Patients not desiring pregnancy at the time of treatment will be managed differently than patients actively seeking pregnancy. For patients desiring pregnancy there are several approaches. The more modern approach in younger patients involves the use of insulin sensitizing agents. These medications allow for a better response to the insulin in the circulation. Very frequently the manifestations of PCOS will demonstrate resolution.
Many women begin to ovulate and have a return of normal menses.
Many clinics have been successful at achieving pregnancy by using insulin sensitizing agents alone. These meds are discontinued after achieving pregnancy. In some patients, ovulation induction using Clomid, and subsequently gonadotropins, may be required. Because of the risk of ovarian hyperstimulation and multiple gestation associated with COH, this approach is used as a secondary treatment. Current trends to treat these patients with insulin sensitizing agents are gaining more popularity.