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

Objective: To summarize the evidence for the use of commonly accepted fertility tests in subfertile women with ovulation problems. Design: Systematic review. Setting: Not applicable. Patient(s): 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). Intervention(s): Performance of a semen analysis or tubal patency test before or during treatment. Main Outcome Measure(s): Prevalence of abnormal tests as well as the diagnostic and prognostic performance of these tests. Result(s): 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. Conclusion(s): 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.