Polycystic ovary syndrome (PCOS) is characterized by menstrual irregularity and evidence of hyperandrogenism, whether clinical (hirsutism, acne, or male pattern balding) or biochemical (elevated serum androgen level). The majority of women who have infertility associated with chronic anovulation in this disorder ovulate in response to clomiphene citrate . However, up to 30 percent remain anovulatory. Furthermore, of the roughly 70 percent who do ovulate in response to clomiphene citrate, only one-half will conceive [2,3]. Although some women who are resistant to clomiphene alone are able to ovulate with metformin (alone or combined with clomiphene), there are still women who are unresponsive. (See "Metformin for treatment of the polycystic ovary syndrome" and "Overview of ovulation induction" and "Ovulation induction with clomiphene citrate".)
In women resistant to clomiphene citrate, or metformin combined with clomiphene, the next step has been gonadotropin therapy. While this treatment causes ovulation in most women, it has several potential problems:
●It can be very difficult to titrate the dose of gonadotropins to achieve monofollicular ovulation.
●The high frequency of multifollicular ovulation results in multiple gestations in 30 percent or more of women .
●The risk of ovarian hyperstimulation syndrome (OHSS) during gonadotropin administration is substantial, necessitating careful monitoring during treatment. (See "Pathogenesis of ovarian hyperstimulation syndrome".)