In most cases, fertility problems in women with polycystic ovary syndrome (PCOS) result from the absence of ovulation (anovulation), but anovulation may not be the only reason for these problems. Before beginning treatment for infertility possibly related to PCOS, be sure that your health care provider rules out other causes.1
Lifestyle changes, such as losing weight, can trigger body changes that facilitate conception in women with PCOS.2,3 Your health care provider may recommend that you try weight loss and other lifestyle changes before trying any medications to see if fertility returns and pregnancy occurs naturally. Research shows that lifestyle changes can help restore ovulation and improve pregnancy rates among women with PCOS.3,4 Research shows that, among obese women with PCOS who experienced menstrual dysfunction, even losing small amounts of weight improved menstrual function and fertility.5
If you have PCOS-related infertility, your health care provider may prescribe one of the following medications to help you get pregnant.
- This is the most common treatment for infertility in women with PCOS.1 The American College of Obstetricians and Gynecologists (ACOG) recommends that clomiphene should be the primary medication for PCOS patients with infertility.
- Clomiphene indirectly causes eggs to mature and be released.6
- Women treated with clomiphene are more likely to have twins or triplets than women who get pregnant naturally. Women who conceive with the aid of clomiphene are slightly more likely to have multiples, most commonly twins.7
- Although this insulin-sensitizing drug is normally used to treat diabetes, it may also be used as an adjunct to increase or regulate ovulation in women with PCOS.
- Metformin can be used alone8 or used with clomiphene when clomiphene alone is not successful.2,3
- Evidence shows that metformin—both alone and in combination with clomiphene—increases ovulation, but it does not increase the rate of pregnancy.9
- Metformin is not approved by the FDA for treating PCOS-related infertility.
- This drug transiently slows estrogen production and causes the body to make more follicle-stimulating hormone (FSH), a hormone needed for ovulation.10
- An NICHD-supported study found that letrozole is more effective than clomiphene in causing ovulation and improving live-birth rates.11
- Studies of letrozole in animals have shown that it causes birth defects if used during pregnancy, but there have been no studies of this drug in pregnant women.10,12
- This surgery may increase the chance of ovulation13 and may be considered if lifestyle changes and medications have been used without success.
- It is unclear whether this treatment is more effective than medications for treating PCOS infertility. The treatment is not recommended by all professional societies.
- In ovarian drilling, the surgeon makes a small cut in your abdomen and inserts a long, thin tool called a laparoscope (pronounced LAP-er-uh-skohp). The surgeon then uses a needle with electric current to puncture and destroy a small part of the ovary. The surgery leads to lower androgen levels, which may improve ovulation.
- This surgery may be less costly than treatment with gonadotropin,14 and it does not seem to increase the risk of multiple pregnancies.15 However, it does carry the risk of scarring the ovaries.8
If you do not get pregnant with the treatments listed above, your health care provider may suggest in vitro fertilization, or IVF.16 In this procedure, sperm and an egg are placed in a dish outside the body, in which fertilization occurs. Then a doctor places the fertilized egg into the uterus. IVF may offer women with PCOS the best chance of getting pregnant, and it may give health care providers better control over the risk of multiple births. But it can be expensive and may not be covered by health care insurance.12
- American Society for Reproductive Medicine. (n.d.). Frequently asked questions about infertility.Retrieved May 23, 2016, from https://www.reproductivefacts.org/faqs/frequently-asked-questions-about-infertility/
- American College of Obstetricians and Gynecologists.2015). Polycystic ovary syndrome. Retrieved May 20, 2016, from http://www.acog.org/Patients/FAQs/Polycystic-Ovary-Syndrome-PCOS
- 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.
- Legro, R. S. (2007). Pregnancy considerations in women with polycystic ovary syndrome. Clinical Obstetrics and Gynecology, 50(1), 295–304.
- ACOG Committee on Practice Bulletins--Gynecology. (2009). ACOG Practice Bulletin No. 108: Polycystic ovary syndrome. Obstetrics and gynecology, Oct; 114(4):936-49. Retrieved May 16, 2018 from https://www.ncbi.nlm.nih.gov/pubmed/19888063
- National Cancer Institute. (2012). Oral contraceptives and cancer risk: Questions and answers. Retrieved May 23, 2016, from http://www.cancer.gov/cancertopics/factsheet/Risk/oral-contraceptives#3
- 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. Retrieved August 26, 2016, from http://www.nature.com/nrendo/journal/v7/n4/full/nrendo.2010.217.html
- 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.
- 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.
- U.S. Food and Drug Administration (FDA). (2000). VANIQA™ (eflornithine hydrochloride) cream, 13.9%.Retrieved May 23, 2016, from http://www.accessdata.fda.gov/drugsatfda_docs/label/2000/21145lbl.pdf (PDF - 133 KB)
- Legro, R. S., Brzyski, R. G., Diamond, M.P., Coutifaris, C., Schlaff, W. D., Casson, P., et al; NICHD Reproductive Medicine Network. (2015). Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. New England Journal of Medicine, 371(2),119–129. Retrieved August 1, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4175743
- FDA. (2010). Femara (letrozole) tablets: Highlights of prescribing information. Retrieved May 23, 2016, from http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020726s019lbl.pdf (PDF - 456 KB)
- American Society for Reproductive Medicine.(2014). Ovarian drilling for infertility. Retrieved May 23, 2016, from https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/ovarian-drilling-for-infertility/
- Flyckt, R. L., & Goldberg, J. M. (2011).Laparoscopic ovarian drilling for clomiphene-resistant polycystic ovary syndrome. Seminars in Reproductive Medicine, 29(2), 138–146.
- 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.
- American Society for Reproductive Medicine. (2015). Assisted reproductive technologies: A guide for patients. Retrieved May 23, 2016, from https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/assisted-reproductive-technologies-booklet/