TY - JOUR
T1 - Ovulation induction in polycystic ovary syndrome
T2 - Current options
AU - Legro, Richard S.
N1 - Funding Information:
Dr. Legro reports consulting fees from Euroscreen, Kindex, Bayer, and Millendo Pharmaceuticals and research funding from Ferring.
Funding Information:
This work was supported by the Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD) Grants R01 HD056510 and U10 HD38992 (to R.S.L.).
Publisher Copyright:
© 2016
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - There are a variety of effective treatment options to induce ovulation in women with polycystic ovary syndrome (PCOS). The most effective treatments are primarily reproductive and target the hypothalamic–pituitary–ovarian (HPO) axis. Letrozole, an aromatase inhibitor, is headed toward replacing clomiphene, a selective estrogen receptor modulator, as the first-choice option. Metabolic treatments likely work indirectly through the HPO axis. Many metabolic treatments have shown initial promise and later failed (troglitozone or d-chiro-inositol) or disappointed (metformin); further studies are needed of newer agents to treat type 2 diabetes. Weight loss interventions, lifestyle related, through obesity drugs or through bariatric surgery have shown mixed results on pregnancy outcomes. With both reproductive and metabolic treatments, combination therapies (such as metformin and clomiphene together) may offer greater benefit to distinct subgroups of patients.
AB - There are a variety of effective treatment options to induce ovulation in women with polycystic ovary syndrome (PCOS). The most effective treatments are primarily reproductive and target the hypothalamic–pituitary–ovarian (HPO) axis. Letrozole, an aromatase inhibitor, is headed toward replacing clomiphene, a selective estrogen receptor modulator, as the first-choice option. Metabolic treatments likely work indirectly through the HPO axis. Many metabolic treatments have shown initial promise and later failed (troglitozone or d-chiro-inositol) or disappointed (metformin); further studies are needed of newer agents to treat type 2 diabetes. Weight loss interventions, lifestyle related, through obesity drugs or through bariatric surgery have shown mixed results on pregnancy outcomes. With both reproductive and metabolic treatments, combination therapies (such as metformin and clomiphene together) may offer greater benefit to distinct subgroups of patients.
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U2 - 10.1016/j.bpobgyn.2016.08.001
DO - 10.1016/j.bpobgyn.2016.08.001
M3 - Review article
C2 - 27866938
AN - SCOPUS:84997830666
VL - 37
SP - 152
EP - 159
JO - Best Practice and Research in Clinical Obstetrics and Gynaecology
JF - Best Practice and Research in Clinical Obstetrics and Gynaecology
SN - 1521-6934
ER -