Treatments for Infertility Resulting from PCOS

Fertility problems related to PCOS often are linked to the absence of ovulation (called anovulation), a key feature of PCOS. However, anovulation may not be the only factor in these problems. Before beginning treatment for infertility possibly related to PCOS, work with your health care provider to rule out other causes.

Losing weight and other lifestyle changes can sometimes trigger body changes that facilitate conception in women with PCOS. Research shows that lifestyle changes can help restore ovulation and improve pregnancy rates among women with PCOS. Among women with PCOS who have obesity and who experienced menstrual dysfunction, losing even a small amount of weight improved menstrual function and fertility.

Health care providers may also recommend one or more of the following treatments to improve fertility in women with PCOS.

Clomiphene or Clomiphene Citrate

This drug is the most common treatment for infertility in women with PCOS. The American College of Obstetricians and Gynecologists (ACOG) recommends clomiphene as the primary medication for women with PCOS-related infertility. It is also U.S. Food and Drug Administration (FDA) approved for treating PCOS-related infertility.
Clomiphene indirectly causes eggs to mature and be released.
Research shows that women who conceive with the aid of clomiphene are slightly more likely to have multiples, most commonly twins.

Metformin

Metformin—an insulin-sensitizing agent—can be used alone or with clomiphene when clomiphene alone is not successful to spur or regulate ovulation in women with PCOS.
Evidence shows that metformin, alone and in combination with clomiphene, improves ovulation, but it does not increase the rate of pregnancy.
Metformin is not FDA approved for treating PCOS-related infertility.

Letrozole

This drug briefly slows estrogen production and causes the body to make more follicle-stimulating hormone (FSH), a hormone needed for ovulation.
An NICHD-supported study found that letrozole was more effective than clomiphene in causing ovulation and improving live-birth rates for women with PCOS.
Studies of letrozole in animal models have shown that it causes congenital anomalies if used during pregnancy, but there have been no studies of this drug in pregnant women.

Gonadotropins

These hormones, given as shots, cause ovulation.
This treatment has a higher risk of multiple pregnancies than treatment with clomiphene.
Your health care provider may use frequent laboratory tests and ultrasound exams to monitor how your body responds to this treatment.

Ovarian Drilling

Because the benefits of this surgery, by itself or in addition to medication treatment, for increasing the chance of ovulation is unclear, it is not recommended by all health care provider groups.
It may be considered if lifestyle changes and medications are unsuccessful and often in combination with other treatments.
In ovarian drilling, the surgeon makes a small cut in the abdomen and inserts a long, thin tool called a laparoscope. The surgeon then uses a needle with electric current to puncture and destroy a small part of the ovary.
The surgery may lead to lower androgen levels, which may improve ovulation. However, it does not seem to improve other metabolism problems, and its effects may be short-lived.
Drilling surgery does not seem to increase the risk of multiple pregnancies. However, it does carry the risk of scarring the ovaries.

If these treatments are not successful, your health care provider may suggest in vitro fertilization (IVF), or another type of assisted reproductive technology (ART). IVF may offer the best chance of pregnancy for women with PCOS. Different types of ART have their own risks and benefits. You should discuss all the options thoroughly with your health care provider before deciding.

References

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