Treatment of PCOS with Anovulatory Infertility and No Other Infertility Factors
This protocol covers women with polycystic ovarian syndrome presenting with anovulatory infertility in whom no other infertility factors have been identified — a setting where ovulation induction is the primary therapeutic goal.
Pharmacological ovulation induction is the recommended starting point in this population. When first-line and second-line ovulation induction approaches have not achieved successful ovulation or pregnancy, escalation to assisted reproductive technology is the evidence-based next step.
Third-Line Approach: In-Vitro Fertilisation
Where earlier ovulation induction therapies have not succeeded, in-vitro fertilisation (IVF) is an established third-line option. The specific protocol used in this clinical setting — including the stimulation strategy, trigger approach, and adjunct considerations — is tailored to the particular characteristics and risks of women with PCOS.
The full evidence-based regimen, including protocol selection details and individualised management considerations, is available via the link below.
References
- 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.
- In the absence of an absolute indication for IVF ± ICSI, women with PCOS and anovulatory infertility could be offered IVF as third line therapy where first or second line ovulation induction therapies have failed.
- A gonadotrophin releasing hormone antagonist protocol is preferred in women with PCOS undergoing an IVF ± ICSI cycle, over a gonadotrophin releasing hormone agonist long protocol, to reduce the duration of stimulation, total gonadotrophin dose and incidence of ovarian hyperstimulation syndrome (OHSS).
- Human chorionic gonadotrophins is best used at the lowest doses to trigger final oocyte maturation in women with PCOS undergoing an IVF ± ICSI cycle to reduce the incidence of OHSS.
- Adjunct metformin therapy could be used before and/or during follicle stimulating hormone ovarian stimulation in women with PCOS undergoing a IVF ± ICSI therapy with a GnRH agonist protocol, to improve the clinical pregnancy rate and reduce the risk of OHSS.
- In units with sufficient expertise, IVM could be offered to achieve pregnancy and livebirth rates approaching those of standard IVF ± ICSI treatment without the risk of OHSS for women with PCOS, where an embryo is generated, then vitrified and thawed and transferred in a subsequent cycle.
DOI: 10.1016/j.fertnstert.2023.07.025
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