Editing Polycystic ovary syndrome (section)

=== Infertility ===
{{Main|Infertility in polycystic ovary syndrome}}

Some individuals with PCOS may have difficulty getting pregnant since their bodies do not produce the hormones necessary for regular ovulation.<ref>{{cite web|title=Erase the Dread and Stigma of PCOD|url=https://www.matria.in/blog/erase-the-dread-and-stigma-of-pcod/|access-date=19 January 2022|website=Matria|language=en|archive-date=19 January 2022|archive-url=https://web.archive.org/web/20220119062417/https://www.matria.in/blog/erase-the-dread-and-stigma-of-pcod/|url-status=live}}</ref> PCOS might also increase the risk of miscarriage or premature delivery. However, it is possible to have a normal pregnancy.{{citation needed|date=April 2023}}

For women who do, [[anovulation]] or infrequent ovulation is a common cause and PCOS is the main cause of anovulatory infertility.<ref>{{cite journal | vauthors = Balen AH, Morley LC, Misso M, Franks S, Legro RS, Wijeyaratne CN, Stener-Victorin E, Fauser BC, Norman RJ, Teede H | title = The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance | journal = Human Reproduction Update | volume = 22 | issue = 6 | pages = 687–708 | date = November 2016 | pmid = 27511809 | doi = 10.1093/humupd/dmw025 }}</ref> Other factors include changed levels of [[gonadotropin]]s, [[hyperandrogenemia]], and [[hyperinsulinemia]].<ref name="Qiao2011">{{cite journal | vauthors = Qiao J, Feng HL | title = Extra- and intra-ovarian factors in polycystic ovary syndrome: impact on oocyte maturation and embryo developmental competence | journal = Human Reproduction Update | volume = 17 | issue = 1 | pages = 17–33 |date= 2010 | pmid = 20639519 | pmc = 3001338 | doi = 10.1093/humupd/dmq032 }}</ref> Like women without PCOS, women with PCOS that are ovulating may be infertile due to other causes, such as tubal blockages due to a history of sexually transmitted diseases.<ref>{{cite web|url=https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/causes/causes-female|title=What are some causes of female infertility?|website=National Institute of Child Health and Human Development, National Institutes of Health|date=31 January 2017|access-date=25 October 2019|archive-date=8 August 2020|archive-url=https://web.archive.org/web/20200808035554/https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/causes/causes-female|url-status=live}}</ref>

For overweight anovulatory women with PCOS, [[weight loss]] and diet adjustments, especially to reduce the intake of simple carbohydrates, are associated with the resumption of natural ovulation.<ref>{{cite journal | vauthors = Jurczewska J, Szostak-Węgierek D | title = The Influence of Diet on Ovulation Disorders in Women-A Narrative Review | journal = Nutrients | volume = 14 | issue = 8 | pages = 1556 | date = April 2022 | pmid = 35458118 | pmc = 9029579 | doi = 10.3390/nu14081556 | doi-access = free }}</ref> Digital health interventions are particularly effective in providing combined therapy to manage PCOS through both lifestyle changes and medication.<ref>{{cite journal | vauthors = Wang L, Liu Y, Tan H, Huang S | title = Transtheoretical model-based mobile health application for PCOS | journal = Reproductive Health | volume = 19 | issue = 1 | pages = 117 | date = May 2022 | pmid = 35549736 | pmc = 9097413 | doi = 10.1186/s12978-022-01422-w | doi-access = free }}</ref>

[[Letrozole|Femara]] is an alternative medicine that raises FSH levels and promotes the development of the follicle.<ref name=":2" />

For those women that, after weight loss, are still anovulatory, or for anovulatory lean women, [[ovulation induction]] using the medications [[letrozole]] or [[clomiphene citrate]] are the principal treatments used to promote ovulation.<ref>{{cite journal | vauthors = Franik S, Le QK, Kremer JA, Kiesel L, Farquhar C | title = Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 9 | pages = CD010287 | date = September 2022 | pmid = 36165742 | pmc = 9514207 | doi = 10.1002/14651858.CD010287.pub4 }}</ref><ref>{{cite journal | vauthors = Tanbo T, Mellembakken J, Bjercke S, Ring E, Åbyholm T, Fedorcsak P | title = Ovulation induction in polycystic ovary syndrome | journal = Acta Obstetricia et Gynecologica Scandinavica | volume = 97 | issue = 10 | pages = 1162–7 | date = October 2018 | pmid = 29889977 | doi = 10.1111/aogs.13395 | hdl-access = free | doi-access = free | hdl = 10852/72989 }}</ref><ref>{{cite journal | vauthors = Hu S, Yu Q, Wang Y, Wang M, Xia W, Zhu C | title = Letrozole versus clomiphene citrate in polycystic ovary syndrome: a meta-analysis of randomized controlled trials | journal = Archives of Gynecology and Obstetrics | volume = 297 | issue = 5 | pages = 1081–8 | date = May 2018 | pmid = 29392438 | doi = 10.1007/s00404-018-4688-6 | s2cid = 4800270 }}</ref> Clomiphene can cause mood swings and abdominal cramping for some.<ref name=":2" />

