Review of nonsurgical and surgical treatment and the role of insulin‐sensitizing agents in the management of infertile women with polycystic ovary syndrome

Abstract

Diet and exercise followed by CC should be used for nonsurgical ovulation induction. For CC-resistant PCOS women, metformin may be included in a stepwise approach before a surgical approach. LOD with electrocautery is superior to laser drilling and gonadotropin therapy.

Ovulation Induction in Women with Polycystic Ovary Syndrome: What is the Optimal Option?

“…LOD with elecrocautery was found to be superior in treating anovulation compared to laser drilling or use of gonadotropins in clomiphene-resistant PCOS patients. The major side effects of LOD are the fact that it is a theater procedure and requires anesthesia; it may reduce ovarian reserve and has been associated with peri-ovarian adhesions [29,30]. When ranked according to efficacy of ovulation induction, the systemic review found out that the clomiphene citrate in combination with metformin was the most efficacious followed by follicle-stimulating hormone, letrozole, metformin, clomiphene, tamoxifen, laparoscopic ovarian drilling, and placebo or no treatment in that order.…”

Effects of metformin on insulin resistance, androgen concentration, ovulation and pregnancy rates in women with polycystic ovary syndrome following laparoscopic ovarian drilling THIS ARTICLE HAS BEEN RETRACTED

“…Polycystic ovary syndrome (PCOS) is a prevalent and heterogeneous condition affecting 6–10% of reproductive‐aged women and 35–40% of infertile women 1,2 . It is the most common cause of chronic anovulation 1,3 , 4 . Patients may also present with menstrual irregularities (usually oligo‐ or amenorrhea), hirsutism, acne or a combination of these.…”

“…Women with PCOS have an increased prevalence of impaired glucose tolerance (35–40%) and a prevalence of type 2 diabetes mellitus (7.5–10%) 7,8 . Furthermore, long‐term risks of metabolic consequences in women with PCOS who are characterized by insulin resistance are also increased, including dyslipidemia, hypertension, coronary artery disease and endometrial carcinoma 1,7–9 …”

Polycystic Ovary Syndrome, Pathophysiology, and Reproductive Health Implications

“…In obese women with PCOS, physical activity and low-calorie diet intake lead to an improvement in ovarian function and reduction of the risk of type 2 diabetes mellitus [18]. Exercise and weight control are highly recommended because of their direct effect not only on the metabolic framework but also on ovarian function and restoration of fertility [19].…”