Infertility treatment in polycystic ovary syndrome: lifestyle interventions, medications and surgery.

Management of patients with polycystic ovary syndrome (PCOS) who wish to become pregnant should include exclusion of other diseases in the woman and additional fertility disorders in the couple. Before the initiation of any pharmacological intervention, the importance of lifestyle modifications should be stressed, particularly weight loss, increased exercise, smoking cessation and reduced alcohol consumption. The pharmacological treatment of choice for the induction of ovulation and for achieving live birth is the combination of metformin and clomiphene citrate. If this combination is unsuccessful, second-line treatments include the administration of gonadotropins and laparoscopic ovarian drilling. Induction of ovulation using clomiphene or gonadotropins leads to single live birth in 72% of cases, whereas laparoscopic ovarian drilling leads to live birth in 50% of cases. In vitro fertilization represents third-line treatment. Finally, individualized interventions can be implemented for the induction of ovulation depending on the specific characteristics of patients with PCOS. These interventions might deviate from the above-designated order of treatments in specific subgroups of patients with PCOS.