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Ovulation induction in women with polycystic ovary syndrome

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 438–439 (2007)Cite this article

Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, anovulation and cystic ovarian morphology. Anovulation in women with PCOS results, in part, from low follicle-stimulating hormone (FSH) concentrations. Anovulatory infertility is the major complaint at presentation of many patients with PCOS, and several medications are available to induce ovulation. Some of these agents are approved for this indication in the US (e.g. clomifene citrate [CC]); others are unapproved but are, nonetheless, commonly used (e.g. metformin). The pros and cons of the available treatment options for anovulation in PCOS are discussed in this Viewpoint.

CC is an estrogen-receptor antagonist that interferes with negative feedback of the estrogen-signaling pathway, which results in increased availability of luteinizing hormone (LH) and FSH. Increased levels of FSH lead to follicular growth, which is followed by a surge in LH concentration and ovulation. Doses of 50–150 mg CC are typically given for a 5-day period on days 3–7 or 5–9 of the menstrual cycle. Ovulation occurs in 70–80% of treated patients, with a cumulative live-birth rate of 41%.1,2 CC has been used for over 40 years, and has a good safety record. Side effects are usually tolerable (breast tenderness, hot flashes and mood changes) and the multiple pregnancy rate is ∼5% (usually twins). A major problem with this drug is the lack of response found in an appreciable number of treated individuals (CC resistance), especially those who are obese or have very high androgen levels. In addition, some treated individuals do not become pregnant despite restoration of ovulation (CC failure).

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  1. Department of Obstetrics and Gynecology, University of Texas Medical School–Houston, 6431 Fannin Street, Suite 3604, Houston, TX 77030, USA shahla.nader-eftekhari@uth.tmc.edu

Authors and Affiliations

  1. S Nader is a Professor in the Department of Obstetrics and Gynecology, University of Texas Medical School, Houston, TX, USA.,

    Shahla Nader

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Nader, S. Ovulation induction in women with polycystic ovary syndrome. Nat Rev Endocrinol 3, 438–439 (2007). https://doi.org/10.1038/ncpendmet0510

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