Polycystic Ovary Syndrome and Infertility: A Narrative Review of Diagnostic and Therapeutic Approaches

Abstract

Objective: To provide an updated synthesis of current evidence regarding the mechanisms, diagnostic tools, and treatment options for infertility in PCOS.

Methods: A narrative literature review was conducted. Databases searched included PubMed, Scopus, and Web of Science, covering the period from January 2015 to March 2024. Search terms included “PCOS,” “infertility,” “letrozole,” “metformin,” “gonadotropins,” and “ART.” Inclusion criteria comprised peer-reviewed studies involving human females (18–45 years), written in English, and focused on infertility related to PCOS. Forty studies were selected, including randomized trials, meta-analyses, and international guidelines. Methodological rigor and clinical relevance were assessed.

Results: Lifestyle changes led to ovulatory restoration in up to 60% of overweight women. Letrozole was superior to clomiphene for ovulation induction. Gonadotropins and ART proved effective in treatment-resistant cases. Metformin offered additional benefits in insulin-resistant patients, especially when used in combination.

Conclusion: PCOS-related infertility requires personalized, multidisciplinary care. Letrozole remains first-line therapy, while advanced interventions are used selectively. Addressing metabolic and psychological factors enhances reproductive success and long-term health.