Fertility Treatments and Outcomes in Women With PCOD: A Systematic Review
Keywords:
Polycystic Ovarian Disease (PCOD), Polycystic Ovary Syndrome (PCOS), Fertility treatments, Ovulation induction, Clomiphene citrate, Assisted reproductive technologies (ART), Intrauterine insemination (IUI), In vitro fertilization (IVF), Pregnancy outcomesAbstract
Background: Polycystic Ovarian Disease (PCOD) is a common endocrine disorder affecting 6–20% of reproductive-aged women globally and is a leading cause of anovulatory infertility. A wide array of pharmacologic and assisted reproductive treatments are employed to address fertility challenges in PCOD, but variability in outcomes necessitates evidence synthesis.
Objective: To systematically review and evaluate the effectiveness, pregnancy outcomes, and safety profiles of various fertility treatments in women with PCOD.
Methods: Six clinical studies (n = 3,285 total participants) meeting predefined inclusion criteria were analyzed. Data were extracted regarding treatment modalities (clomiphene citrate, letrozole, metformin, IUI, IVF), ovulation and pregnancy rates, and adverse outcomes. Study types included randomized controlled trials (RCTs), retrospective cohorts, and case-control designs.
Results: Clomiphene citrate (CC) demonstrated ovulation rates between 49–73%, with pregnancy rates around 22–28% in responsive individuals. Letrozole showed higher live birth rates (27.5% vs. 19.1%) compared to CC in one RCT. Metformin, particularly in combination with CC, improved ovulation and reduced insulin resistance, with one study reporting a 44.6% pregnancy rate following laparoscopic ovarian drilling in CC-resistant patients pretreated with metformin. Intrauterine insemination (IUI) led to a cumulative pregnancy rate of 39.4% after three cycles. IVF outcomes showed increased oocyte yield in PCOD patients (mean 15.8 vs. 11.4 in controls) but similar pregnancy rates (33.6% vs. 35.1%). Adverse outcomes such as ovarian hyperstimulation syndrome (OHSS) and gestational diabetes were more prevalent in PCOD cohorts.
Conclusion: A stepwise approach incorporating pharmacologic induction (especially letrozole and metformin) and ART offers effective fertility outcomes in PCOD, though individualization is crucial due to heterogeneous responses and elevated risk of complications. High-quality RCTs with standardized outcome reporting and long-term follow-up are needed to optimize treatment strategies.
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