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Challenge: Polycystic ovaries and PCOS in IVF treatment.

Background:

 Polycystic ovarian morphology is present in 20–30% of IVF patients.

 Not all women with polycystic ovaries have polycystic ovary syndrome (PCOS).

 The presence of polycystic ovaries is associated with sensitive response to stimulation and an increased risk of OHSS.

Assessment:

 Baseline pelvic USS provides morphological appearance of polycystic ovaries.

 Baseline endocrine profile enables appropriate regimen choice.

 Assessment of glucose tolerance is important if overweight.

 Counsel for increased obstetric risk (gestational diabetes, preeclampsia and fetal morbidity) if overweight.

Management options:

 Treatment plan aimed to minimize risk of OHSS which is a life‐threatening condition

 Use low dose stimulation in a short GnRH‐antagonist protocol.

 Metformin therapy may reduce the risk of OHSS in a long GnRH‐agonist protocol

 Use progestogens and not hCG for luteal support

 Consider a GnRH‐agonist trigger in GnRH‐antagonist protocols if there is a significant risk of OHSS

 Consider segmentation, that is elective cryopreservation of all embryos for use in subsequent frozen embryo replacement cycles