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Review

A Review of First Line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome

by
Michael Costello
1,*,
Rhonda Garad
2,
Roger Hart
3,
Hayden Homer
4,
Louise Johnson
5,
Cailin Jordan
6,
Edgar Mocanu
7,
Jie Qiao
8,
Luk Rombauts
9,
Helena J. Teede
10,
Eszter Vanky
11,
Christos Venetis
1 and
William Ledger
1
1
University of New South Wales, High St, Kensington, Sydney, NSW 2033, Australia
2
Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, and Monash Health, Melbourne, VIC 3168, Australia
3
Division of Obstetrics and Gynaecology, The University of Western Australia, University of Western Australia, Crawley, WA 6008, UK
4
Christopher Chen Oocyte Biology Research Laboratory, UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia
5
Victorian Assisted Reproductive Treatment Authority, Melbourne, VIC 3000, Australia
6
Genea Hollywood Fertility, Wembley 6014, Australia
7
Royal College of Surgeons, Rotunda Hospital, Dublin D02 YN77, Ireland
8
Department of Obstetrics and Gynaecology, Medical Center for Human Reproduction, Peking University Third Hospital, Beijing 100191, China
9
Department of Obstetrics and Gynaecology, Monash University, Melbourne 3168, Australia
10
National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash University, Melbourne, VIC 3168, Australia
11
Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 1517 Trondheim, Norway
 
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*
Author to whom correspondence should be addressed.
Med. Sci. 2019, 7(9), 95; https://doi.org/10.3390/medsci7090095
Submission received: 14 May 2019 / Revised: 5 September 2019 / Accepted: 6 September 2019 / Published: 10 September 2019
(This article belongs to the Special Issue Polycystic Ovary Syndrome)
Versions Notes

Abstract

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility in women of reproductive age. Lifestyle change is considered the first line treatment for the management of infertile anovulatory women with PCOS, and weight loss for those who are overweight or obese. First line medical ovulation induction therapy to improve fertility outcomes is letrozole, whilst other less efficacious ovulation induction agents, such as clomiphene citrate, metformin, and metformin combined with clomiphene citrate, may also be considered. Metformin combined with clomiphene citrate is more effective than clomiphene citrate alone. In obese women with PCOS, clomiphene citrate could be used in preference to metformin alone whilst clomiphene citrate could be added to metformin alone in order to improve reproductive outcome in all women with PCOS. Gonadotrophins, which are more effective than clomiphene citrate in therapy naïve women with PCOS, can be considered a first line therapy in the presence of ultrasound monitoring, following counselling on the cost and the potential risk of multiple pregnancy.
Keywords: polycystic ovary syndrome; infertility; treatment; ovulation induction polycystic ovary syndrome; infertility; treatment; ovulation induction

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MDPI and ACS Style

Costello, M.; Garad, R.; Hart, R.; Homer, H.; Johnson, L.; Jordan, C.; Mocanu, E.; Qiao, J.; Rombauts, L.; Teede, H.J.; et al. A Review of First Line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome. Med. Sci. 2019, 7, 95. https://doi.org/10.3390/medsci7090095

AMA Style

Costello M, Garad R, Hart R, Homer H, Johnson L, Jordan C, Mocanu E, Qiao J, Rombauts L, Teede HJ, et al. A Review of First Line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome. Medical Sciences. 2019; 7(9):95. https://doi.org/10.3390/medsci7090095

Chicago/Turabian Style

Costello, Michael, Rhonda Garad, Roger Hart, Hayden Homer, Louise Johnson, Cailin Jordan, Edgar Mocanu, Jie Qiao, Luk Rombauts, Helena J. Teede, and et al. 2019. "A Review of First Line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome" Medical Sciences 7, no. 9: 95. https://doi.org/10.3390/medsci7090095

APA Style

Costello, M., Garad, R., Hart, R., Homer, H., Johnson, L., Jordan, C., Mocanu, E., Qiao, J., Rombauts, L., Teede, H. J., Vanky, E., Venetis, C., & Ledger, W. (2019). A Review of First Line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome. Medical Sciences, 7(9), 95. https://doi.org/10.3390/medsci7090095

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