It is the leading cause of infertility due to ovulation disorders, and, paradoxically, one of the conditions where the chances of success remain the highest — provided it is taken seriously.
Polycystic ovary syndrome affects around one in ten women of childbearing age. Diagnosis is based on the Rotterdam criteria: two out of three of the following: irregular or absent periods; clinical or laboratory signs of excess androgens; and a polycystic appearance of the ovaries on ultrasound or an elevated AMH level. Other causes must also have been ruled out.
The term is misleading, and patients have been saying so for a long time: these are not cysts but follicles blocked at an early stage, and the syndrome is primarily hormonal and metabolic. An international campaign is calling for it to be renamed, and in France a petition submitted to the National Assembly is supporting this call. The debate is not merely cosmetic: the current name leads patients to view the condition solely through a gynaecological lens, whereas management also involves metabolic factors — insulin resistance, weight, and the risk of type 2 diabetes.
The main problem is anovulation or dysovulation: without regular ovulation, conception becomes unpredictable. On the other hand, the ovarian reserve is generally high, with AMH often above 4 ng/ml and a high antral follicle count. This is good news: there is sufficient ovarian reserve. The long-term prognosis is better than in cases of ovarian insufficiency.
The downside is the risk of ovarian hyperstimulation during IVF. A patient with PCOS is precisely the type of patient who over-responds, which requires tailored protocols.
Weight loss, where a patient is overweight: a 5–10 per cent reduction in body weight restores ovulation in a significant proportion of patients. This is the intervention with the best cost-benefit ratio, yet the most frustrating to implement because the syndrome itself makes weight loss difficult.
Letrozole is recommended as first-line treatment by the 2023 international guidelines, ahead of clomiphene citrate, with a higher live birth rate. Details of the stimulation protocols are available here.
Metformin is considered in cases of insulin resistance, either alone or in combination with other treatments.
Inositol — myo-inositol, often combined with D-chiro-inositol — improves metabolic parameters and, in some cases, the regularity of cycles. Data on live births remain limited: it is a reasonable supplement, not a treatment for infertility, and it is no substitute for medical care.
It is indicated after six ovulatory cycles without pregnancy, or from the outset if there is another factor — fallopian tubes, sperm, age. Three adjustments are standard practice:
With these precautions in place, the results are good: the number of eggs retrieved is high and the cumulative birth rates are comparable to, or even higher than, those for other indications in women of the same age.
A fasting blood glucose test with insulin levels or glycated haemoglobin, a TSH test, a prolactin test, a lipid profile, and an antral follicle count using AMH. A very high AMH level is not necessarily good news in itself: it mainly indicates a risk of an excessive response, and it is this information that the doctor uses to select the dose. The article on AMH explains how to interpret the results.
No. It disrupts ovulation, but the ovarian reserve is generally high and the prognosis remains good. The majority of affected women conceive, with or without medical assistance.
Because the term suggests cysts, whereas it actually refers to blocked follicles, and because it obscures the metabolic aspect of the syndrome. An international campaign and a petition in France are calling for this change.
It improves metabolic parameters and sometimes the regularity of cycles, but data on live births remain limited. It is a sensible supplement, not a treatment for infertility.
Ovarian hyperstimulation, as these ovaries respond strongly. An antagonist protocol, agonist-triggered ovulation and a strategy of freezing all embryos significantly reduce this risk.
Source: https://fertilitegrece.com/en/blog/pcos-fertility-ivf/ — Triada Baloukoudis, IVF patient coordination in Greece. General information, not medical or legal advice. Printed on
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