The second- and third-line treatments and supporting evidence of polycystic ovary syndrome-related infertility
WANG Yaoyao1 HAO Songli2▲
1.Department of Traditional Chinese Medicine, Shandong Yellow River Hospital, Yellow River Shandong Bureau, Shandong Province, Ji′nan 250032, China; 2.Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Heilongjiang Province, Harbin 150040, China
Abstract：In Clomiphene resistant anovulatory patients with polycystic ovary syndrome (PCOS) and no other infertility factors, either Metformin combined with Clomiphene citrate or Gonadotrophins could be used as a second-line pharmacological therapy, although Gonadotrophins are more effective. Gonadotrophins could also be used as a second-line pharmacological therapy in anovulatory patients with PCOS and Clomiphene failure. Laparoscopic ovarian surgery can also be used as a second-line therapy for ovulation induction in anovulatory patients with Clomiphene resistant PCOS and no other infertility factors. The usefulness of Letrozole as a second-line pharmacological treatment for ovulation induction in Clomiphene resistant women with PCOS requires further research. In terms of improving fertility, both pharmacological anti-obesity agents and bariatric surgery should be considered an experimental therapy in anovulatory women with PCOS and no other infertility factors. First-or second-line ovulation induction therapies have failed, in vitro fertilization (IVF)/intracytoplasmic single sperm injection (ICSI) could be offered as a third-line therapy in patients with PCOS in the absence of an absolute indication for IVF/ICSI. However, absolute indications for IVF/ICSI are lacking. For patients with PCOS undergoing IVF/ICSI treatment, the gonadotropin-releasing hormone antagonist protocol is preferred and an elective frozen embryo transfer strategy could be considered. In assisted conception units with sufficient expertise, in-vitro maturation of oocytes could be offered to women with PCOS.
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2020, Vol. 17 
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