Infertility Riding on Polycystic Ovarian Syndrome (PCOS): A Review of Treatment Modalities

Abstract

Polycystic ovarian syndrome (PCOS) is the commonest cause of anovulatory infertility. Depending on the population studied between 5 and 18% of women of reproductive age suffer from PCOS, however not all of them are anovulatory or experience subfertility. PCOS has been associated with numerous reproductive and metabolic abnormalities. Despite enormous advances in the management of reproductive dysfunction, insight into the metabolic implications of PCOS is limited by the lack of uniform diagnostic criteria, the heterogeneity of the condition and the presence of confounders including obesity. Obesity clearly has a role in long term health and may best predict both reproductive and metabolic dysfunction as well as negatively affect the response to treatment in women with PCOS. Diabetes, cardiovascular disease and cancer are also at the forefront of any risk assessment or comprehensive treatment strategy for these women. Lifestyle modifications including dietary changes, increased exercise and weight loss are appropriate first line interventions for many women with PCOS. Pharmaceuticals including metformin, lipid lowering agents and oral contraceptives should be tailored to the individual’s risk profile and treatment goals. The fertility treatment in women with subfertility and PCOS aimed to safely induce monofollicular ovulation resulting in the birth of a singleton child. Women with PCOS undergoing fertility treatment are at risk of multi-follicular development as well as ovarian hyper-stimulation syndrome (OHSS), so they must be carefully counselled and monitored during fertility treatment. It is imperative that prior to embarking on fertility treatment, a patient’s health and weight is optimised. This chapter will explore the latest evidence for fertility treatments for women with PCOS.