INFERTILITY AND POLYCYSTIC OVARIES

BMJ  2007;335:663-666 (29 September).

Managing anovulatory infertility and polycystic ovary syndrome

BY: Adam H Balen, professor of reproductive medicine and surgery, Anthony J Rutherford, consultant in reproductive medicine and surgery.

Summary points

• Polycystic ovary syndrome is the most common endocrine problem affecting women and the most common cause of anovulatory infertility
• Oral clomifene citrate remains the first line treatment to induce ovulation
• Gonadotrophin treatment needs careful monitoring to reduce risk of multiple pregnancy
• Despite early promise, the role of metformin and insulin lowering agents is unclear in the management of anovulatory polycystic ovary syndrome

Anovulation is the cause of infertility in about a third of couples attending infertility clinics, and polycystic ovary syndrome accounts for 90% of such cases.

The definition of polycystic ovary syndrome recognises obesity as an association and not a diagnostic criterion. Only 40-50% of women with the syndrome are overweight.

Obesity has a profound effect on both natural and assisted conception—it influences the chance of becoming pregnant and the likelihood of a healthy pregnancy. Obesity is associated with increased rates of congenital anomalies (neural tube defects and cardiac defects), miscarriage, gestational diabetes, hypertension, problems during delivery, stillbirth, and maternal mortality.