Women with polycystic ovary syndrome (PCOS) do not ovulate regularly and often have difficulty becoming pregnant. Although the medication clomiphene (Clomid) is commonly used to stimulate ovulation, it doesn't work for some women with PCOS. This is because PCOS ovulation problems are linked to an imbalance of multiple body systems. Often other treatment measures can restore balance to the body's metabolism and hormone system, making ovulation medication unnecessary (or more effective if it is used).1
- Before considering medication to stimulate ovulation, overweight women with polycystic ovary syndrome are advised to lower their body mass index (BMI) with diet and exercise. Even a modest weight reduction can trigger ovulation in women with PCOS.2
- If weight loss does not help start ovulation, clomiphene is usually tried first, sometimes combined with a steroid. About 50% to 70% of women with PCOS will ovulate when treated with clomiphene.1 Many doctors are now trying metformin before clomiphene; research continues in this area.
- If clomiphene does not start ovulation, metformin can be added.2 Metformin helps the body process insulin properly (insulin resistance caused by PCOS can prevent normal ovulation).1 Combining the two treatments can make it more likely that clomiphene will trigger ovulation in women with PCOS.2
- Women who do not ovulate with metformin and clomiphene treatment are sometimes treated with gonadotropins, which are similar to the hormones the body produces to start ovulation. During this type of treatment, a woman must have daily monitoring of egg follicle development, using blood tests and ultrasound, to prevent ovarian hyperstimulation syndrome.
- If clomiphene does not work, your doctor may try a medication called letrozole. Letrozole is thought to harm the fetus if it is used during pregnancy. Talk to your doctor about being sure you are not pregnant before taking this drug.
Laparoscopic ovarian surgery such as ovarian drilling (partial destruction of an ovary, which can trigger ovulation) or in vitro fertilization (IVF) are sometimes used for women with PCOS who have tried weight loss and fertility medication, but still are not ovulating.2 For more information, see the topic Polycystic Ovary Syndrome (PCOS).
References
Citations
Haas DA, et al. (2003). Effects of metformin on body mass index, menstrual cyclicity, and ovulation induction in women with polycystic ovary syndrome. Fertility and Sterility, 79(3): 469–481.
American College of Obstetricians and Gynecologists (2002, reaffirmed 2006). Management of infertility caused by ovulatory dysfunction. ACOG Practice Bulletin No. 34. Obstetrics and Gynecology, 99(2): 347–358.
Credits
| Author | Bets Davis, MFA |
| Editor | Kathleen M. Ariss, MS |
| Associate Editor | Michele Cronen |
| Associate Editor | Pat Truman |
| Associate Editor | Terrina Vail |
| Primary Medical Reviewer | Joy Melnikow, MD, MPH - Family Medicine |
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
| Specialist Medical Reviewer | Kirtly Jones, MD - Obstetrics and Gynecology |
| Last Updated | April 7, 2006 |
© 1995-2007, Healthwise, Incorporated, P.O. Box 1989, Boise, ID 83701. ALL RIGHTS RESERVED.
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information. For more information, click here. Privacy Policy. How this information was developed.
