Inducing ovulation in patients with PCOS can be accomplished through several approaches: reducing insulin concentrations, follicle stimulating hormone (FSH) stimulation or reducing LH concentrations (6). Reducing insulin concentrations can be accomplished by either weight loss or insulin-sensitizing agents, like metformin. Clomiphene citrate or gonadotrophin therapies have traditionally been used to stimulate FSH; more recently, aromatase inhibitors have been investigated for this purpose. Laparoscopic ovarian drilling (LOD), gonadotrophin releasing hormone (GnRH) agonists and GnRH antagonists work through reducing LH concentrations and are second- or third-line agents for the treatment of infertility.
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