How to manage the reproductive issues of PCOS: a 2015 integrated endocrinological and gynecological consensus statement of the Italian Society of Endocrinology

Background and objective. The treatment of reproductive alterations in women with PCOS remains controversial. The aim of the study was to develop evidence-based guidelines to improve the management of these abnormalities.Methods. A panel of experts appointed by the Italian Society of Endocrinology (SIE) reviewed the literature, and systematic reviews were compiled. A consensus was reached and the strength of recommendations was graded according to the quality of the evidence.Conclusions. The approach to the reproductive alterations of PCOS should be tailored according to the characteristics and needs of each individual patient. In overweight/obese women, lifestyle intervention may reduce metabolic risk and pregnancy complications and is therefore always recommended, although its role in improving the reproductive issues remains uncertain. In most infertile PCOS women clomiphene is the first-line therapy for ovulation induction. Metformin may be combined with clomiphene in clomiphene-resistant subjects, as a second-line approach. The recommended third-line therapy uses gonadotropins, with careful monitoring of ovarian response and possible combination with metformin to reduce ovarian hyperstimulation risk. In vitro fertilization is recommended when all these strategies fail. Aromatase inhibitors are not recommended for ovulation induction, as they need further assessment of potential risks. In PCOS women with reproductive alterations not seeking pregnancy, hormonal contraceptives, metformin or both may be used for the management of reproductive abnormalities. Several features, such as age, anthropometric and metabolic characteristics, need for contraception and specific contraindication should guide this choice.