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Integrated Strategies for Enhancement of Fertility in PCOS

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Infertility in Women with Polycystic Ovary Syndrome

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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.

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Authors and Affiliations

  1. King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, WA, 6008, Australia

    Edwina Coghlan

  2. School of Women’s and Infants’ Health, University of Western Australia, Perth, WA, 6008, Australia

    Roger J. Hart

  3. Fertility Specialists of Wetern Australia, Bethesda Hospital, 25 Queenslea Drive, Claremont, Perth, WA, 6010, Australia

    Roger J. Hart

  4. School of Women’s and Infants’ Health, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, WA, 6008, Australia

    Roger J. Hart

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  1. Edwina Coghlan
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Correspondence to Roger J. Hart .

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Editors and Affiliations

  1. Unit of Reproductive Medicine and Surgery, ASMN-IRCCS of Reggio Emilia, Reggio Emilia, Italy

    Stefano Palomba

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Coghlan, E., Hart, R.J. (2018). Integrated Strategies for Enhancement of Fertility in PCOS. In: Palomba, S. (eds) Infertility in Women with Polycystic Ovary Syndrome. Springer, Cham. https://doi.org/10.1007/978-3-319-45534-1_21

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  • DOI: https://doi.org/10.1007/978-3-319-45534-1_21

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