Treatment of PCOS with Anovulatory Infertility and No Other Infertility Factors
In women with polycystic ovarian syndrome whose infertility is driven solely by anovulation — with no other contributory infertility factors identified — guidelines support a structured pharmacological approach to restore ovulation and improve the chances of pregnancy and live birth.
Clinical scenario
This protocol applies when PCOS is the sole identified cause of infertility: cycles are anovulatory, and evaluation has excluded other infertility factors. The therapeutic goal is ovulation induction, targeting improvements in ovulation rate, pregnancy rate, and live birth rate.
Treatment approach
The protocol specifies a first-line pharmacological ovulation induction agent, with letrozole identified as the preferred starting point. Alternative ovulation induction agents are addressed for situations where the first-line choice is unavailable, not permitted, or cost-prohibitive — and specific guidance applies depending on body weight.
The complete agent selection criteria, alternative sequences, and weight-stratified decisions are in the full protocol.References
DOI: 10.1016/j.fertnstert.2023.07.025
- Letrozole should be considered first line pharmacological treatment for ovulation induction in women with PCOS with anovulatory infertility and no other infertility factors to improve ovulation, pregnancy and live birth rates.
- Where letrozole is not available or use is not permitted or cost is prohibitive, health professionals can use other ovulation induction agents.
- Clomiphene citrate could be used alone in women with PCOS with anovulatory infertility and no other infertility factors to improve ovulation and pregnancy rates.
- Metformin could be used alone in women with PCOS, with anovulatory infertility and no other infertility factors, to improve ovulation, pregnancy and live birth rates, although women should be informed that there are more effective ovulation induction agents.
- Clomiphene citrate could be used in preference, when considering clomiphene citrate or metformin for ovulation induction in women with PCOS who are obese (BMI is ≥ 30 kg/m2) with anovulatory infertility and no other infertility factors.
- Clomiphene citrate could be combined with metformin, rather than persisting with clomiphene citrate alone, in women with PCOS who are clomiphene citrate-resistant, with anovulatory infertility and no other infertility factors, to improve ovulation and pregnancy rates.