Treatments for Infertility Resulting from PCOS

Fertility problems related to PCOS often are linked to the absence of ovulation (called anovulation), a key feature of PCOS. However, anovulation may not be the only factor in these problems. Before beginning treatment for infertility possibly related to PCOS, work with your health care provider to rule out other causes.1

Losing weight and other lifestyle changes can sometimes trigger body changes that facilitate conception in people with PCOS.2,3 Research shows that lifestyle changes can help restore ovulation and improve pregnancy rates among people with PCOS.3,4 Among people with PCOS who have obesity and who experienced menstrual dysfunction, losing even a small amount of weight improved menstrual function and fertility.5

Health care providers may also recommend one or more of the following treatments to improve fertility in people with PCOS. 

  • This drug is the most common treatment for infertility in people with PCOS.1 The American College of Obstetricians and Gynecologists (ACOG) recommends clomiphene as the primary medication for people with PCOS-related infertility. It is also U.S. Food and Drug Administration (FDA) approved for treating PCOS-related infertility.6
  • Clomiphene indirectly causes eggs to mature and be released.7
  • Research shows that people who conceive with the aid of clomiphene are slightly more likely to have multiples, most commonly twins.8

  • Metformin—an insulin-sensitizing agent—can be used alone9 or with clomiphene when clomiphene alone is not successful to spur or regulate ovulation in people with PCOS.2,3
  • Evidence shows that metformin, alone and in combination with clomiphene, improves ovulation, but it does not increase the rate of pregnancy.10
  • Metformin is not FDA approved for treating PCOS-related infertility.

  • This drug briefly slows estrogen production and causes the body to make more follicle-stimulating hormone (FSH), a hormone needed for ovulation.11
  • An NICHD-supported study found that letrozole was more effective than clomiphene in causing ovulation and improving live-birth rates for people with PCOS.12
  • Studies of letrozole in animal models have shown that it causes congenital anomalies if used during pregnancy, but there have been no studies of this drug in pregnant people.11, 13

  • These hormones, given as shots, cause ovulation.
  • This treatment has a higher risk of multiple pregnancies than treatment with clomiphene.4
  • Your health care provider may use frequent laboratory tests and ultrasound exams to monitor how your body responds to this treatment.4

  • Because the benefits of this surgery, by itself or in addition to medication treatment, for increasing the chance of ovulation14 is unclear, it is not recommended by all health care provider groups.
  • It may be considered if lifestyle changes and medications are unsuccessful and often in combination with other treatments.
  • In ovarian drilling, the surgeon makes a small cut in the abdomen and inserts a long, thin tool called a laparoscope. The surgeon then uses a needle with electric current to puncture and destroy a small part of the ovary.
  • The surgery may lead to lower androgen levels, which may improve ovulation. However, it does not seem to improve other metabolism problems, and its effects may be short-lived.
  • Drilling surgery does not seem to increase the risk of multiple pregnancies.15 However, it does carry the risk of scarring the ovaries.8

If these treatments are not successful, your health care provider may suggest in vitro fertilization (IVF), or another type of assisted reproductive technology (ART).16 IVF may offer the best chance of pregnancy for people with PCOS. Different types of ART have their own risks and benefits. You should discuss all the options thoroughly with your health care provider before deciding.

Citations

  1. American Society for Reproductive Medicine. (n.d.). Frequently asked questions about infertility. Retrieved July 26, 2024, from https://www.reproductivefacts.org/faqs/frequently-asked-questions-about-infertility/ external link
  2. ACOG. (2015). Polycystic ovary syndrome frequently asked questions. Retrieved July 26, 2024, from http://www.acog.org/Patients/FAQs/Polycystic-Ovary-Syndrome-PCOS external link
  3. Moran, L. J., Pasquali, R., Teede, H. J., Hoeger, K.M., & Norman, R. J. (2009). Treatment of obesity in polycystic ovary syndrome: A position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertility and Sterility, 92(6), 1966–1982. PMID: 19062007
  4. Legro, R. S. (2007). Pregnancy considerations in women with polycystic ovary syndrome. Clinical Obstetrics and Gynecology, 50(1), 295–304. PMID: 17304043
  5. ACOG. (2018). Practice Bulletin No. 194: Polycystic ovary syndrome. Retrieved July 26, 2024, from https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/06/polycystic-ovary-syndrome external link
  6. FDA. (n.d.). Drugs@FDA: FDA-approved drugs information on clomiphene citrate. Retrieved July 26, 2024, from https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=075528
  7. National Cancer Institute. (2012). Oral contraceptives and cancer risk: Questions and answers. Retrieved July 26, 2024, from https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet#3  
  8. Goodarzi, M. O., Dumesic, D. A., Chazenbalk, G., & Azziz, R. (2011). Polycystic ovary syndrome: etiology, pathogenesis, and diagnosis. Nature Reviews: Endocrinology, 7(4), 219–231. PMID: 21263450
  9. Johnson, N. (2011). Metformin is a reasonable first-line treatment option for non-obese women with infertility related to anovulatory polycystic ovary syndrome—A meta-analysis of randomised trials. Australian and New Zealand Journal of Obstetrics & Gynaecology, 51(2), 125–129. PMID: 21466513
  10. Vause, T. D., Cheung, A. P., Sierra, S., Claman, P., Graham, J., Guillemin, J. A., et al.; Society of Obstetricians and Gynecologists of Canada. (2010). Ovulation induction in polycystic ovary syndrome. Journal of Obstetrics and Gynaecology Canada, 32(5), 495–502.
  11. FDA. (2000). VANIQA™ (eflornithine hydrochloride) cream, 13.9%. Retrieved July 26, 2024, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2000/21145lbl.pdf (PDF 236 KB)
  12. Legro, R. S., Brzyski, R. G., Diamond, M. P., Coutifaris, C., Schlaff, W. D., Casson, P., Christman, G. M., Huang, H., Yan, Q., Alvero, R., Haisenleder, D. J., Barnhart, K. T., Bates, G. W., Usadi, R., Lucidi, S., Baker, V., Trussell, J. C., Krawetz, S. A., Snyder, P., Ohl, D., … NICHD Reproductive Medicine Network (2014). Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. The New England Journal of Medicine, 371(2), 119–129. PMID: 25006718
  13. FDA. (2010). Femara (letrozole) tablets: Highlights of prescribing information. Retrieved July 26, 2024, from https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/ovarian-drilling-for-infertility/ external link
  14. American Society for Reproductive Medicine (ASRM). (2014). Ovarian drilling for infertility. Retrieved July 26, 2024, from https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/ovarian-drilling-for-infertility/ external link
  15. Fernandez, H., Morin-Surruca, M., Torre, A., Faivre,E., Deffieux, X., & Gervaise, A. (2011). Ovarian drilling for surgical treatment of polycystic ovarian syndrome: A comprehensive review. Reproductive Biomedicine Online, 22(6), 556–568.
  16. ASRM. (2018). Assisted reproductive technologies: A guide for patients. Retrieved July 26, 2024, from https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/ovarian-drilling-for-infertility/ external link
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