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PCOS occurs mostly in women who are in their 20s or 30s, and affects 6-8% worldwide. Most women get diagnosed when they are trying to conceive. PCOS, also known as polycystic ovary syndrome, is when there is a hormonal imbalance in the ovaries (which are responsible for producing and releasing eggs) that produces extra hormones. When diagnosed, the ovaries are producing extreme amounts of hormones called androgens (male hormones), some symptoms are characterized by irregular or absent menstrual cycles, often leading to infertility due to anovulation when the ovaries fail to release an egg during a menstrual cycle.
For women with PCOS who want to conceive, ovulation induction is one of many treatments that can significantly increase fertility. Ovulation induction involves the use of medications to stimulate the ovaries to release one or more eggs. Since many women with PCOS do not ovulate regularly, if at all, this treatment helps stimulate a natural ovulation cycle, and this can improve the chances of conception. The most commonly used medications for ovulation induction include letrozole and gonadotropins. Letrozole, originally developed as a breast cancer drug, has become a popular alternative to clomiphene. It works by lowering estrogen levels, which in turn increases the production of FSH, which will induce ovulation. Studies have shown that letrozole is often more effective than clomiphene in inducing ovulation in women with PCOS. Letrozole also has a lower risk of multiple pregnancies and is associated with higher live birth rates.
In more complex cases, or when oral medications fail, injectable gonadotropins may be used. These are synthetic versions of the natural hormones FSH and luteinizing hormone (LH), and they directly stimulate the ovaries. While effective, gonadotropins carry a higher risk of multiple pregnancies and ovarian hyperstimulation syndrome (OHSS), so they require careful monitoring by a fertility specialist. In addition to medication, lifestyle changes can enhance the success of ovulation induction. Weight loss through diet and exercise can significantly improve hormonal balance and insulin sensitivity in women with PCOS, increasing the likelihood of regular ovulation. Sometimes, insulin-sensitizing drugs like metformin are also used in conjunction with ovulation induction to further boost fertility outcomes.
In conclusion, ovulation induction is a powerful and effective fertility treatment for women with PCOS. Stimulating the ovaries to release eggs helps overcome one of the primary barriers to conception in these patients. With a variety of medication options and supportive lifestyle strategies, many women with PCOS can achieve successful ovulation and, most importantly, pregnancy. As fertility science continues to advance, the outlook for women with PCOS seeking to build families remains hopeful, as there is no cure for it yet, but we hope to see many more discoveries in the near future, as well as many success stories about fertility and baby announcements.
References
Bhatnagar, A. S. (2007). The early days of letrozole. Breast cancer research and treatment. https://pmc.ncbi.nlm.nih.gov/articles/PMC2001227/
CNY Fertility. (2021, December 9). Letrozole for PCOS: How it works, success rates, and more. https://www.cnyfertility.com/letrozole-for-pcos/
PCOS (polycystic ovary syndrome): Symptoms & treatment. Cleveland Clinic. (2025, March 19). https://my.clevelandclinic.org/health/diseases/8316-polycystic-ovary-syndrome-pcos
Shibboleth authentication request. (n.d.-a). https://www-sciencedirect-com.uaf.idm.oclc.org/science/article/pii/S0039128X13001050
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Wang, K., Li, Y., & Chen, Y. (2023, December 13). Androgen excess: A hallmark of polycystic ovary syndrome. Frontiers in endocrinology. https://pmc.ncbi.nlm.nih.gov/articles/PMC10751361/