Polycystic Ovarian Syndrome and Fertility

Implantation is a complex synchronized endometrial blastocyst cross-talk. Human reproduction is a relatively inefficient process. The probability of conception is only 25-30% per cycle of all the pregnancies that are lost, 75% represents the failure of implantation. Recurrent implantation failure refers to the failure to achieve a clinical pregnancy after transfer of at least four good quality embryos in a minimum of three fresh or frozen cycles in a woman under the age of 40 years. There are multiple factors of recurrent implantation failure, mainly embryo factor, uterine factors, tubal factors, ovarian factors etc. In PCOS patients markers of uterine receptivity like V3 integrin, HOXA-10 and IGFBP-1 expression are decreased during the secretory phase. PCOS endometrium overexpresses androgen receptors and fails down to regulate estrogen receptor: α in the window of implantation. A thorough evaluation of both the female and the male partner is warranted to ascertain. Various treatment modalities to improve the chances of implantation like correcting uterine/tubal factors, endometrial coring, day-5 blastocyst transfer, assisted hatching have been explored. PGD/PGS is also done to improve the chances of implantation. Now personalized embryo transfer using a personalized window of implantation called endometrial receptivity array is also offered to patients with recurrent implantation failure. Time-lapse imaging of the cultured embryo may provide a complete picture of the developmental kinetics that the embryo undergoes. Applying this system, the morpho-kinetic parameters specific to embryos that are capable of implanting can be identified. The promising future options are gene therapy and endometrial stem cell therapy.