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

PURPOSE OF REVIEW: Clomifene citrate is the first and the most used agent for inducing ovulation in patients affected by polycystic ovary syndrome (PCOS). About 60-85% of PCOS women ovulated under clomifene citrate, whereas the others were defined clomifene citrate-resistant. The purpose of the current review will be to describe treatment strategies to induce ovulation in infertile PCOS patients with clomifene citrate resistance.

RECENT FINDINGS: Clomifene citrate and metformin association are a valid option for inducing ovulation in clomifene citrate-resistant PCOS patients. Surgical ovulation induction by laparoscopic ovarian drilling should be reserved to well selected cases. Excellent preliminary results are obtained using new drug formulations, such as aromatase inhibitors.

SUMMARY: 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.