Polycystic ovary syndrome: diagnosis and management of related infertility

Polycystic ovary syndrome (PCOS) is one of the most common complex and heterogeneous endocrine disorder in women with uncertain aetiology. The syndrome is associated with a wide range of symptoms and the diagnosis is based on the Rotterdam criteria. This review describes the currently available evidence regarding the therapeutic challenges raised in these women. Before any intervention is initiated, pre-conceptional counselling should be provided emphasizing the importance of life style changes, especially weight reduction and exercise in overweight women. The recommended first-line treatment for ovulation induction remains clomifene citrate. Second-line interventions include exogenous gonadotropins and laparoscopic ovarian drilling. The recommended third-line treatment is in vitro fertilization. More patient-tailored approaches should be developed for ovulation induction based on initial screening characteristics of women with PCOS. Insufficient evidence is currently available to recommend the clinical use of aromatase inhibitors for routine ovulation induction. Metformin use in PCOS should be restricted to women with glucose intolerance.