Ovulation induction in women with polycystic ovary syndrome

• PCOS is the primary cause of anovulatory infertility.
• Weight loss can induce ovulation and potentiate other ovulation-inducing therapies.
• Clomiphene citrate remains the first-line pharmacological therapy.
• Gonadotropins and ovarian drilling should be considered second-line therapies.
• Assisted reproduction is used as third-line therapy unless otherwise specified.

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. There are multiple ways to induce ovulation in PCOS patients, which will eventually provide a successful live birth. Each of these treatments varies in aggressiveness and effectiveness. Ranging from lifestyle modifications, through insulin-sensitizing agents, selective estrogen receptor modulators, aromatase inhibitors, gonadotropins, to laparoscopic ovarian drilling and assisted reproductive techniques, each method achieves ovulation induction through different mechanisms of action. This review provides a description and specific characteristics of the different methods used for ovulation induction which can help to design a personalized approach to each PCOS patient, and a general stepwise approach to ovulation induction in these patients.