Infertility care of the PCOS patient

When approaching the management of infertility in the polycystic ovarian syndrome (PCOS) patient, there are several important considerations for maximizing favorable reproductive outcomes. Prior to conception, healthy lifestyle habits should be prioritized, with a focus on healthy body mass, optimal blood glucoses, and balanced diet and exercise regimens. Pharmacologic fertility strategies include aromatase inhibitors and selective estrogen receptor modulators (SERMs) as first-line agents. Gonadotropins can be considered when these agents fail. Alternatively, laparoscopic ovarian drilling can be utilized as a second-line approach when surgical management is indicated or desired. In vitro fertilization (IVF) is generally considered third-line unless there is an absolute indication for its use. A variant of traditional IVF known as in vitro maturation (IVM) may prove useful in this patient population to reduce the risk of ovarian hyperstimulation syndrome (OHSS). This chapter reviews the available evidence and most recent recommendations for the above treatment modalities in addition to current areas of investigation, such as the use of inositols and traditional Chinese medicine, in the care of PCOS patients desiring fertility.