A brief update on the evidence supporting the treatment of infertility in polycystic ovary syndrome

Michael F. Costello, Marie L. Misso, Adam Balen, Jacqueline Boyle, Luigi Devoto, Rhonda M. Garad, Roger Hart, Louise Johnson, Cailin Jordan, Richard S. Legro, Rob J. Norman, Lisa Moran, Edgar Mocanu, Jie Qiao, Ray J. Rodgers, Luk Rombauts, Eliza C. Tassone, Shakila Thangaratinam, Eszter Vanky, Helena J. Teede

Research output: Contribution to journalArticle

Abstract

Background: Polycystic ovary syndrome (PCOS) is complex with reproductive, metabolic and psychological features. Infertility is a prevalent presenting feature of PCOS with approximately 75% of these women suffering infertility due to anovulation, making PCOS by far the most common cause of anovulatory infertility. Previous guidelines either lacked rigorous evidence-based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated. Aims: This review paper aims to provide a brief update on the best available and most current research evidence supporting the treatment of PCOS which informed the recommendations in the assessment and treatment of infertility section of the international evidence-based guideline on PCOS 2018. Materials and Methods: International evidence-based guideline development engaged professional societies and consumer organisations with multidisciplinary experts and women with PCOS directly involved at all stages. Results: Lifestyle change alone is considered the first-line treatment for the management of infertile anovulatory PCOS women who are overweight or obese. Letrozole should now be considered first-line pharmacological treatment for ovulation induction to improve fertility outcomes. Clomiphene citrate alone and metformin alone could also be used as first-line pharmacological therapy, although both are less effective than letrozole and metformin is less effective than clomiphene citrate in obese women. Gonadotrophins or laparoscopic ovarian surgery are usually second-line ovulation induction therapies. In the absence of an absolute indication for in vitro fertilisation (IVF) / intracytoplasmic sperm injection, women with PCOS and anovulatory infertility could be offered IVF as third-line therapy where first- or second-line ovulation induction therapies have failed. Conclusion: This review provides the best available evidence informing recommendations (along with clinical expertise and consumer preference) which provide clinicians with clear advice on best practice for the management of infertile women with PCOS.

Original languageEnglish
JournalAustralian and New Zealand Journal of Obstetrics and Gynaecology
DOIs
Publication statusPublished - 1 Jan 2019

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Polycystic Ovary Syndrome
Infertility
letrozole
Ovulation Induction
Clomiphene
Therapeutics
Metformin
Guidelines
Fertilization in Vitro
Consumer Organizations
Pharmacology
Anovulation
Internationality
Intracytoplasmic Sperm Injections
Practice Management
Gonadotropins
Practice Guidelines
Laparoscopy
Fertility
Life Style

Cite this

Costello, Michael F. ; Misso, Marie L. ; Balen, Adam ; Boyle, Jacqueline ; Devoto, Luigi ; Garad, Rhonda M. ; Hart, Roger ; Johnson, Louise ; Jordan, Cailin ; Legro, Richard S. ; Norman, Rob J. ; Moran, Lisa ; Mocanu, Edgar ; Qiao, Jie ; Rodgers, Ray J. ; Rombauts, Luk ; Tassone, Eliza C. ; Thangaratinam, Shakila ; Vanky, Eszter ; Teede, Helena J. / A brief update on the evidence supporting the treatment of infertility in polycystic ovary syndrome. In: Australian and New Zealand Journal of Obstetrics and Gynaecology. 2019.
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title = "A brief update on the evidence supporting the treatment of infertility in polycystic ovary syndrome",
abstract = "Background: Polycystic ovary syndrome (PCOS) is complex with reproductive, metabolic and psychological features. Infertility is a prevalent presenting feature of PCOS with approximately 75{\%} of these women suffering infertility due to anovulation, making PCOS by far the most common cause of anovulatory infertility. Previous guidelines either lacked rigorous evidence-based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated. Aims: This review paper aims to provide a brief update on the best available and most current research evidence supporting the treatment of PCOS which informed the recommendations in the assessment and treatment of infertility section of the international evidence-based guideline on PCOS 2018. Materials and Methods: International evidence-based guideline development engaged professional societies and consumer organisations with multidisciplinary experts and women with PCOS directly involved at all stages. Results: Lifestyle change alone is considered the first-line treatment for the management of infertile anovulatory PCOS women who are overweight or obese. Letrozole should now be considered first-line pharmacological treatment for ovulation induction to improve fertility outcomes. Clomiphene citrate alone and metformin alone could also be used as first-line pharmacological therapy, although both are less effective than letrozole and metformin is less effective than clomiphene citrate in obese women. Gonadotrophins or laparoscopic ovarian surgery are usually second-line ovulation induction therapies. In the absence of an absolute indication for in vitro fertilisation (IVF) / intracytoplasmic sperm injection, women with PCOS and anovulatory infertility could be offered IVF as third-line therapy where first- or second-line ovulation induction therapies have failed. Conclusion: This review provides the best available evidence informing recommendations (along with clinical expertise and consumer preference) which provide clinicians with clear advice on best practice for the management of infertile women with PCOS.",
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author = "Costello, {Michael F.} and Misso, {Marie L.} and Adam Balen and Jacqueline Boyle and Luigi Devoto and Garad, {Rhonda M.} and Roger Hart and Louise Johnson and Cailin Jordan and Legro, {Richard S.} and Norman, {Rob J.} and Lisa Moran and Edgar Mocanu and Jie Qiao and Rodgers, {Ray J.} and Luk Rombauts and Tassone, {Eliza C.} and Shakila Thangaratinam and Eszter Vanky and Teede, {Helena J.}",
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Costello, MF, Misso, ML, Balen, A, Boyle, J, Devoto, L, Garad, RM, Hart, R, Johnson, L, Jordan, C, Legro, RS, Norman, RJ, Moran, L, Mocanu, E, Qiao, J, Rodgers, RJ, Rombauts, L, Tassone, EC, Thangaratinam, S, Vanky, E & Teede, HJ 2019, 'A brief update on the evidence supporting the treatment of infertility in polycystic ovary syndrome' Australian and New Zealand Journal of Obstetrics and Gynaecology. https://doi.org/10.1111/ajo.13051

