We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
Published online by Cambridge University Press: 05 July 2014
Introduction
The management of anovulatory infertility in polycystic ovary syndrome (PCOS) has traditionally involved the use of clomifene citrate and then gonadotrophin therapy or laparoscopic ovarian surgery in those who are clomifene resistant. The principles of therapy are first to optimise health (for example, weight loss for those who are overweight) before commencing therapy and then induce regular unifollicular ovulation, while minimising the risks of ovarian hyperstimulation syndrome and multiple pregnancy. Weight loss improves the endocrine profile and the likelihood of ovulation and a healthy pregnancy.
From the 1930s to the early 1960s, wedge resection of the ovary was the only treatment for PCOS. Wedge resection required a laparotomy and removal of up to 75% of each ovary, and often resulted in extensive pelvic adhesions. The modern-day, minimal access alternative to gonadotrophin therapy for clomifene-resistant PCOS is laparoscopic ovarian surgery, usually employing diathermy or laser. Laparoscopic ovarian surgery has therefore replaced ovarian wedge resection as the surgical treatment for clomifene resistance in women with PCOS. It is free of the risks of multiple pregnancy and ovarian hyperstimulation and does not require intensive ultrasound monitoring. Furthermore, ovarian diathermy is said to be as effective as routine gonadotrophin therapy in the treatment of clomifene-insensitive PCOS, although the evidence for this will be discussed in this chapter.
To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Find out more about the Kindle Personal Document Service.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.
