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Why Does Ovulation Become Difficult in PCOS?
In PCOS, the normal rise and fall of reproductive hormones throughout the menstrual cycle is disrupted. You often have higher luteinising hormone (LH) and androgen levels, lower follicle-stimulating hormone (FSH), and insulin resistance. All these things stop a mature egg from being released. Ovulation induction simply gives your body the right push so that one (or sometimes more) healthy egg can grow and be released.How Losing Weight Supports Ovulation Induction in PCOS
For many people with PCOS, losing weight is the most powerful first step. Even a modest weight loss of 5 to 10 per cent of your current body weight can lower insulin levels, reduce androgen production, and bring back natural ovulation in a large number of individuals.When you lose weight through healthy eating and regular exercise, your periods often become regular on their own, and the chances of getting pregnant improve.
If you are overweight, your doctor will almost always suggest trying lifestyle changes for a few months before prescribing any medicines.
What Are The Best Ovulation Induction Options For PCOS
If you have PCOS and are struggling to ovulate, there are several effective ovulation induction options that can improve your chances of conception:1. Letrozole
Letrozole (an aromatase inhibitor) is now considered the best first-choice medicine for most people with PCOS who need help to ovulate. It works by temporarily lowering oestrogen levels, which signals the brain to produce more FSH and helps a single healthy follicle grow.Letrozole results in higher ovulation rates, better pregnancy rates, and higher live-birth rates than the older medication, clomiphene citrate. It also causes fewer twins and a thicker womb lining, which is good for the baby to implant.
2. Clomiphene Citrate
Clomiphene remains a good option, especially if letrozole is unavailable or unsuitable for you. It has been used safely for many decades.There are two ways to give it:
- Traditional Method:
- Stair-Step Method:
3. Clomiphene combined with Dexamethasone
If clomiphene alone does not work after a few cycles, doctors sometimes add low-dose dexamethasone (a mild steroid) or metformin. Adding dexamethasone has helped many previously resistant women ovulate.Metformin improves insulin sensitivity and may be useful, especially if you have signs of insulin resistance or are overweight.
4. Injectable Gonadotrophins
If tablets are ineffective after 3 to 6 cycles, the next step is usually injectable FSH (gonadotrophins). These injections directly give the hormone your body needs to grow follicles.There are two main ways to give them:
- Conventional step-up protocol: You start at around 75 IU and increase the dose gradually if needed.
- Chronic low-dose protocol: You start at a very low dose (37.5 to 75 IU) and increase it slowly to reduce the risk of overstimulation.
5. Myo-Inositol
Myo-inositol is a natural sugar found in the body that helps your cells respond better to insulin. It's known to reduce androgen levels, improve egg quality, and increase ovulation rates when taken daily.Some people use it alone, while others add it to clomiphene or letrozole. It is safe and has minimal side effects.
6. Laparoscopic Ovarian Drilling
Laparoscopic ovarian drilling is usually kept for people who do not respond to tablets and do not want repeated injections or monitoring. In this minor keyhole surgery, a few tiny punctures are made on the surface of each ovary. This lowers androgen production and often restores natural ovulation for many months or years.Pregnancy rates after drilling are similar to repeated gonadotropin cycles, and the multiple-pregnancy risk is lower because ovulation happens naturally. It is a one-time procedure and avoids the cost and stress of repeated injections.
Choosing the right ovulation induction option for PCOS is really about finding what works best for your body. The good news is that 80 to 90 per cent of women with PCOS can achieve a healthy pregnancy using these step-by-step treatment approaches. So don’t lose hope. When the right treatment is started at the right time, it works beautifully for the vast majority of couples!
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FAQs on Best Ovulation Induction Options for PCOS
- Can I try ovulation induction for PCOS if I have thyroid issues?
Yes, but your thyroid levels should be corrected first. Once your thyroid-stimulating hormone (TSH) is in the normal range, ovulation induction works more effectively. - Are there any long-term side effects of ovulation induction medicines?
While most side effects are temporary, the main long-term concern is a slightly higher chance of multiple pregnancy and a small increased risk of certain cancers. However, the current research is mixed and not conclusive.
