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12 - In vitro fertilization and the patient with polycystic ovaries or polycystic ovary syndrome

Published online by Cambridge University Press:  29 September 2009

By
Adam H. Balen
Edited by
Gabor T. Kovacs  and
Robert Norman
Adam H. Balen
Affiliation:
Leeds General Infirmary, Leeds
Gabor T. Kovacs
Affiliation:
Monash University, Victoria
Robert Norman
Affiliation:
University of Adelaide
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Summary

Introduction

In vitro fertilization (IVF) is not the first-line treatment for polycystic ovary syndrome (PCOS), but many patients with the syndrome may be referred for IVF, either because there is another reason for their infertility or because they fail to conceive despite ovulating (whether spontaneously or with assistance) – that is their infertility remains unexplained. Furthermore, approximately 30% of women have polycystic ovaries as detected by ultrasound scan. Many will have little in the way of symptoms and may present for assisted conception treatment because of other reasons (for example tubal factor or male factor). When stimulated these women with asymptomatic polycystic ovaries have a tendency to respond sensitively and are at increased risk of developing the ovarian hyperstimulation syndrome (OHSS). An understanding of the management of such patients is therefore important to specialists involved in IVF.

The association of enlarged, sclerocystic ovaries with amenorrhea, infertility, and hirsutism, as described by Stein and Leventhal (1935), is now described as the polycystic ovary syndrome (PCOS). In recent years it has become apparent that polycystic ovaries may be present in women who are not hirsute and who have a regular menstrual cycle. Thus, a clinical spectrum exists between the typical Stein–Leventhal picture (PCOS) and the symptomless women with polycystic ovaries. Even the clinical picture of patients with PCOS exhibits considerable heterogeneity (Balen et al. 1995). This heterogeneous disorder may present, at one end of the spectrum, with the single finding of polycystic ovarian morphology as detected by pelvic ultrasound.

Type
Chapter
Information
Polycystic Ovary Syndrome , pp. 177 - 203
Publisher: Cambridge University Press
Print publication year: 2007

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References

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