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A Review of Second- and Third-line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome

1
University of New South Wales, High St. Kensington, Sydney, NSW 2052, Australia
2
Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University and Monash Health, Melbourne, VIC 3168, Australia
3
Division of Obstetrics and Gynaecology, The University of Western Australia, University of Western Australia, Crawley, WA 6008, Australia
4
Christopher Chen Oocyte Biology Research Laboratory, UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia
5
Victorian Assisted Reproductive Treatment Authority, Melbourne, VIC 3000, Australia
6
Genea Hollywood Fertility, Wembley 6014, Australia
7
Royal College of Surgeons, Rotunda Hospital, D02 YN77 Dublin, Ireland
8
Department of Obstetrics and Gynaecology, Medical Center for Human Reproduction, Peking University Third Hospital, Beijing 100191, China
9
Department of Obstetrics and Gynaecology, Monash University, Melbourne 3168, Australia
10
National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash University, Melbourne 3168, VIC, Australia
11
National Health and Medical Research Council Centre for Research Excellence in PCOS, University of Adelaide, Adelaide 5006, SA, Australia
12
University of New South Wales, Sydney 2033, NSW, Australia
13
Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 1517 Trondheim, Norway
*
Author to whom correspondence should be addressed.
Med. Sci. 2019, 7(7), 75; https://doi.org/10.3390/medsci7070075
Received: 14 May 2019 / Revised: 13 June 2019 / Accepted: 20 June 2019 / Published: 26 June 2019
(This article belongs to the Special Issue Polycystic Ovary Syndrome)
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PDF [217 KB, uploaded 26 June 2019]

Abstract

In clomiphene-citrate-resistant anovulatory women 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 women with PCOS and clomiphene-citrate-failure. Laparoscopic ovarian surgery can also be used as a second-line therapy for ovulation induction in anovulatory women with clomiphene-citrate-resistant PCOS and no other infertility factors. The usefulness of letrozole as a second-line pharmacological treatment for ovulation induction in clomiphene-citrate-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. Where first- or second-line ovulation induction therapies have failed, in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) could be offered as a third-line therapy in women with PCOS in the absence of an absolute indication for IVF/ICSI. For women with PCOS undergoing IVF/ICSI treatment, the gonadotropin-releasing hormone (GnRH) antagonist protocol is preferred and an elective frozen embryo transfer strategy could be considered. In assisted conception units with sufficient expertise, in-vitro maturation (IVM) of oocytes could be offered to women with PCOS. View Full-Text
Keywords: polycystic ovary syndrome; infertility; surgery; assisted reproductive technology; IVF; IVM polycystic ovary syndrome; infertility; surgery; assisted reproductive technology; IVF; IVM
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Costello, M.F.; Garad, R.M.; Hart, R.; Homer, H.; Johnson, L.; Jordan, C.; Mocanu, E.; Qiao, J.; Rombauts, L.; Teede, H.J.; Vanky, E.; Venetis, C.A.; Ledger, W.L. A Review of Second- and Third-line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome. Med. Sci. 2019, 7, 75.

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