Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Aug 1;21(1):70.
doi: 10.1186/s12958-023-01120-7.

Women with PCOS who undergo IVF: a comprehensive review of therapeutic strategies for successful outcomes

Alexander M Kotlyar  1   2 , David B Seifer  3
Affiliations
Review

Women with PCOS who undergo IVF: a comprehensive review of therapeutic strategies for successful outcomes

Alexander M Kotlyar et al. Reprod Biol Endocrinol. .

Abstract

Polycystic ovarian syndrome (PCOS) is a widespread syndrome that poses unique challenges and constraints to the field of assisted reproductive technology. This condition is the most common cause of anovulation among infertile couples. Debate exists over the best therapeutic course of action when patients with PCOS proceed to IVF. In this review, we evaluate the best-performing and safest methods of IVF preparation, ovarian stimulation, trigger method for maturation of stimulated egg growth, and planning for embryo transfer. Pre-IVF considerations include being aware of individual AMH and vitamin D levels as well as BMI prior to selecting an ovarian stimulation protocol. Numerous supplements such as myo-inositol complement the benefits of lifestyle change and may enhance IVF performance including oocyte yield and pregnancy rate. Concerning stimulation protocols, antagonist cycles with the judicious use of GnRH agonist trigger, pre-treatment with metformin and vitamin D repletion may help mitigate the accompanied risk of ovarian hyperstimulation syndrome (OHSS). Following ovarian stimulation, PCOS patients typically undergo programmed frozen embryo transfer (FET) cycles which are more conducive for women with irregular cycles, but likely carry a higher risk of hypertensive disorders of pregnancy. However, newer stimulated FET protocols using Letrozole may offer improved outcomes. Overall, patients with PCOS require careful individual tailoring of their IVF cycle to achieve optimal results.

Keywords: AMH; In-vitro fertilization; OHSS; Ovarian hyperstimulation; PCOS.

PubMed Disclaimer

Conflict of interest statement

AMK declares no competing interests. DBS declares royalties from a license agreement between Rutgers Medical School/MGH and Beckman Coulter for Anti-Müllerian hormone as a measure of ovarian reserve and Medical Advisory Board for Womens Integrated Network Honorarium outside the submitted work.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Balen AH, Morley LC, Misso M, Franks S, Legro RS, Wijeyaratne CN, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update. 2016;22(6):687–708. doi: 10.1093/humupd/dmw025. - DOI - PubMed
    1. March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod. 2010;25(2):544–51. doi: 10.1093/humrep/dep399. - DOI - PubMed
    1. Teede HJ, Misso ML, Deeks AA, Moran LJ, Stuckey BG, Wong JL, et al. Assessment and management of polycystic ovary syndrome: summary of an evidence-based guideline. Med J Aust. 2011;195(6):65–112. - PubMed
    1. Pellatt L, Hanna L, Brincat M, Galea R, Brain H, Whitehead S, et al. Granulosa cell production of anti-Müllerian hormone is increased in polycystic ovaries. J Clin Endocrinol Metab. 2007;92(1):240–5. doi: 10.1210/jc.2006-1582. - DOI - PubMed
    1. Pellatt L, Rice S, Mason HD. Anti-Müllerian hormone and polycystic ovary syndrome: a mountain too high? Reproduction. 2010;139(5):825–33. doi: 10.1530/REP-09-0415. - DOI - PubMed

Substances