Fertility Management in Women with PCOD

Initial Approach: Lifestyle Modifications

The American Academy of Family Physicians recommends that women with PCOD who wish to conceive start with weight loss and exercise, as modest weight loss of just 5% of initial body weight significantly improves both metabolic and reproductive abnormalities, including ovulation and pregnancy rates 1
Weight loss should target a 30% energy deficit or 500-750 kcal/day reduction, and exercise programs show positive effects even without weight loss 2, 1
These lifestyle changes must be implemented first, as they form the foundation of fertility treatment 1

The American College of Obstetricians and Gynecologists recommends clomiphene citrate as the first-line pharmacological treatment, based on strong evidence of effectiveness, with approximately 80% of PCOD patients ovulating and half of those who ovulate conceiving 1, 3

The American Diabetes Association notes that metformin improves insulin sensitivity and ovulation frequency, and appears safe during pregnancy, though its effects on early pregnancy outcomes are not fully established 1, 4
Metformin reduces insulin levels, which subsequently decreases ovarian androgen production, and improves or maintains glucose tolerance over time in PCOD patients 3, 1

The American College of Obstetricians and Gynecologists recommends that all women with PCOD attempting pregnancy receive preconception counseling about increased pregnancy risks, and screen for metabolic abnormalities before conception: fasting glucose, 2-hour glucose tolerance test, and lipid profile 5, 3, 2

The National Kidney Foundation recommends that women with PCOD who become pregnant require closer monitoring throughout pregnancy, with regular monitoring of blood pressure, kidney function, and proteinuria, and prescription of low-dose aspirin from week 12 to week 36 to reduce preeclampsia risk 5