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Drugs that are commonly used for the treatment of anovulatory infertility include:

• Clomiphene citrate
• Metformin
• Exogenous gonadotropins

Clomiphene Citrate

Clomiphene citrate (Clomid) is the standard first-line pharmacotherapy in anovulatory women with PCOS. It is initiated at low doses in order to reduce the chances for multiple births, which overall is approximately 6-7%. There are varying reports of the percentages of women who ovulate when taking clomiphene citrate.

At low doses, some research indicates the success rate for ovulation at approximately 50% and at the next higher dosage level, an additional 20% of women ovulate. Other studies estimate ovulation rates to range from 40-85%. For women oligomenorrhea, there is success rate for ovulation estimated at 93-95%. Some studies suggest that possible indicators of success for treatment are body weight and androgen levels.

Estimates are that women with PCOS exhibited conception rates following clomiphene citrate that are comparable to rates of conception in the general population. The majority of pregnancies occur within the first 6 ovulatory cycles. Some reports indicate that more than 70% of pregnancies occur within the first three cycles. If pregnancy does not occur within the first three cycles, some are of opinion that there should be a reassessment of treatment and that treatment should include the addition of either:

• Metformin
• Exogenous gonadotropins

Side effects of clomiphene citrate include:

• Hot flashes
• Headaches
• Blurred vision

Metformin

If clomiphene citrate alone is not successful in inducing ovulation, several studies have shown that metformin improves ovulation resulting in enhanced fertility. A meta-analysis of metformin use for anovulatory infertility indicated that ovulation was achieved in approximately 46% of women. When women were given metformin together with clomiphene citrate, 76% ovulated, compared to only 42% of those receiving clomiphene citrate alone.

Currently there is little information regarding the correlation of treatment with metformin with pregnancy rates and live births.

Exogenous Gonadotropins

Exogenous gonadotropins are synthetic drugs that mimic the action of gonadotropins produced by the body.

• Perganol
• Humegon

If a woman does not ovulate in response to clomiphene citrate, exogenous gonadotropin therapy may be considered as an option. Because women with PCOS are at a higher risk for ovarian hyperstimulation syndrome, the lowest, effective, possible doses of gonadotropins are prescribed. This strategy also minimizes the chances for multiple pregnancies. Chances for multiple birth with gonadotropin treatment is approximately 16-18%, higher than with clomiphene citrate.

There are various gonadotropin regimens that are used and most involve incremental dosage elevations while carefully monitoring hormone levels. In one study of 269 women with PCOS and anovulatory infertility, approximately 73% experienced ovulatory cycles following gonadotropin treatment and a majority of these women produced only a single follicle. The overall conception rate was 48% resulting in 129 pregnancies and 7 twin births.

Gonadotropin treatment is usually administered for six cycles. Most researchers have found that pregnancies occur within the first three cycles. Miscarriage rate was comparable to that of the general population.

The greatest factor that predicts the outcome of treatment is body mass index (BMI) - the higher the BMI, the less probability for conception and, if pregnancy does occur, there is a higher rate of miscarriage.