What is Polycystic Ovary Syndrome (PCOS)?
Polycystic Ovary Syndrome (PCOS) is the most common endocrine metabolic disorder in women of childbearing age, characterized by hyperandrogenemia, ovulation disorders and polycystic ovarian changes. The core pathology is the accumulation of multiple immature follicles in the ovaries, leading to excessive androgen secretion, which causes menstrual disorders, hirsutism, acne, obesity and infertility.
Diagnostic criteria and staging
According to the 2023 updated Rotterdam Consensus, the diagnosis of PCOS needs to fulfill 2/3 of the following:
Ovulatory disorders: menstrual cycles >35 days or <8 menses per year. Hyperandrogenemia: clinical manifestations of hirsutism (mFG score ≥4), acne, or abnormal biochemical markers (free testosterone >2.1 pg/ml).
Ovarian polycystic changes (PCOM): unilateral ovarian sinus follicle count ≥20 or ovarian volume ≥10 cm³.
PCOS was categorized into four phenotypes:
Classic type (hyperandrogenism + ovulatory disorders + PCOM): 60-70% of cases, with the highest risk of metabolic abnormalities.
Non-hyperandrogenic phenotype (ovulation disorder + PCOM): 10%-15% of cases, with milder symptoms.
Who is susceptible to PCOS? Analysis of high-risk groups
The prevalence of PCOS is 5-20%, with the following groups at significantly higher risk:
Obese women: those with a BMI ≥25 have a 3-fold increased risk of developing the disease, and accumulation of abdominal fat exacerbates insulin resistance.
Genetically predisposed: women with a family history of diabetes, hypertension or PCOS are at higher risk.
Those with abnormal menstruation during puberty: persistent scanty menstruation or amenorrhea after menarche requires vigilance.
Chronic stress or late nights: Elevated cortisol levels interfere with hypothalamic-pituitary-ovarian axis (HPO axis) function.
People with unhealthy diet: High sugar and high fat diet leads to insulin resistance and elevated androgens.
Treatment of Polycystic Ovary Syndrome
Lifestyle intervention – first-line basic treatment
Weight management: weight loss of 5-10% can increase ovulation rates by 40-60%. 150 minutes of moderate-intensity exercise (e.g. brisk walking, swimming) per week is recommended in combination with a low glycemic index (low GI) diet.
Metabolic regulation: obese patients can improve insulin resistance and reduce fasting insulin levels in combination with metformin (1500-2000 mg/day).
Pharmacological treatment – precise regulation for symptoms
Regulate the menstrual cycle:
Short-acting contraceptives (COCs): e.g. ethinyl estradiol cyproterone to reduce androgens and restore regular menstruation.
Progestogens: cyclic use of dextroprogesterone to protect the endometrium and prevent hyperplasia.
Ovulation-promoting therapy:
Clomiphene (CC): first line drug, ovulation rate about 20-40%.
Letrozole: more effective in CC-resistant individuals, pregnancy rate increased to 50%.
Surgical treatment – conservative option
Laparoscopic ovarian perforation (LOD): for patients with recalcitrant anovulation, pregnancy rate about 40% at 6 months after surgery.
Ovarian wedge resection (OWR): now used sparingly and only in severe cases.
Assisted Reproductive Technology (ART) – the ultimate solution
In Vitro Fertilization (IVF-ET): for patients with multiple failed ovulation attempts or combination of other infertility factors (e.g. tubal problems). antagonist regimen or PPOS regimen for PCOS patients, which reduces the risk of Ovarian Hyperstimulation Syndrome (OHSS).
The triple whammy of PCOS on fertility
Ovulatory disorders: 70%-80% of patients are anovulatory due to stagnant follicular development.
Decreased endometrial tolerance: prolonged estrogen exposure triggers endometrial hyperplasia and reduces embryo implantation rate by 30%.
Chain reaction of metabolic abnormalities: insulin resistance leads to impaired mitochondrial function of oocytes and increased risk of miscarriage to 32% (12% in normal population).
Impact of PCOS on in vitro fertilization (IVF): both advantages and challenges
Advantages
Higher number of eggs acquired: PCOS has a rich ovarian reserve, with an average of 15-20 eggs acquired.
Higher success rate in younger patients: IVF live birth rate is about 60% in patients under 35 years old.
Challenges
Risk of OHSS: up to 10% incidence of moderate to severe OHSS, requiring a whole embryo freezing strategy.
Variable egg quality: high androgenic environment leads to increased rates of embryonic aneuploidy.
Superimposed metabolic problems: 3-fold increased risk of gestational diabetes mellitus, requiring strict glycemic control.
How to improve IVF success in PCOS patients?
Personalized Ovulation Promotion Program
Antagonist regimen: reduce early onset of LH peak, reduce OHSS risk.
Microstimulation regimen: for highly responsive patients with AMH > 3.5 ng/ml.
Pretreatment and metabolic optimization
Metformin: continued use up to 12 weeks of gestation reduces miscarriage rate to 11.6% (36.3% in non-users).
Antioxidant therapy: coenzyme Q10 (600 mg/day) to improve oocyte mitochondrial function.
Embryo screening and transfer strategies
Blastocyst culture: screen embryos with high developmental potential and increase live birth rate to 50%.
Single embryo transfer (SET): reduce the risk of multiple pregnancies and prioritize chromosomally normal embryos.
Full-cycle health management
Pregnancy monitoring: OGTT testing every 3 months to control fasting blood glucose <5.3 mmol/L.
Psychological support: cognitive behavioral therapy (CBT) reduces anxiety scores by 43%.
Conclusion
Although polycystic ovary syndrome cannot be cured, more than 90% of patients can achieve their fertility goals through the comprehensive management of lifestyle intervention, medication and assisted reproductive technology. The key lies in early diagnosis, standardized treatment and long-term metabolic monitoring. For PCOS patients planning IVF, choosing an experienced fertility center and developing an individualized plan are the core guarantees for a successful pregnancy.
