Invited review
Ovulation induction in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is one of the most common female reproductive endocrine disorders. It is a complex disorder that leads to, among other things, irregular ovulation or anovulation. Weight loss as a strategy to reduce hirsutism has been demonstrated to be effective by several authors in PCOS women. Weight loss, through diet and exercise, improves health in a much more cost-effective manner than drug therapy, eliminating costs for chemical treatments, while still achieving the same result. For lean women with PCOS or those who are unable to lose weight, clomiphene citrate (CC) is the first line of treatment and has been for many years. The discrepancy between ovulation rates and pregnancy rates, the high incidence of clomiphene resistance, and CC’s relatively long half life of 5 days has prompted researchers to look for alternative methods for ovulation induction. Metformin is a versatile treatment that can be used in monotherapy, combination therapy or as pre-treatment to ovulation induction with CC. By reducing the dosage of gonadotropins, aromatase inhibitors effectively improve upon the adverse outcomes of this procedure. Surgery is considered the last line of therapy for treating women with PCOS. It is ideal for women who are both clomiphene resistant and unable to respond to FSH therapy.