Hum Reprod. 2008 Mar;23(3):462-77.
Consensus on infertility treatment related to polycystic ovary syndrome.
Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group.
Collaborators (31)
Thessaloniki 54603, Greece.
The treatment of infertile women with polycystic ovary syndrome (PCOS) is
surrounded by many controversies. This paper describes, on the basis of the
currently available evidence, the consensus reached by a group of experts
regarding the therapeutic challenges raised in these women. Before any
intervention is initiated, preconceptional counselling should be provided
emphasizing the importance of life style, especially weight reduction and
exercise in overweight women, smoking and alcohol consumption. The recommended
first-line treatment for ovulation induction remains the anti-estrogen
clomiphene citrate (CC). Recommended second-line intervention, should CC fail to
result in pregnancy, is either exogenous gonadotrophins or laparoscopic ovarian
surgery (LOS). The use of exogenous gonadotrophins is associated with increased
chances for multiple pregnancy and, therefore, intense monitoring of ovarian
response is required. LOS alone is usually effective in <50% of women and
additional ovulation induction medication is required under those circumstances.
Overall, ovulation induction (representing the CC, gonadotrophin paradigm) is
reported to be highly effective with a cumulative singleton live birth rate of
72%. Recommended third-line treatment is in vitro fertilization. More
patient-tailored approaches should be developed for ovulation induction based on
initial screening characteristics of women with PCOS. Such approaches may result
in deviation from the above mentioned first-, second- or third-line ovulation
strategies in well-defined subsets of patients. Metformin use in PCOS should be
restricted to women with glucose intolerance. Based on recent data available in
the literature, the routine use of this drug in ovulation induction is not
recommended. Insufficient evidence is currently available to recommend the
clinical use of aromatase inhibitors for routine ovulation induction. Even
singleton pregnancies in PCOS are associated with increased health risk for both
the mother and the fetus.
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