Previously, the anti-diabetes medication [[metformin]] was a recommended treatment for anovulation, but it appears less effective than letrozole or clomiphene.<ref>{{cite journal | title = Role of metformin for ovulation induction in infertile patients with polycystic ovary syndrome (PCOS): a guideline | journal = Fertility and Sterility | volume = 108 | issue = 3 | pages = 426–441 | date = September 2017 | pmid = 28865539 | doi = 10.1016/j.fertnstert.2017.06.026 | doi-access = free | vauthors = Penzias A, Bendikson K, Butts S, Coutifaris C, Falcone T, Fossum G, Gitlin S, Gracia C, Hansen K, La Barbera A, Mersereau J, Odem R, Paulson R, Pfeifer S, Pisarska M, Rebar R, Reindollar R, Rosen M, Sandlow J, Vernon M }}</ref><ref>{{cite journal | vauthors = Legro RS, Barnhart HX, Schlaff WD, Carr BR, Diamond MP, Carson SA, Steinkampf MP, Coutifaris C, McGovern PG, Cataldo NA, Gosman GG, Nestler JE, Giudice LC, Leppert PC, Myers ER | title = Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome | journal = The New England Journal of Medicine | volume = 356 | issue = 6 | pages = 551–566 | date = February 2007 | pmid = 17287476 | doi = 10.1056/NEJMoa063971 | doi-access = free }}{{primary source inline|date=June 2018}}</ref>

For women not responsive to letrozole or clomiphene and diet and lifestyle modification, there are options available including [[assisted reproductive technology]] procedures such as [[controlled ovarian hyperstimulation]] with [[follicle-stimulating hormone]] (FSH) injections followed by [[in vitro fertilisation]] (IVF).<ref>{{cite journal | vauthors = Homburg R | title = Management of infertility and prevention of ovarian hyperstimulation in women with polycystic ovary syndrome | journal = Best Practice & Research. Clinical Obstetrics & Gynaecology | volume = 18 | issue = 5 | pages = 773–788 | date = October 2004 | pmid = 15380146 | doi = 10.1016/j.bpobgyn.2004.05.006 }}</ref>

Though surgery is not commonly performed, the polycystic ovaries can be treated with a laparoscopic procedure called "[[ovarian drilling]]" (puncture of 4–10 small follicles with electrocautery, laser, or biopsy needles),<ref>{{Cite journal |last1=Bordewijk |first1=Esmée M. |last2=Ng |first2=Ka Ying Bonnie |last3=Rakic |first3=Lidija |last4=Mol |first4=Ben Willem J. |last5=Brown |first5=Julie |last6=Crawford |first6=Tineke J. |last7=van Wely |first7=Madelon |date=11 February 2020 |title=Laparoscopic ovarian drilling for ovulation induction in women with anovulatory polycystic ovary syndrome |journal=The Cochrane Database of Systematic Reviews |volume=2 |issue=2 |pages=CD001122 |doi=10.1002/14651858.CD001122.pub5 |issn=1469-493X |pmc=7013239 |pmid=32048270}}</ref> which often results in either resumption of spontaneous ovulations<ref name=emedicine_treatment /> or ovulations after adjuvant treatment with clomiphene or FSH.<ref>{{cite journal | vauthors = Ghanem ME, Elboghdady LA, Hassan M, Helal AS, Gibreel A, Houssen M, Shaker ME, Bahlol I, Mesbah Y | title = Clomiphene citrate co-treatment with low dose urinary FSH versus urinary FSH for clomiphene resistant PCOS: randomized controlled trial | journal = Journal of Assisted Reproduction and Genetics | volume = 30 | issue = 11 | pages = 1477–85 | date = November 2013 | pmid = 24014214 | pmc = 3879942 | doi = 10.1007/s10815-013-0090-2 }}</ref> (Ovarian wedge resection is no longer used as much due to complications such as [[adhesions]] and the presence of frequently effective medications.) There are, however, concerns about the long-term effects of ovarian drilling on ovarian function.<ref name=emedicine_treatment />

In a small UK randomized trial, [[bariatric surgery]] led to more spontaneous ovulations than behavioral interventions combined with medical therapy in adult women with PCOS, raising the prospect that surgery could enhance prospects of spontaneous fertility.<ref>{{Cite journal |last=Smarasinghe |first=Suhaniya SNS |date=8 June 2024 |title=Bariatric surgery for spontaneous ovulation in women living with polycystic ovary syndrome: the BAMBINI multicentre, open-label, randomised controlled trial |url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00538-5/fulltext |journal=The Lancet |volume=403 |issue=10443 |pages=2489–2503|doi=10.1016/S0140-6736(24)00538-5 |pmid=38782004 }}</ref>