Ovulation induction in the management of anovulatory polycystic ovary syndrome

Mol Cell Endocrinol. 2013 Jul 5;373(1-2):77-82. doi: 10.1016/j.mce.2012.10.008. Epub 2012 Oct 17.


The aim of this brief review is to describe the management of anovulatory infertility in the polycystic ovary syndrome (PCOS). This has traditionally involved the use of clomiphene citrate (CC), and then gonadotropin therapy or laparoscopic ovarian surgery, in those who are clomiphene resistant (The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, 2008). Recently developed therapeutic approaches include aromatase inhibitors and the potential use of in vitro maturation (IVM) of oocytes collected from unstimulated (or minimally stimulated) polycystic ovaries. Unfortunately the early promise of the insulin sensitizing drugs has not been translated into significant improvement in outcomes and therefore are not prescribed unless the patient has an impairment of glucose tolerance (The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, 2008). There has been an unfortunate shift away from Mono-follicular ovulation induction remains the first line approach for the management of anovulatory PCOS, and in vitro fertilization treatment (IVF) should be reserved for those who fail to respond or who have additional infertility factors (The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, 2008). Superovulation for IVF presents significant risks for women with polycystic ovaries, namely the potentially life-threatening complication of ovarian hyperstimulation syndrome (OHSS). Carefully conducted and monitored ovulation induction can achieve good cumulative conception rates and furthermore, multiple pregnancy rates can be minimized with strict adherence to criteria that limit the number of follicles that are permitted to ovulate.

Publication types

  • Review

MeSH terms

  • Anovulation / drug therapy
  • Anovulation / etiology
  • Aromatase Inhibitors / therapeutic use
  • Clomiphene / therapeutic use
  • Female
  • Gonadotropins / therapeutic use
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Infertility, Female / drug therapy*
  • Infertility, Female / etiology
  • Metformin / therapeutic use
  • Ovulation Induction*
  • Polycystic Ovary Syndrome / complications
  • Polycystic Ovary Syndrome / drug therapy*
  • Polycystic Ovary Syndrome / physiopathology


  • Aromatase Inhibitors
  • Gonadotropins
  • Hypoglycemic Agents
  • Clomiphene
  • Metformin