PCOS and pregnancy: a review of available therapies to improve the outcome of pregnancy in women with polycystic ovary syndrome

Abstract

Polycystic ovary syndrome (PCOS) is a common cause of female infertility affecting multiple aspects of a women's health. Areas covered: The aim of this review is to summarize the existing evidence on the treatment of PCOS patients and to examine the actual available therapies to overcome the problem of infertility and improve the outcome of pregnancy. We analyse different treatment strategies such as lifestyle modification, bariatric surgery, insulin sensitizing agents, inositol, clomiphene citrate (CC), aromatase inhibitors, gonadotrophins, laparoscopic ovarian drilling, and assisted reproductive techniques (ART). Expert commentary: Lifestyle modification is the best initial management for obese PCOS patients seeking pregnancy and insulin sensitizing agents seem to have an important role in treating insulin resistance. Up to now, CC maintains a central role in the induction of ovulation and it has been confirmed as the first-line treatment; the use of gonadotrophins is considered the second-line in CC resistant patients; laparoscopic ovarian drilling is an alternative to gonadotrophins in patients who need laparoscopy for another reason. However, in anovulatory patients, ART represents the only possible alternative to obtain pregnancy. Larger and well-designed studies are needed to clarify the best way to improve the outcome of pregnancy in PCOS women.

Fertility concerns and related information needs and preferences of women with PCOS

“…Optimising health in the preconception period is crucial to increasing the chances of conception (Dorney and Black, 2018), particularly for women with PCOS. Conception for women with PCOS often requires a multifaceted approach that includes lifestyle interventions, pharmacological treatments or ART (Artini et al , 2018). According to the international evidence-based guideline for the assessment and management of PCOS, factors such as weight, smoking, alcohol, diet, exercise, sleep and mental, emotional and sexual health need to be optimised in women with PCOS in order to improve reproductive and obstetric outcomes (Teede et al , 2018).…”

Is it worth reducing twins to singletons after IVF‐ET? A retrospective cohort study using propensity score matching

“…The results showed that three factors may affect the decision for fetal reduction: maternal age, infertility type and main cause of infertility ( P < 0.05). As the pregnancy outcome has been shown to be related to maternal age, education of the couples, parity, main causes of infertility, body mass index, type and number of embryos transferred, and whether the embryos were frozen‐thawed, we conducted further propensity score matching for the above factors. All baseline characteristic variables were well balanced after matching (Table ).…”

In Search of New Therapeutics—Molecular Aspects of the PCOS Pathophysiology: Genetics, Hormones, Metabolism and Beyond

“…The hormonal imbalance related to polycystic ovary syndrome is a common cause of female infertility, which has many negative consequences to physical health, psychological health and social well-being [ 101 , 102 ]. In women with PCOS, many therapeutic methods are used to increase their chances of getting pregnant.…”

“…Drugs such as clomiphene citrate and gonadotropins are used to induce ovulation, but many patients require assisted reproductive techniques to get pregnant. Numerous studies are needed to thoroughly understand the mechanisms related to the maturation of ovarian follicles, which may allow the use of new substances in treatment [ 101 , 104 ].…”