JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):53
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263592

P-41. Comparative evaluation between hormonal and non-hormonal approaches in the treatment of infertility associated with Polycystic Ovary Syndrome

Maria Beatriz Leopoldino¹, Ana Clara Tavares¹, Marcelo Cavalcante¹, Marina Pinheiro Bezerra de Menezes¹

¹ UNIFOR - Universidade de Fortaleza - Fortaleza - CE - Brasil

Objective: The present study aims to analyze the most current scientific evidence on the different therapeutic approaches available for the treatment of infertility in women diagnosed with Polycystic Ovary Syndrome, with an emphasis on comparing hormonal and non-hormonal strategies in order to identify possible advantages, limitations, and levels of effectiveness associated with each.
Methods: This is a narrative review, conducted in the PubMed database, using the descriptors: “Female infertility,” “Polycystic Ovary Syndrome,” “Assisted Reproductive Technique,” and “Reproductive Techniques.” The search resulted in 36 studies, filtered by publication date between 2020 and 2025, by language (English or Portuguese), and by study type: meta-analyses and systematic reviews. Among the articles generated from this search, six articles were selected that met the inclusion criteria: studies that addressed women of reproductive age with a confirmed diagnosis of PCOS, according to clinical and/or laboratory criteria, associated with infertility, and that comparatively evaluated hormonal and non-hormonal therapeutic approaches, in addition to the presence of relevant clinical reproductive outcomes.
Results: The analysis of the selected studies shows that both hormonal and non-hormonal approaches are effective in managing infertility in women with PCOS, although with particularities regarding clinical outcomes and safety. Among hormonal therapies, the use of letrozole demonstrated superiority over clomiphene citrate (CC), with higher rates of clinical pregnancy and live births, as well as a lower risk of multiple pregnancy and ovarian hyperstimulation syndrome (OHSS), according to the Cochrane review by Franik et al. (2022). Compared to laparoscopic ovarian drilling, letrozole showed a tendency toward better reproductive outcomes, albeit with low certainty evidence. Regarding non-hormonal approaches, metformin has been widely studied. According to the Cochrane systematic review (Tso et al., 2020), metformin may reduce the risk of OHSS and improve the clinical pregnancy rate when combined with in vitro fertilization (IVF), but there was no conclusive evidence of an increase in the live birth rate. The heterogeneity of the protocols and the low quality of some studies limit the strength of the conclusions. In addition, strategies related to nutritional status and lifestyle were also addressed. The study by Prieto-Huecas et al. (2023) showed that a higher body mass index (BMI) is negatively associated with ovarian reserve, with an impact on antral follicle count and anti-Müllerian hormone (AMH) levels, suggesting that weight reduction may improve reproductive response. Other emerging interventions include the use of GLP-1 analogs, as indicated by Tavares et al. (2025), who highlight beneficial effects on weight loss, improved insulin sensitivity, and immune modulation, promoting a more favorable environment for embryo implantation. Although promising, GLP-1RAs require more clinical evidence before being routinely incorporated into practice. Finally, in the context of assisted reproduction, the study by Datta et al. (2021) demonstrated that mild ovarian stimulation (≤150 IU of gonadotropin/day) is comparable to conventional stimulation in terms of live birth rate, but with a lower risk of OHSS and lower cost, suggesting it as a viable alternative.
Conclusion: Evidence indicates that hormonal and non-hormonal approaches are effective in managing infertility in women with PCOS, with individualized treatment being essential. Letrozole stands out among hormonal methods for its better outcomes and lower risk of complications, while metformin, lifestyle changes, and GLP-1 analogs show promising benefits but still require further evidence. In assisted reproduction, mild ovarian stimulation is a safe and cost-effective alternative, reinforcing the importance of personalized and evidence-based approaches.