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Clinical Review

Managing anovulatory infertility and polycystic ovary syndrome

BMJ 2007; 335 doi: (Published 27 September 2007) Cite this as: BMJ 2007;335:663
  1. Adam H Balen, professor of reproductive medicine and surgery,
  2. Anthony J Rutherford, consultant in reproductive medicine and surgery
  1. Leeds General Infirmary, Leeds LS2 9NS
  1. Correspondence to: A H Balen

    In this second overview of the current management of infertility we discuss anovulatory infertility and polycystic ovary syndrome. This syndrome (formerly known as Stein-Leventhal syndrome) is the most common hormonal disturbance in women—around one fifth of women in the United Kingdom are affected. It is also the most common reason for women not to ovulate, and the combination of being overweight and having polycystic ovary syndrome can have a profound effect on reproductive health.

    Summary points

    • Polycystic ovary syndrome is the most common endocrine problem affecting women and the most common cause of anovulatory infertility

    • Oral clomifene citrate remains the first line treatment to induce ovulation

    • Gonadotrophin treatment needs careful monitoring to reduce risk of multiple pregnancy

    • Despite early promise, the role of metformin and insulin lowering agents is unclear in the management of anovulatory polycystic ovary syndrome

    Sources and selection criteria

    We referred to the Cochrane database of systematic reviews, The National Institute for Health and Clinical Excellence (NICE) guidelines for the investigation and management of infertility (2004), and our knowledge of the current literature.

    What is polycystic ovary syndrome?

    Anovulation is the cause of infertility in about a third of couples attending infertility clinics, and polycystic ovary syndrome accounts for 90% of such cases.1 Once tests have excluded other causes of androgen excess and menstrual disturbance, the syndrome can be confirmed by the presence of two of the following criteria— biochemical or clinical hyperandrogenism (hirsutism, acne, or alopecia); menstrual irregularity; and polycystic ovaries (figure).2 Symptoms, signs, and biochemical features vary greatly among affected women and may change over time in individual women.3 This review will concentrate on the management of infertility. The general practitioner should be able to start investigations and formulate a diagnosis before referral to a specialist in reproductive medicine.

    Three dimensional ultrasound scan of a polycystic ovary (centre) showing multiple cysts …

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