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A review of second- and third-line infertility treatments and supporting evidence in women with polycystic ovary syndrome.

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posted on 10.12.2021, 16:02 by Michael F Costello, Rhonda M Garad, Roger Hart, Hayden Homer, Louise Johnson, Cailin Jordan, Edgar MocanuEdgar Mocanu, Jie Qiao, Luk Rombauts, Helena J Teede, Eszter Vanky, Christos A Venetis, William L Ledger
In clomiphene-citrate-resistant anovulatory women with polycystic ovary syndrome (PCOS) and no other infertility factors, either metformin combined with clomiphene citrate or gonadotrophins could be used as a second-line pharmacological therapy, although gonadotrophins are more effective. Gonadotrophins could also be used as a second-line pharmacological therapy in anovulatory women with PCOS and clomiphene-citrate-failure. Laparoscopic ovarian surgery can also be used as a second-line therapy for ovulation induction in anovulatory women with clomiphene-citrate-resistant PCOS and no other infertility factors. The usefulness of letrozole as a second-line pharmacological treatment for ovulation induction in clomiphene-citrate-resistant women with PCOS requires further research. In terms of improving fertility, both pharmacological anti-obesity agents and bariatric surgery should be considered an experimental therapy in anovulatory women with PCOS and no other infertility factors. Where first- or second-line ovulation induction therapies have failed, in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) could be offered as a third-line therapy in women with PCOS in the absence of an absolute indication for IVF/ICSI. For women with PCOS undergoing IVF/ICSI treatment, the gonadotropin-releasing hormone (GnRH) antagonist protocol is preferred and an elective frozen embryo transfer strategy could be considered. In assisted conception units with sufficient expertise, in-vitro maturation (IVM) of oocytes could be offered to women with PCOS.

History

Comments

The original article is available at https://www.mdpi.com

Published Citation

Costello MF. et al. A review of second- and third-line infertility treatments and supporting evidence in women with polycystic ovary syndrome. Med Sci (Basel). 2019;7(7):75.

Publication Date

26 June 2019

PubMed ID

31247909

Department/Unit

  • Obstetrics and Gynaecology

Publisher

MDPI AG

Version

  • Published Version (Version of Record)