Diagnosis and Management of Infertility in Women With Polycystic Ovary Syndrome

The document from December 2011 reviews the diagnosis and management of infertility in women with polycystic ovary syndrome (PCOS), detailing a case where a 30-year-old woman with PCOS and primary infertility successfully conceived using a combination of clomiphene citrate and metformin after clomiphene alone failed. It outlines the diagnostic criteria for PCOS, which requires two of the following: infrequent menstruation, hyperandrogenism, and polycystic ovaries, while ruling out other causes. The review emphasizes comprehensive infertility evaluations and discusses treatment options, including clomiphene citrate as the first-line therapy with a 23% live birth rate over six months, and metformin, which alone has a 7% live birth rate but increases to 27% when combined with clomiphene. It notes that combined therapy may be more effective in certain subgroups, such as those with a BMI ≥ 35 and less severe hirsutism. The document also explores alternative treatments for clomiphene-resistant patients, the risks of pregnancy complications in PCOS, and the safety and implications of metformin use during pregnancy. It concludes that while PCOS-related infertility is largely treatable, attention should be given to managing obstetric complications and pre-conception health.