PCOS is associated with ovulation problems and therefore ovulation induction is often required. The ovaries will often respond to tablets; Tamoxifen (tamoxifen infertility) is thought to provide a good balance of hormone production although clomiphene (Clomid clomiphene citrate) may also prove to be effective. If the ovaries do not respond to tablets more powerful agents (gonadotrophins e.g. Pergonal, Humegon or Metrodin gonadotrophins) given by injection will almost invariably prove to be successful. Increased levels of LH occur in 40% of women with PCOS and this seems to reduce the chance of conception and there is also an increased risk of miscarriage. LH levels can be suppressed by GnRH agonists (gonadotrophins) but disappointingly studies in these situations have shown no improvement. Ovarian drilling (ovarian drilling) may have a part to play when ovulation stimulation proves difficult to achieve with drugs. Before commencing ovulation stimulation, it seems sensible to ensure reasonable male fertility by checking a semen analysis. Many authorities recommend testing Fallopian tube patency before commencing treatment. My own view is that if there is clear evidence of PCOS and anovulation, a few months of treatment before confirming tubal patency will save many women from an uncomfortable procedure.
Related Medical Abstracts - Click on the paper title:-
- Effects of metformin on insulin resistance, androgen concentration, ovulation and pregnancy rates in women with polycystic ovary syndrome following laparoscopic ovarian drilling.(2006)
- The use of metformin to augment the induction of ovulation in obese infertile patients with polycystic ovary syndrome. (2001)
- Laparoscopic treatment of polycystic ovaries with insulated needle cautery: A reappraisal. (2000)
- Minilaparoscopic ovarian drilling under local anesthesia in patients with polycystic ovary syndrome.?
- Ovulation induction with low dose alternate day recombinant follicle stimulating hormone (Puregon).(1999)
- Management of anovulatory infertility. (1999)
- A cost comparison of infertility treatment for clomipheneresistant polycystic ovary syndrome. (1999)
- The impact of insulin resistance on the outcome of ovulation induction with low-dose follicle stimulating hormone in women with polycystic ovary syndrome. (1998)
- Predictors of patients remaining anovulatory during clomiphenecitrate induction of ovulation in normogonadotropic oligoamenorrheic infertility.(1998)
- Dual suppression with oral contraceptives and gonadotrophin releasing-hormone agonists improves in-vitro fertilization outcome in high responder patients. (1997)
- Development, pharmacology and clinical experience with clomiphenecitrate. (1996)
- The number of follicles and ovarian volume in the assessment of response to clomiphene citrate treatment in polycystic ovarian syndrome. (1996)
- Effect of short-term gonadotropin releasing hormone agonist protocol in polycystic ovary syndrome. (1995)
- Cumulative conception and live birth rates after the treatment of anovulatory infertility: Safety and efficacy of ovulation induction in 200 patients. (1994)
- Treatment of anovulation with pulsatile gonadotropin-releasing hormone: Prognostic factors and clinical results in 600 cycles. (1994)
- clomiphene-dexamethasone treatment of clomiphene -resistant women with and without the polycystic ovary syndrome. (1992)
See Also:
PCOS - Polycystic Ovary Syndrome
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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