A brief update on the evidence supporting the treatment of infertility in polycystic ovary syndrome. / Costello, Michael F.; Misso, Marie L.; Balen, Adam; Boyle, Jacqueline; Devoto, Luigi; Garad, Rhonda M.; Hart, Roger; Johnson, Louise; Jordan, Cailin; Legro, Richard S.; Norman, Rob J.; Moran, Lisa; Mocanu, Edgar; Qiao, Jie; Rodgers, Ray J.; Rombauts, Luk; Tassone, Eliza C.; Thangaratinam, Shakila; Vanky, Eszter; Teede, Helena J.

In: Australian and New Zealand Journal of Obstetrics and Gynaecology, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A brief update on the evidence supporting the treatment of infertility in polycystic ovary syndrome

AU - Costello, Michael F.

AU - Misso, Marie L.

AU - Balen, Adam

AU - Boyle, Jacqueline

AU - Devoto, Luigi

AU - Garad, Rhonda M.

AU - Hart, Roger

AU - Johnson, Louise

AU - Jordan, Cailin

AU - Legro, Richard S.

AU - Norman, Rob J.

AU - Moran, Lisa

AU - Mocanu, Edgar

AU - Qiao, Jie

AU - Rodgers, Ray J.

AU - Rombauts, Luk

AU - Tassone, Eliza C.

AU - Thangaratinam, Shakila

AU - Vanky, Eszter

AU - Teede, Helena J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Polycystic ovary syndrome (PCOS) is complex with reproductive, metabolic and psychological features. Infertility is a prevalent presenting feature of PCOS with approximately 75% of these women suffering infertility due to anovulation, making PCOS by far the most common cause of anovulatory infertility. Previous guidelines either lacked rigorous evidence-based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated. Aims: This review paper aims to provide a brief update on the best available and most current research evidence supporting the treatment of PCOS which informed the recommendations in the assessment and treatment of infertility section of the international evidence-based guideline on PCOS 2018. Materials and Methods: International evidence-based guideline development engaged professional societies and consumer organisations with multidisciplinary experts and women with PCOS directly involved at all stages. Results: Lifestyle change alone is considered the first-line treatment for the management of infertile anovulatory PCOS women who are overweight or obese. Letrozole should now be considered first-line pharmacological treatment for ovulation induction to improve fertility outcomes. Clomiphene citrate alone and metformin alone could also be used as first-line pharmacological therapy, although both are less effective than letrozole and metformin is less effective than clomiphene citrate in obese women. Gonadotrophins or laparoscopic ovarian surgery are usually second-line ovulation induction therapies. In the absence of an absolute indication for in vitro fertilisation (IVF) / intracytoplasmic sperm injection, women with PCOS and anovulatory infertility could be offered IVF as third-line therapy where first- or second-line ovulation induction therapies have failed. Conclusion: This review provides the best available evidence informing recommendations (along with clinical expertise and consumer preference) which provide clinicians with clear advice on best practice for the management of infertile women with PCOS.

AB - Background: Polycystic ovary syndrome (PCOS) is complex with reproductive, metabolic and psychological features. Infertility is a prevalent presenting feature of PCOS with approximately 75% of these women suffering infertility due to anovulation, making PCOS by far the most common cause of anovulatory infertility. Previous guidelines either lacked rigorous evidence-based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated. Aims: This review paper aims to provide a brief update on the best available and most current research evidence supporting the treatment of PCOS which informed the recommendations in the assessment and treatment of infertility section of the international evidence-based guideline on PCOS 2018. Materials and Methods: International evidence-based guideline development engaged professional societies and consumer organisations with multidisciplinary experts and women with PCOS directly involved at all stages. Results: Lifestyle change alone is considered the first-line treatment for the management of infertile anovulatory PCOS women who are overweight or obese. Letrozole should now be considered first-line pharmacological treatment for ovulation induction to improve fertility outcomes. Clomiphene citrate alone and metformin alone could also be used as first-line pharmacological therapy, although both are less effective than letrozole and metformin is less effective than clomiphene citrate in obese women. Gonadotrophins or laparoscopic ovarian surgery are usually second-line ovulation induction therapies. In the absence of an absolute indication for in vitro fertilisation (IVF) / intracytoplasmic sperm injection, women with PCOS and anovulatory infertility could be offered IVF as third-line therapy where first- or second-line ovulation induction therapies have failed. Conclusion: This review provides the best available evidence informing recommendations (along with clinical expertise and consumer preference) which provide clinicians with clear advice on best practice for the management of infertile women with PCOS.

KW - evidence-based medicine

KW - female

KW - infertility

KW - polycystic Ovary Syndrome

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SN - 0004-8666

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