Topic Overview

Women with polycystic ovary syndrome (PCOS) do not ovulate regularly. They often have trouble getting pregnant. The medicines clomiphene and letrozole are commonly used to stimulate ovulation. But medicine doesn’t work for some women who have PCOS. This is because many body systems are involved in PCOS ovulation problems. Often other treatment can restore balance to the body’s metabolism and hormone system, so that ovulation medicine is not needed (or works better if it is used).

• Before considering medicine to stimulate ovulation, overweight women with polycystic ovary syndrome should try to lower their body mass index (BMI) with diet and exercise. Even a modest weight loss may trigger ovulation.
• If weight loss does not help start ovulation, clomiphene or letrozole are usually tried.
• If clomiphene does not start ovulation, it may be combined with another medicine, such as metformin. Combining the two treatments may make it more likely that clomiphene will trigger ovulation.
• Women who do not ovulate with a combination of medicines are sometimes treated with gonadotropins. These 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 to prevent ovarian hyperstimulation syndrome. The monitoring requires blood tests and ultrasound.

Laparoscopic ovarian surgery or in vitro fertilization (IVF) is sometimes used for women with PCOS who have tried weight loss and medicine, but still are not ovulating. (A surgery sometimes used is ovarian drilling. This involves partial destruction of an ovary, which can trigger ovulation.)^{footnote 1}