Ovulation Induction in Polycystic Ovary Syndrome: Current Options

Abstract There are a variety of effective treatment options to induce ovulation in women with polycystic ovary syndrome (PCOS). The most effective treatments are primarily reproductive and target the hypothalamic-piuitary-ovarian (HPO) axis. Letrozole, an aromatase inhibitor, is headed towards replacing clomiphene, a selective estrogen receptor modulator, as the first choice option. Metabolic treatments likely work indirectly through the HPO axis. Many metabolic treatments have shown initial promise and later failed (troglitozone or d-chiro-inositol) or disappointed (metformin), further study is needed of newer agents to treat type 2 diabetes. Weight loss interventions, both lifestyle related, through obesity drugs, or through bariatric surgery have shown mixed results on pregnancy outcomes. With both reproductive and metabolic treatments, combination therapies (such as metformin and clomiphene together) may offer greater benefit to distinct subgroups of patients.