Polycystic ovarian syndrome: Ovulation induction

Before initiating treatment to induce ovulation in cases of PCOS, an appropriate evaluation of the patient and her partner, based on individual considerations, is important to optimize outcome. For obese patients who have PCOS, weight loss measures should be pursued before pharmacologic treatment is initiated. For most patients, the pharmacologic agent of choice to induce ovulation is clomiphene citrate, alone, or in combination with a glucocorticoid. Treatment with metformin, alone, or in combination with clomiphene citrate, may also be beneficial. For patients who are not responsive to clomiphene citrate, injectable gonadotropin treatment is usually warranted, although depending on individual circumstances, laparoscopic ovarian drilling may be appropriate.