Polycystic ovarian syndrome: diagnosis and management of related infertility

Polycystic ovarian syndrome (PCOS) is the most common cause of anovulatory infertility accounting for about 75% of cases. It is defined as a syndrome of ovarian dysfunction associated with hyperandrogenism and polycystic ovary morphology. The diagnosis of PCOS is based on the presence of at least two of three criteria including: (1) olig-/anovulation; (2) hyperandrogenaemia (clinical and/or biochemical); and (3) polycystic ovaries on ultrasound scan. Several treatment options are available for women with anovulatory infertility related to PCOS including weight reduction, clomiphene citrate (CC), gonadotropins, laparoscopic ovarian diathermy (LOD), metformin and letrozole. The 2007 Thessaloniki ESHRE/ASRM-Sponsored PCOS Workshop Group reached a consensus regarding the therapeutic strategies in infertile women with PCOS. In overweight/obese women with PCOS, weight loss of at least 5–10% should be achieved before any medical intervention. CC remains the first-choice for induction of ovulation in PCOS women. LOD or gonadotropin ovarian stimulation can be offered after failure of CC to achieve a pregnancy. Both approaches are equally effective but LOD avoids complications such as ovarian hyperstimulation syndrome and multiple pregnancies. Current evidence does not support the routine use of metformin in anovulatory infertility associated with PCOS. At present, only very limited clinical data are available on the use of letrozole, which should only be used in the context of research.