Integrated Strategies for Enhancement of Fertility in PCOS

Edwina Coghlan, Roger James Hart

Research output: Chapter in Book/Conference paperChapterpeer-review

Abstract

Polycystic ovary syndrome (PCOS) is a common cause of anovulatory infertility; hence, ovulation induction is usually the first line of treatment for the majority. Prior to commencing ovulation induction, it is imperative to optimise any coexisting metabolic disorder, and the first line of treatment is lifestyle intervention. Pharmacological interventions consist of aromatase inhibitors, clomiphene citrate and metformin therapy, often combined with clomiphene in patients who are overweight. Subsequently intervention with gonadotrophins using a low-dose step-up protocol to minimise the risk of a multiple pregnancy is the next step. In the presence of normal pelvis at the time of laparoscopy, and in the absence of any impairment of the semen sample, it is reasonable to perform laparoscopic ovarian drilling. If these interventions are unsuccessful, or in the presence of other causes of infertility, such as a compromised semen sample, or fallopian tube compromise, in vitro fertilisation (IVF) is required. Patients with PCOS are ideally suited to the approach of in vitro oocyte maturation (IVM) to minimise their risk of ovarian hyperstimulation syndrome (OHSS). Other techniques to minimise the risk of this serious complication of IVF consist of the use of an antagonist rather than an agonist regime; the adjuvant use of metformin, adopting a ‘freeze-all’ approach after the use of an agonist trigger; and the administration of cabergoline to minimise the risk of severe OHSS.
Original languageEnglish
Title of host publicationInfertility in Women with Polycystic Ovary Syndrome
Subtitle of host publicationPathogenesis and Management
EditorsStefano Palomba
Place of PublicationSwitzerland
PublisherSpringer International Publishing
Chapter21
Pages289-304
ISBN (Electronic)9783319455341
ISBN (Print)9783319455334
DOIs
Publication statusPublished - 2018

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