilling.pdf (PDF - 19.08 KB) [top]
    
24. Flyckt, R. L., & Goldberg, J. M. (2011). Laparoscopic ovarian drilling for clomiphene-resistant polycystic ovary syndrome. Seminars in Reproductive Medicine, 29, 138–146. [top]
    
25. Fernandez, H., Morin-Surruca, M., Torre, A., Faivre, E., Deffieux, X., & Gervaise, A. (2011). Ovarian drilling for surgical treatment of polycystic ovary syndrome: A comprehensive review. Reproductive Biomedicine Online, 22, 556–568. [top]
    
26. Johnson, N. (2011). Metformin is a reasonable first-line treatment option for non-obese women with infertility related to anovulatory polycystic ovary syndrome—A meta-analysis of randomised trials. Australian and New Zealand Journal of Obstetrics & Gynaecology, 51, 125–129. [top]
    
27. American Society for Reproductive Medicine. (2008). Assisted reproductive technologies: A guide for patients. Birmingham, AL: American Society for Reproductive Medicine. Retrieved December 22, 2011, from http://www.reproductivefacts.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/ART.pdf (PDF - 2.12 MB) [top]
    
28. FDA. (2010). Femara (letrozole) tablets: Highlights of prescribing information. Retrieved December 22, 2011, from http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020726s019lbl.pdf (PDF - 456 KB) [top]