Journal
BEST PRACTICE & RESEARCH CLINICAL OBSTETRICS & GYNAECOLOGY
Volume 37, Issue -, Pages 152-159Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.bpobgyn.2016.08.001
Keywords
insulin resistance; hyperandrogenism; infertility; clinical trials
Categories
Funding
- Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD) [R01 HD056510, U10 HD38992]
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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 pituitary ovarian (HPO) axis. Letrozole, an aromatase inhibitor, is headed toward 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 studies are needed of newer agents to treat type 2 diabetes. Weight loss interventions, 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. (C) 2016 Published by Elsevier Ltd.
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