Topic Overview

Women with polycystic ovary syndrome (PCOS) do not ovulate regularly and often have difficulty becoming pregnant. Although the medicine clomiphene (such as Clomid) is commonly used to stimulate ovulation, it doesn't work for some women who have PCOS. This is because PCOS ovulation problems are linked to an imbalance of multiple body systems. Often other treatment measures can restore balance to the body's metabolism and hormone system, making ovulation medicine unnecessary (or more effective if it is used).

• Before considering medicine to stimulate ovulation, overweight women with polycystic ovary syndrome are advised to lower their body mass index (BMI) with diet and exercise. Even a modest weight reduction may trigger ovulation in women who have PCOS.
• If weight loss does not help start ovulation, clomiphene is usually tried first, sometimes combined with a steroid.
• If clomiphene does not start ovulation, it may be combined with another medicine, such as metformin, to start ovulation. Combining the two treatments may make it more likely that clomiphene will trigger ovulation in women who have PCOS.
• Women who do not ovulate with a combination of medicines are sometimes treated with gonadotropins, which are similar to the hormones the body produces to start ovulation. During this type of treatment, a woman must have daily monitoring of egg follicle development, using blood tests and ultrasound, to prevent ovarian hyperstimulation syndrome.
• If clomiphene does not work, your doctor may try a medicine called letrozole. Letrozole is thought to harm the fetus if it is used during pregnancy. Talk to your doctor about being sure you are not pregnant before taking this drug.

Laparoscopic ovarian surgery such as ovarian drilling (partial destruction of an ovary, which can trigger ovulation) or in vitro fertilization (IVF) are sometimes used for women with PCOS who have tried weight loss and fertility medicine, but still are not ovulating.¹ For more information, see the topic Polycystic Ovary Syndrome (PCOS).