Management strategies for ovulation induction in women with polycystic ovary syndrome and known clomifene citrate resistance

Abstract

In clomifene citrate-resistant PCOS patients, clomifene citrate and metformin combination and laparoscopic ovarian drilling, in selected cases, should be considered before gonadotropin administration. The efficacy of the other treatments must be confirmed in future well designed studies.

Reproductive outcome after letrozole versus laparoscopic ovarian drilling for clomiphene‐resistant polycystic ovary syndrome

“…The traditional second-line strategies for the treatment of women with CC-resistant PCOS comprise gonadotropins and LOD [6]. Both approaches are expensive and not without risks.…”

“…Finding other mechanisms to induce ovulation in patients with CC resistance is a desirable target in reproductive medicine. The traditional therapeutic options in patients with CC-resistant PCOS include gonadotropins and surgery [6]. However, gonadotropin treatment requires intensive ovulation monitoring, carries increased risks of multiple pregnancies and ovarian hyperstimulation syndrome, and is associated with high direct and indirect costs, and surgical ovulation induction carries anesthetic, intraoperative, and postoperative risks [7].…”

Polycystic Ovary Syndrome: Effect and Mechanisms of Acupuncture for Ovulation Induction

“…Approximate 20% of PCOS women are designated to be CC resistant [180, 181] and if CC fails, gonadotropin (FSH) therapy or laparoscopic ovarian surgery is considered as further treatment. The efficacy of gonadotropins is a 70% ovulation rate and a 20% pregnancy rate [178], but the treatment is costly and requires intensive ovarian monitoring [182]. Laparoscopic ovarian surgery (LOS), such as ovarian drilling by electrocautery or laser, has a pregnancy rate between 25–51% and a live birth between 24–44% [183].…”

Efficacy of extended clomifene citrate regimen in comparison with gonadotropins in clomifene citrate-resistant women with polycystic ovary syndrome

“…9 However, gonadotropins administration is characterized by the need of intensive ovulation monitoring, increased risk of multiple pregnancy, ovarian hyperstimulation syndrome (OHSS), and high direct and indirect costs. 10 In the present study, we hypothesized that a prolonged use of CC for 10 days in ovulation induction might overcome the CC resistance, and provide comparable treatment outcomes when compared with gonadotropins therapy in CC resistant PCOS patients in the form of biochemical and clinical pregnancy rates as well as the ovulation rate.…”