The basic fertility workup in women with polycystic ovary syndrome: a systematic review

Abstract

<h4>Objective</h4>To summarize the evidence for the use of commonly accepted fertility tests in subfertile women with ovulation problems.<h4>Design</h4>Systematic review.<h4>Setting</h4>Not applicable.<h4>Patient(s)</h4>The study population included women starting with clomiphene citrate (CC) as first-line treatment, women starting with second-line treatment if CC failed to result in pregnancy, and women starting with second-line treatment if CC failed to result in ovulation (CC resistant).<h4>Intervention(s)</h4>Performance of a semen analysis or tubal patency test before or during treatment.<h4>Main outcome measure(s)</h4>Prevalence of abnormal tests as well as the diagnostic and prognostic performance of these tests.<h4>Result(s)</h4>Four studies reported on 3,017 women starting with CC as first-line treatment. The prevalence of male factor infertility was 10%, and in 0.3% of couples azoospermia was found (two studies). Semen parameters were not associated with pregnancy chance (one study). The prevalence of bilateral tubal disease was 4% (two studies). Three studies reported on 462 women starting with second-line treatment if CC failed to result in a pregnancy. Semen parameters were not predictive for pregnancy (one study). The prevalence of bilateral tubal disease in these women was 8% (three studies). Two studies reported on 168 CC-resistant women and total motile sperm count did not predict live birth (two studies). For all other outcomes, no studies were available.<h4>Conclusion(s)</h4>Data on the basic fertility workup in subfertile women with anovulation are scarce. Based on the available data, the workup should contain a semen analysis, and, for women who need to start second-line treatment if CC failed to result in pregnancy or women with CC resistance, assessment of tubal patency.