PCOS and infertility:

PCOS and infertility:

PCOS is the most frequent cause of anovulation in infertile women and ovulation induction is the most common treatment. According to ESHRE 2023 this disorder should be cared as follow:

1-Preconception care:
women with PCOS requirements for preconception care is increased.so supplementation with folate, vitamin D, B-group vitamins (B-1, B-6, B-12) , and Vitamin E may be beneficial in improving reproductive outcomes.

2- Tubal patency testing:
women with PCOS and infertility due to anovulation alone with normal semen analysis should be individualized to do tubal patency testing before ovulation induction with timed intercourse or intrauterine insemination.
As women with tubal pathology in PCOS including those with:
● a history of previous abdominal septic surgery like peritonitis or pelvic surgical procedures
● a history of sexual transmitted infection or pelvic inflammatory disease or a positive serum test for
sexually transmitted infection
● concomitant endometriosis should do tubal patency test

3- ovulation induction:
A- Aromatase inhibitor:
– (AI) are effective as ovulation-inducing agents, letrozole being the most widely use AI.
– Letrozole should be the first-line for ovulation induction in infertile women with PCOS.
– concerns around fetal anomalies have been refuted with comparable rates to natural conception or other agents.
B- Clomiphene citrate and metformin:
– Clomiphene citrate is a SERM with both estrogenic and anti-estrogenic properties. Multiple pregnancy increases with clomiphene citrate and ovarian hyperstimulation syndrome is less than 1%. The potential for borderline increased risk of ovarian tumors with 12 cycles.
– Metformin is an insulin sensitizing agent, has been most widely studied in PCOS and has the most reassuring safety profile, but it is efficacy has been controversial.
– Clomiphene citrate could be used in preference to metformin in women with PCOS with anovulatory infertility and no other infertility factors, to improve ovulation, clinical pregnancy and live birth rates.

C- Gonadotrophins:
– Gonadotrophins could be second-line pharmacological therapy for women with PCOS who are anovulatory and infertile, with no other infertility factors and who have failed first-line oral ovulation induction.

4- Laparoscopic ovarian surgery:
– Laparoscopic ovarian surgery could be second-line therapy for women with PCOS who are infertile, with clomiphene citrate resistance and no other infertility factors

5 – In vitro fertilisation and in vitro maturation:

– IVF could be offered in women with PCOS and anovulatory infertility, if first- or second-line ovulation induction therapies have failed

– The use of a GnRH antagonist protocol for women with PCOS undergoing IVF/ICSI is the recommended as it enables the use of an agonist trigger, with the freezing of all embryos generated if required, without compromising the cumulative live birth rate, to reduce the risk of significant ovarian hyperstimulation syndrome.

Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a very common hormonal disorder, affecting up to 12% of women of childbearing age. But not everyone is aware of the symptoms, long-term effects, and how PCOS can best be managed.

The disorder can cause irregular periods and make it harder to get pregnant. However, not all of the problems posed by PCOS are related to reproduction. 

1. PCOS can trigger a variety of symptoms.

Common symptoms of PCOS are:

– Irregular periods, light periods or missed periods. Some patients may have unscheduled prolonged bleeding.

– Ovaries that are large or have many cysts — this is where the name polycystic comes from.

– PCOS is characterized by the absence of ovulation and high levels of androgens. This can cause a cluster of symptoms that may affect reproductive function and lead to other side effects.

– Excess hair on their face, chin, or other areas of the body

– Acne on the face, chest, and upper back

– Thinning hair or hair loss on the scalp

– Excess body weight

Dark skin patches, especially around the neck, groin, or under the breasts

Skin tags in the armpits or neck

2. PCOS may have multiple causes.


While the exact cause of PCOS isn’t fully understood, experts suspect that a few key factors are involved.


 A- Increased androgen hormones, or male hormones — All people with a uterus make small amounts of androgen. However, those with PCOS produce more androgen than is typical. High levels of androgen can stop ovulation and cause other common PCOS symptoms like extra hair growth and acne.


B- Insulin resistance — the hormone that controls how food is changed into energy may also be at play. It’s produced by the pancreas. When you are resistant to it, your blood sugar levels go up, making your body make more insulin. This in turn causes male hormone levels to increase, causing issues with ovulation. Signs of insulin resistance include dark patches on skin.

3. Certain people may be more prone to the disorder.


PCOS can occur in people with a uterus any time after puberty, and all races and ethnicities may be affected. But having excess body weight or having a mother or sister with PCOS may put someone at higher risk. It’s also most common to be diagnosed in their 20s or 30s, simply because that’s when many patients see their doctor for problems with getting pregnant

4. Many people with PCOS experience infertility.


PCOS is the most common cause of anovulatory infertility or fertility that stems from the absence of ovulation. The condition doesn’t make it impossible to get pregnant though.

5. PCOS can raise the risk of long-term health problems.


The effects of PCOS can be lifelong. Too much glucose and insulin in the blood, which occurs in more than half of people with PCOS, can increase the risk for type 2 diabetes and metabolic syndrome. They may also be more likely to experience:


– Obstructive sleep apnea.

– Excess body weight.

– Heart disease and high blood pressure.

– Mood disorders, such as depression or anxiety.

– Endometrial hyperplasia

6. There’s no single test for PCOS.

– Complete health history, including menstrual history and family health history

Physical exam to look for skin changes, acne, or abnormal hair growth

– Blood test to check male hormone levels, sugar levels, and other hormones that could cause abnormal menstrual cycles

– Pelvic ultrasound to look for cysts

7. PCOS can be managed.


There’s no cure for PCOS, but symptoms can be managed. Lifestyle changes and treatments can go a long way toward managing symptoms, improving the chances for pregnancy, and reducing the risk for long-term complications.


ULTRASOUND IN INFERTILITY COURSE – 29-30 th October 2019 /National Training Institute-Cairo/EGYPT


Organized by : Haneen Diaa      +2/01017572747   –    +2/01024800838