Management of PCOS Women Preparing Pregnancy

As well known, infertility is a prevalent presenting feature of PCOS with ~75% of these women suffering infertility due to anovulation, making PCOS the most common cause of anovulatory infertility. Women with PCOS often have many concerns about childbearing including whether they could become pregnant and what they should do before they try to become pregnant. Polycystic ovary syndrome (PCOS) is a common female reproductive endocrine disease. The prevalence in premenopausal women ranges from 6 to 20%, possibly making this syndrome as the most common endocrine and metabolic disorder in women of reproductive age [1–3]. According to the reports in specialized departments of China like in our “Department of Gynecological Endocrinology,” it stands as the most important disease – in our daily clinic from more than 500 outpatients, at least 50% are diagnosed with PCOS, and more than 50,000 per year of our PCOS patients get treatment as described in this chapter. The disease can begin in early adolescence, the etiology is not yet clear, the pathogenesis is complex, and it is related to environmental (especially nutrition) factors. Particularly, genetical factors may also play an important role in the development of the disease and differences in type and outcome [4]. Changes of endocrine and metabolic markers are often associated with PCOS although are not decisive for the diagnosis. In 2003, the “European Society for Human Reproduction and Embryology (ESHRE)” and the “American Society of Reproductive Medicine (ASRM)” revised the diagnostic criteria for PCOS at the Rotterdam meeting [5]: (1) rare ovulation or anovulation; (2) abnormal clinical manifestations and/or biochemical indicators of hyperandrogenism; and (3) polycystic ovarian morphology (PCOM): follicle number of 2–9 mm in diameter in one or both ovaries ≥12 and/or ovarian volume >10 cm3. In 2018 the cut-off for follicle number was raised to 20 or more in either ovary [2]. If at least two of the three abovementioned criteria are met, “PCOS” can be diagnosed, whereby diseases such as thyroid dysfunction, Cushing’s syndrome, androgen-secreting tumors, hyper-prolactinemia, pituitary gland diseases, and premature ovarian failure must be excluded.