Polycystic Ovarian Syndrome and Fertility

PCOS is a common polygenic multifactorial condition affecting a wide population. PCOS poses an interesting problem for assisted reproduction. Initial treatment of infertility in PCOS is ovulation induction with clomiphene citrate, letrozole, and low dose gonadotrophin. LOD has been suggested as an effective alternative to OI. Patients’ refractory to all these interventions or with existing pathology can undergo ART with a closely monitored setting to produce the desired outcome without much complication. Ovarian stimulation for women with PCOS often requires a different approach to that for women with normal ovaries. The response often is slow but then spiral rapidly to a picture of over response leading to OHSS and cyst formation. More oocytes are retrieved but fertilization rates were reduced when compared to another group of infertility patients. Despite comparable pregnancy rates, the miscarriage rate in PCOS following IVF remains high compared with women with normal ovaries. This the unwanted outcome is proportional to BMI, increased waist-hip ratio, and insulin resistance. OHSS is the most serious iatrogenic complication of IVF treatment. Patients with PCOS are at a higher risk of OHSS during IVF. The incidence is hard to quantify ranging from 10 to 18%. Pituitary desensitization with a GnRH agonist or antagonist has become a universal concept with ART. Risk of OHSS is more with agonist protocol in PCOS patients. The pros and cons of different gonadotrophin preparation have been debated for years. After the initial use of hMG and then highly purified FSH came the recombinant FSH, LH, and hCG. Overall, there appears to be little difference in outcomes when all studies are combined. Use of metformin as an adjunct within the context of IVF has been explored. Although there is variable data on improvement of take-home baby rate with metformin, it definitely reduces the incidence of OHSS. IVM has attracted a lot of attention as a new technique in patients with PCOS.