PCOS with Anovulatory Infertility: What to Do When First-Line Treatment Has Not Achieved Ovulation
Women with polycystic ovarian syndrome who have infertility and anovulation as the sole identified factors sometimes do not achieve ovulation with first-line treatment. This protocol addresses the structured next step for that situation.
Clinical situation
The patient has infertility with anovulation and no other infertility factors identified. The therapeutic goal is confirmed ovulation.
Previous line — failure condition
First-line ovulation induction was attempted but did not achieve the goal
First-line therapy — letrozole (preferred), or alternatives including clomiphene citrate combined with metformin, clomiphene citrate alone, metformin alone, or gonadotrophins — was used with the aim of achieving confirmed ovulation. This protocol is indicated when that goal was not reached.
Second-line approach — partial overview
Treatment direction
After first-line failure, the second-line approach involves either a hormonal intervention conducted under close ultrasound monitoring, or a surgical option. The specific protocol — including which intervention to use, how monitoring is structured, and how the regimen is adjusted — is set out in full in the linked resource.
References
- Letrozole should be the first-line pharmacological treatment for ovulation induction in infertile anovulatory women with PCOS, with no other infertility factors.
- Gonadotrophins could be second-line pharmacological therapy for women with PCOS who are anovulatory and infertile, with no other infertility factors and who have failed first line oral ovulation induction.
- A low dose step-up gonadotrophin protocol should be used to optimize the chance of monofollicular development.
- Laparoscopic ovarian surgery could be second-line therapy for women with PCOS who are anovulatory and infertile, with clomiphene citrate resistance and no other infertility factors.
DOI: 10.1016/j.fertnstert.2023.07.025
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