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Chapter 11 - Ovulation Induction in Polycystic Ovary Syndrome

Published online by Cambridge University Press:  13 May 2022

By
Evert J. P. van Santbrink
Edited by
Gabor T. Kovacs ,
Bart Fauser  and
Richard S. Legro
Gabor T. Kovacs
Affiliation:
Monash University, Melbourne, Australia
Bart Fauser
Affiliation:
University Medical Center, Utrecht, Netherlands
Richard S. Legro
Affiliation:
Penn State Medical Center, Hershey, PA, USA
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Summary

Chronic anovulation is a very common disorder in polycystic ovary syndrome (PCOS) patients wishing to conceive. In these patients, ovulation induction resulting in restoration of a regular menstrual cycle with monofollicular ovulation may normalize the probability of pregnancy. This may be achieved either by increasing the follicle-stimulating hormone (FSH) serum concentration or by improving the endocrine ovarian milieu resulting in enhanced FSH responsiveness of the ovaries. Later on, this favorable endocrine milieu may also benefit implantation, embryo development and reduce risks in pregnancy for mother and child. A combination of both strategies could be used to individualize treatment in a patient-tailored way: for every patient an optimal effective treatment plan based on specific individual characteristics. Although there has been a tendency to ultimately skip ovulation induction and start in vitro fertilization (IVF) immediately because this would result in better pregnancy chances, this choice neglects the significant risks and physical burden of IVF treatment and significant higher costs. Ovulation induction in PCOS patients, as discussed in this chapter, is a very successful treatment option with a cumulative single live birth of greater than 70% during a 24-month follow-up period.

Keywords

ovulation inductionclomiphene citrateletrozolemetforminfollicle-stimulating hormone (FSH)gonadotropinsaromatase inhibitorsinsulin sensitizerscomplicationspregnancy
Type
Chapter
Information
Polycystic Ovary Syndrome , pp. 102 - 109
Publisher: Cambridge University Press
Print publication year: 2022

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